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Cisplatin

Klassificering: C!

Preparat: Cisplatin Accord, Cisplatin Ebewe, Cisplatin Pfizer

ATC kod: L01XA01

Substanser: cisplatin

Sammanfattning

Sannolikt har kvinnor bättre effekt vid cisplatin-baserad kombinationsbehandling. Dock är kvinnor mer benägna att utveckla hematologiska biverkningar och njurtoxicitet samt att drabbas av kräkningar. Ototoxicitet verkar vara vanligare bland pojkar än flickor, och fler män än kvinnor drabbas av hicka. Cisplatin ska undvikas till flickor och kvinnor som kan tänkas bli gravida om inte en effektiv preventivmetod används.

Additional information

Generally, women mount stronger innate and adaptive immune responses than men [1]. Women with lung cancer have a more favorable survival compared to men [2]. The 5-year survival is 17 percent among men, and 24 percent among women, in Sweden [3].

The incidence of lung cancer has decreased among men since from 1980s but has increased significantly among women, which reflects women's changing smoking habits. Now the proportion of smoking women is greater than the proportion of smoking men. In Sweden lung cancer made up 6.1% of all yearly cases of cancer, year 2016. The incidence was higher among women (6.8%, n=2067), compared to men (5.4%, n=1824) [3].

Since chemotherapeutic agents share some adverse effects, evaluation of a particular agent’s sex-related adverse effects during combination chemotherapy is complicated. Another factor that complicates the evaluation of chemotherapeutic treatments’ effect is a poorer prognosis in men compared to women of most oncologic diseases that affects both sexes [4, 5]. For instance, and related to this particular context, female sex is a favorable prognostic factor in non-small cell lung cancer (NSCLC) [6-10]. The increased risk of cancer for men has generally been explained by differences in exposure of carcinogenic factors such as smoking, alcohol consumption and exposure of harmful work-related substances [4, 5]. The belief that men might present later with more advanced cancer might in part explain the poorer prognosis seen in men [4].

Pharmacokinetics and dosing

Pharmacokinetic data do not indicate sex differences [11].

Effects

Small-cell lung cancer

A sex-based retrospective analysis of four small-cell lung cancer trials on patients (648 men, 358 women) who received similar chemotherapy consisting of cyclophosphamide-doxorubicin-vincristine and etoposide-cisplatin showed women have increased overall response rates (80.3%vs 66.9%, respectively) and survival (median years 1.3 vs 0.91, respectively) compared with men [7].

Non‐small cell lung cancer

A systemic review and meta-analysis published in Cochrane library 2015 evaluated the effects of administering chemotherapy following surgery or following surgery plus radiotherapy in patients with early-stage non‐small cell lung cancer.  When surgery plus adjuvant chemotherapy compared to surgery alone, the analyses were based on 8447 participants. Addition of chemotherapy was associated with an absolute increase in survival of 4% at five years. Evaluating surgery plus radiotherapy plus chemotherapy versus surgery plus radiotherapy alone (n= 2660) revealed a comparable benefit, i.e. 4% increase in survival rate at five years. The study indicated no significant evidence that any patient subgroup defined by age, sex, histology, performance status, or stage benefited more or less from adjuvant chemotherapy. However, a tendency towards a more favorable effect on survival observed for women versus men when the effect of surgery and chemotherapy was compared to the effect of surgery alone [12]. A combined analysis of two parallel phase III trials (418 men, 113 women) conducted to test the efficacy of adding cisplatin to first-line treatment for elderly patients with advanced non–small-cell lung cancer. The addition of cisplatin to single-agent chemotherapy neither prolonged overall survival nor improve global health status score of quality of life. Subgroup analyses revealed no sex-related differences in this regard [13].

Bladder cancer

A meta-analysis including 15 studies and 3071 patients, reported 2008 to 2019, showed that female patients with bladder cancer had more advanced disease than their male counterparts and had experienced worse oncologic outcomes. However, they benefit from neoadjuvant (but not adjuvant) cisplatin-based combination chemotherapy in addition to radical cystectomy more than do male patients. Female patients who had undergone radical cystectomy and neoadjuvant chemotherapy were likely to have better disease recurrence rate and cancer-specific mortality (but not overall mortality) rates than were the male patients (pooled hazard ratio, 0.66 and 95% CI, 0.44-0.98; and pooled hazard ratio, 0.49 and 95% CI, 0.29-0.81, respectively) [14].

Adverse effects

Emesis

Female sex predicts a greater risk for acute emesis and poor antiemetic control [15]. A study on 301 patients who received cisplatin-based combination chemotherapy, with antiemetic therapy based on metoclopramide, showed that patient’s sex may play an important role in modulating the antiemetic response to metoclopramide in cisplatin-based chemotherapy. Female sex predicted for increased incidence of nausea and vomiting [16].

Nephrotoxicity

Data from a retrospective study on patients (203 men, 197 women) with advanced solid tumors who had been treated with weekly high-dose cisplatin in the period 1990-2001 indicated a higher incidence of nephrotoxicity (defined as over 25% decline in estimated creatinine clearance) among women (OR 1.71, 95%CI 1.09-2.7) [17]. A retrospective study of adult patients (520 men, 301 women) treated with cisplatin from January 1, 2000 to September 21, 2011 showed a higher risk of acute kidney injury (defined as an increase from the baseline creatinine of 25% within 30 days after the first cycle of cisplatin) among women than men [18]. A retrospective nationwide cohort study, using Taiwan's National Health Insurance Research Database reviewed the records of 3973 men and 1154 women who had been treated with cisplatin. The proportion of women who had developed a new diagnosis of kidney disease during the first 90 days following the treatment was 39%. The proportion for men was 37%, but the difference was not statistically significant. However, stratifying patients by age group indicated that only postmenopausal women had a significantly higher risk of kidney injury (hazard ratio: 1.28; 95%CI: 1.02-1.61) than did men [19].

Hematological toxicity

A sex-based retrospective analysis of four small cell lung cancer trials on patients (648 men, 358 women) who received cyclophosphamide-doxorubicin-vincristine and etoposide-cisplatin indicated increased grade 3 and 4 hematological toxicity in females compared to men (anemia, 16.3% v 7.6%, leukopenia 80.4% v 69.2%). However, toxic death rates were similar for men and women (1.5% v 1.1%, respectively). Women also had significantly more stomatitis and vomiting of all grades [7].

Ototoxicity

A retrospective chart review of pediatric patients (age <18 years, 58 boys, 44 girls) who had completed cisplatin therapy showed that boys were four times more likely to experience hearing loss than girls (33 boys vs 10 girls). Severity of ototoxicity was inversely related to age [20].

Hiccups

Patients receiving cisplatin-based regimens were evaluated in a crossover study with two arms both including ondansetron and dexamethasone but with different ondansetron dosage intervals (233 men, 130 women in arm A, 228 men, 130 women in arm B). Women had significantly higher rates of vomiting and nausea. Men had a significantly higher incidence of hiccups in both treatment arms (35.2% vs 3.1% in arm A and 36% vs 2.3% in arm B, respectively). Hiccups usually began 24 h after cisplatin administration and persisted for some days [21].

Reproductive health issues

Cisplatin like most other anti-cancer drugs is not compatible with pregnancy. Therefore, it is recommended that both men and women use contraceptives during and for at least 6 months after use of cisplatin [22]. Swedish users, please consult Janusmed Drugs and Birth Defects (Janusmed fosterpåverkan).

Försäljning på recept

Läkemedel innehållande cisplatin (ATC-kod L01XA01) används huvudsakligen på sjukhus och därför saknas könsspecifika användningsdata [23].

Uppdaterat: 2022-04-20

Litteratursökningsdatum: 2021-05-30

Referenser

  1. Klein SL, Flanagan KL. Sex differences in immune responses. Nat Rev Immunol. 2016;16(10):626-38. PubMed
  2. Vera Regitz-Zagrosek. Sex and Gender Differences in Pharmacology. Springer-Verlag Berlin Heidelberg; 2012.
  3. Socialstyrelsen. Cancer i siffror 2018. Socialstyrelsen [www]. [updated 2018-06-10, cited 2020-10-01]. länk
  4. Radkiewicz, C. Sex differences in cancer risk and survival. [dissertation]. Dept of Medical Epidemiology and Biostatistics: Karolinska Institutet; 2019.
  5. Edgren G, Liang L, Adami HO, Chang ET. Enigmatic sex disparities in cancer incidence. Eur J Epidemiol. 2012;27(3):187-96. PubMed
  6. Ferguson MK, Skosey C, Hoffman PC, Golomb HM. Sex-associated differences in presentation and survival in patients with lung cancer. J Clin Oncol. 1990;8(8):1402-7. PubMed
  7. Singh S, Parulekar W, Murray N, Feld R, Evans WK, Tu D et al. Influence of sex on toxicity and treatment outcome in small-cell lung cancer. J Clin Oncol. 2005;23(4):850-6. PubMed
  8. de Perrot M, Licker M, Bouchardy C, Usel M, Robert J, Spiliopoulos A. Sex differences in presentation, management, and prognosis of patients with non-small cell lung carcinoma. J Thorac Cardiovasc Surg. 2000;119(1):21-6. PubMed
  9. Visbal AL, Williams BA, Nichols FC, Marks RS, Jett JR, Aubry MC et al. Gender differences in non-small-cell lung cancer survival: an analysis of 4,618 patients diagnosed between 1997 and 2002. Ann Thorac Surg. 2004;78(1):209-15; discussion 215. PubMed
  10. Hsu LH, Chu NM, Liu CC, Tsai SY, You DL, Ko JS et al. Sex-associated differences in non-small cell lung cancer in the new era: is gender an independent prognostic factor?. Lung Cancer. 2009;66(2):262-7. PubMed
  11. de Jongh FE, Gallo JM, Shen M, Verweij J, Sparreboom A. Population pharmacokinetics of cisplatin in adult cancer patients. Cancer Chemother Pharmacol. 2004;54(2):105-12. PubMed
  12. Burdett S, Pignon JP, Tierney J, Tribodet H, Stewart L, Le Pechoux C et al. Adjuvant chemotherapy for resected early-stage non-small cell lung cancer. Cochrane Database Syst Rev. 2015(3):CD011430. PubMed
  13. Gridelli C, Morabito A, Cavanna L, Luciani A, Maione P, Bonanno L et al. Cisplatin-Based First-Line Treatment of Elderly Patients With Advanced Non-Small-Cell Lung Cancer: Joint Analysis of MILES-3 and MILES-4 Phase III Trials. J Clin Oncol. 2018;36(25):2585-2592. PubMed
  14. Kimura S, Iwata T, Abufaraj M, Janisch F, D'Andrea D, Moschini M et al. Impact of Gender on Chemotherapeutic Response and Oncologic Outcomes in Patients Treated With Radical Cystectomy and Perioperative Chemotherapy for Bladder Cancer: A Systematic Review and Meta-Analysis. Clin Genitourin Cancer. 2020;18(2):78-87. PubMed
  15. Gralla RJ, Osoba D, Kris MG, Kirkbride P, Hesketh PJ, Chinnery LW et al. Recommendations for the use of antiemetics: evidence-based, clinical practice guidelines American Society of Clinical Oncology. J Clin Oncol. 1999;17(9):2971-94. PubMed
  16. Tsavaris N, Mylonakis N, Bacoyiannis C, Kosmas C, Kalergis G, Iakovidis V et al. Factors that influence the antiemetic activity of metoclopramide to cisplatin based chemotherapy. Oncol Rep. 1998;5:1147-55. PubMed
  17. de Jongh FE, van Veen RN, Veltman SJ, de Wit R, van der Burg ME, van den Bent MJ et al. Weekly high-dose cisplatin is a feasible treatment option: analysis on prognostic factors for toxicity in 400 patients. Br J Cancer. 2003;88(8):1199-206. PubMed
  18. Latcha S, Jaimes EA, Patil S, Glezerman IG, Mehta S, Flombaum CD. Long-Term Renal Outcomes after Cisplatin Treatment. Clin J Am Soc Nephrol. 2016;11(7):1173-9. PubMed
  19. Chen WY, Hsiao CH, Chen YC, Ho CH, Wang JJ, Hsing CH et al. Cisplatin Nephrotoxicity Might Have a Sex Difference An analysis Based on Women's Sex Hormone Changes. J Cancer. 2017;8(19):3939-3944. PubMed
  20. Yancey A, Harris MS, Egbelakin A, Gilbert J, Pisoni DB, Renbarger J. Risk factors for cisplatin-associated ototoxicity in pediatric oncology patients. Pediatr Blood Cancer. 2012;59(1):144-8. PubMed
  21. Liaw CC, Wang CH, Chang HK, Liau CT, Yeh KY, Huang JS et al. Gender discrepancy observed between chemotherapy-induced emesis and hiccups. Support Care Cancer. 2001;9(6):435-41. PubMed
  22. Cisplatin Accord (cisplatin). Summary of Product Characteristics. Swedish Medical Products Agency [updated 2020-06-30, cited 2021-05-22]
  23. Conise (INSIKT). Kalmar: eHälsomyndigheten. 2018 [cited 2021-11-18.] länk

Författare: Alan Fotoohi

Faktagranskat av: Diana Rydberg

Godkänt av: Karin Schenck-Gustafsson