High-Dose Cisplatin in Hypertonic Saline

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Abstract
To overcome the dose limiting toxicity of cisplatin, high-dose cisplatin (200 mg/m2 body surface area in 5 divided daily doses with each dose administered in 250 ml of 3% saline) was administered together with extensive hydration (250 ml/h normal saline with 20 meq KCl/l). In 17 previously untreated patients with poor prognosis nonseminomatous testicular cancer, 8 with tumor-associated obstructive uropathy, there no statistially significant decrease in creatinine clearance or elevation of serum creatinine after 3-4 cycles of a high-dose cisplatin combination chemotherapy regimen. High-dose cisplatin in combination with vinblastine, bleomycin and VP-16 [etoposide] produced an 88% complete response rate in these high-risk patients who are characterized primarily by the presence of advanced bulky lung and abdominal disease. Six patients with ovarian cancer who had a relapse after treatment with standard dose cisplatin regimens were treated with high-dose cisplatin; 3 partial responses were seen. Four patients had no adverse effects on renal function; 2 patients had transient elevations in serum creatinine (4-5 mg/dl). Hypertonic saline did not provide protection against the nonrenal toxicities of cisplatin.