Navigating Cisplatin Toxicity in Cervical Cancer: Clinical Insights from a Case Report

Cervical cancer refers to a specific kind of tumor that may develop anywhere from the lower part of the uterus (the cervix) to the vaginal opening. About 80% of women in the United States have been infected with the human papillomavirus (HPV), the causative agent of this kind of illness. Because alterations in the cervix may take up to fifteen years to manifest, cervical cancer affects women of all ages, but it most often affects those in their teen and early adult years. Adenocarcinoma and squamous cell carcinoma are the two main histological forms of cervical cancer. About 70% of cervical cancer diagnoses are adenocarcinoma, whereas about 25% are squamous cell carcinoma. A mix of both known as adeno-squamous carcinoma which is rare more aggressive containing features of both squamous and glandular cells. _[1]

ETIOLOGICAL FACTORS

Cervical cancer is caused by various etiological factors and are.,The main cause of cervical cancer is HPV (Human Papilloma Virus), involvement in sexual activity at early age, smoking and tobacco consumption, multiple sexual partners, other sexually transmitted diseases like herpes, chlamydia etc, use of more oral contraceptive pills, genetic or family history. _[2]

EPIDEMOLOGY:

Cervical cancer ranks first in India. Nearly 140,000 women in India were diagnosed with cervical cancer in 2001, according to estimates. Geographical and temporal differences in cancer risk by personal variables such as age, sex, and racial or ethnic groupings may be uncovered using data on cancer incidence derived from population-based registries. Various regions of India are home to 21 distinct population-based cancer registries. Out of them, information on occurrence is accessible for fourteen registries; eleven of these are situated in metropolitan regions, while three are situated in rural areas. One study found that cervical cancer was more frequent in women than any other kind of cancer._[3]

PATHOGENESIS:

 

 

 

 

PHARMACOKINETICS

ABSORPTION:  Cisplatin enters cells by passive diffusion across the cell membrane; a concentration gradient from higher to lower can cause it to pass straight through the phospholipid bilayer. Cisplatin concentrations are higher in liver, kidney and the remaining small part in bladder, muscle, pancreas, spleen.

DISTRIBUTION: 90% of plasma proteins are irreversibly bound by cisplatin. Unlike typical drug-protein binding, cisplatin does not bind to plasma proteins instantly and reversibly. Cisplatin is cytotoxic when it binds to platinum that isn't bound to proteins.

METABOLISM: In the liver, cisplatin undergoes non-enzymatic metabolism and changes into proteins, water, and small molecules. It can create inactive complexes when it reacts with glutathione.

ELIMINATION: Eliminated through kidney in urine within 24hrs. Some part of the cisplatin is also excreted through liver by irreversibly binding to plasma protein(albumin), and small amounts of drug is excreted through breast milk._{[14 – 16]}

HALF-LIFE:  Plasma half-life of cisplatin is 30 minutes under IV infusion; it is slowly eliminated with a half-life of 5 days or more.

PHARMACODYNAMICS:  As cisplatin belongs to the class of alkylating agent. It directly binds to the alkyl groups of and stops the cross-link of guanine bases in DNA helix strands, directly attacking DNA. _[17]

DOSE:  ADULTS - Cisplatin STANDARD DOSE is 40mg/m² IV WEEKLY

CLINICAL INDICATIONS:

Cisplatin can be used for various cancers in a similar mechanism of inhibiting tumor cell growth and development., Cisplatin can be used as alone or along with chemoradiation therapy in treating Cervical cancer, Head and neck cancers, Ovarian cancer, Testicular cancer, Bladder cancer, Gastritis cancer, Lung cancer, Esophageal cancer and Others like medulloblastoma, neuroblastoma, penial, anal, osteosarcoma. _[18]

ADVERSE EFFECTS:

Cisplatin is irreversibly bound and the most part of the drug is accumulated in the tissues, where it causes serious side effects like;

Nephrotoxicity – Decreased urine output, lower Mg, K levels, elevated creatinine levels.

Neurotoxicity – Stroke like episodes, cognitive dysfunction, peripheral neuropathy.

Ototoxicity – Hearing loss, tinnitus, difficulty in hearing.

Hepatotoxicity – Jaundice, elevated levels of aminotransferase, decreased levels of albumin in blood.

Myelosuppression – Neutropenia, anaemia, thrombocytopenia.

Emetogenic – Severe nausea, vomiting, dehydration, delayed emesis._[19]

CONTRAINDICATIONS:

Possible advantages outweigh the risks, patients in those with prior kidney disease and hearing impairment should not undergo this treatment.

• Patients with a history of hypersensitivity or myelo-suppression should not be given cisplatin. _[20]

DRUG INTERACTIONS:

1. Cisplatin + Doxorubicin

This combination together may increase the risk of side effects like bone marrow or gastrointestinal tract.

2. Cisplatin + Cyclophosphamide

Cyclophosphamide's side effects, particularly bone marrow suppression and stomach/intestinal issues, may worsen when combined with cisplatin or other comparable chemotherapy. Low blood cell counts, infections, anaemia, bleeding, nausea, vomiting, and mouth or abdominal sores are all made more likely as a result.

3. Cisplatin + Dexamethasone

Using dexamethasone with cisplatin may require dose adjustments or special monitoring. Taking both together can increase the risk of muscle pain or cramps, weakness, dizziness, confusion, and loss of appetite. Inform your doctor promptly if these symptoms occur.

4. Cisplatin + Paclitaxel

Using cisplatin with paclitaxel can increase the risk of low blood counts, infections, bleeding, anaemia, and nerve damage. Symptoms such as fatigue, unusual bruising or bleeding, fever,flu like feelings, vision changes, or tingling and numbness in hands or feet should be reported promptly. _[21]

CASE DISCUSSION:

CASE STUDY – 1

A patient of 60 yrs female, has admitted in the oncology department on 07/01/2026 with the chief complaints of Post-menopausal bleeding, sever abdominal pain, fever and chills since 1 week. Patient doesn’t have any known history and S/P Hysterectomy and T1b1NXMX (representing a specific stage of cervical cancer).

Upon biopsy it is clearly diagnosed with cervix cancer stage – III C. Now came for the treatment and needed investigations done and reports correlated clinically, planned for weekly chemotherapy. On examination the patient is conscious and coherent, Pulse rate – 79bpm, Blood pressure –120/80mmHg, Respiratory rate – 18/min, Temperature – 98.4 F, CVS – S₁S₂+, SPO2 – 98% ra, Lungs – BAE+

On 07/01/2026 – WEEK 1 chemotherapy on CCRT; CISPLATIN- 40mg/ IV in 1 UNIT NS over 2hrs

PET SCAN – FDG avid ill-defined enhancing lesion centered on the right side of vault region in pelvis. FDG avid heterogeneously enhancing lesion in left adnexa, likely deposit/lymph node, likely metastasis.

USG ABDOMEN – No significant sonological abnormality detected.

HISTOPATHOLOGY – picture suggestive of well differentiated squamous cell carcinoma, cervix, [T1b1NXMX].

CECT – Calcified fibroids in uterus, collection in endometrial cavity.

Based on examination the patient was diagnosed with cervical cancer -IIIC, Cycle 1 was started with premedications of INJ.PALNOX 0.26 mg + INJ. DEXA 8mg IV in 100ml NS, TAB- PERINORM – 10mg, INJ. KCL 2AMP+ INJ. MGSO4 1AMP.

Patient and their attenders are advised for the laboratory investigations of CBP, RFT, LFTELECTROLYTES results must be bought every week.

On 14/01/2026 – WEEK 2 chemotherapy on CCRT; CISPLATIN – 40mg/IV

On 21/01/2026 – WEEK 3 chemotherapy on CCRT; CISPLATIN – 40mg/IV

On 28/01/2026 – WEEK 4 chemotherapy on CCRT; CISPLATIN – 40mg/IV

Laboratory Investigations found in the normal range for all the above cycles.

On 04/02/2026 – came for WEEK 5 chemotherapy on CCRT, CISPLATIN – 40mg/IV

The investigations found few abnormal range parameters, like Hb – 10.1 mg/dL, WBC – 2300cell/cumm, PLATELET COUNT – 1,20,994/mm³, SERUM CREATININE – 1.6mg/dL, SODIUM – 131mEq/L, POTASSIUM – 3.0 mEq/L. These were the abnormal parameters identified in this patient after 4 cycles.

CASE STUDY – 2

A patient of 54 yrs old, female has admitted in oncology department on  05/02/2026 with the chief complaints of Body pains, previously the patient was diagnosed with cervix carcinoma– large cell Non-keratinising squamous cell carcinoma FIGO stage III C1. Patient has a previous history of Hypertension on medication Rx [ T. MACPRIL-H – 2.5mg]. On examination the patient is conscious and coherent, Pulse rate – 79bpm, Blood pressure –130/80mmHg, Respiratory rate – 18/min, Temperature – 98 F, CVS – S₁S₂+, SPO2 – 98% ra.

Previously the patient has taken 6 cycles of Paclitaxel + Carboplatin for every 3 weeks. Now came for CISPALTIN chemotherapy for 6 weeks.

On 06/02/2026 – planned for cisplatin chemotherapy and WEEK 1 CISPLATIN 40mg/IV in NS

Based on examination, WHOLE BODY PET CT SCAN results; Shows FDG avid liver parenchymal &sub capsular deposits, peritoneal and omental deposits, avid extensive infra diaphragmatic, sub cranial and bilateral cervical level IV lymph nodes.

CT SCAN OF ABDOMEN – Two mass lesions noted in right lobe in liver – PROBABLY LIVER METASTASIS. Minimal ascites, cystitis, cervix appears normal at scan, moderate left hydronephrosis with narrowing at pelvic ureteric junction, thin strip of fluid noted in endometrial cavity. Mild mesenteric fat haziness noted in abdomen, reactive thickening.

PUNCH BIOSPY – features suggestive of large cell non-keratinising squamous cell carcinoma.

MRI PELVIS – Features of cervical carcinoma, few enlarged bilateral iliac lymph nodes noted likely deposits .

All necessary investigations were done as advised, reports correlated and enclosed. After thorough evaluation chemotherapy is started with premedications INJ. ZOFER – 8mg , INJ-DEXA 8mg in 100ml NS over 30minutes , CAP APRECAP 125mg, INJ. AVIL 1AMP, INJ. RANTAC 50 mg followed by INJ.CISPLATIN 40mg IV in NS OVER 2 hours. Patient is advised with laboratory investigations of  CBP, ELECTRLYTES, RFT, LFT on each cycle.

On 12/02/2026 – WEEK 2 chemotherapy of CISPLATIN 40mg/ IV all the parameters were normal.

On 18/02/2026 – WEEK 3 chemotherapy of CISAPLTIN 40mg/IV, the abnormal parameters noted are Hb – 9.9mg/dL, SGOT – 48U/L , SGPT – 50U/L, TOTAL BIRUBIN – 1.6 mg/dL, ALKALINE PHOSPHATASE – 242.0U/L , SODIUM – 130mEq/L. These are the few abnormal findings after 2 cycles.

CASE STUDY – 3

A patient of 64 yrs old, female has admitted in oncology department on 26/12/25 with the chief complaints of Post menopausal bleeding ON & OFF since 1 month, body pains. Patient is diagnosed with cervix cancer locally advanced stage – III. These were the few investigation’s performed to diagnose the cervical cancer. On examination the patient is conscious and coherent, Pulse rate – 79bpm, Blood pressure –110/80mmHg, Respiratory rate – 22/min, Temperature – 98.2 F, CVS – S₁S₂+, SPO2 – 98% ra, Lungs – BAE+

USG ABDMONEN & PELVIS – Cervix appeared bulky with altered echotexture – neoplastic lesion

HISTOPATHOLOGY – Non-keratinising squamous cell carcinoma

MRI PELVIS & ABDOMEN – Neoplastic etiology of cervix with extensions and deposits are described.

PET CT WHOLE BODY SCAN – FDG avid heterogeneously enhancing soft tissue lesion involving cervix, lower uterine segment and upper vagina, showing parametrial extension into mesorectum and abutting posterior wall of urinary bladder.

All necessary investigations were conducted and planned for Cisplatin based chemotherapy and the patient is advised with laboratory test reports on every visit.

On 26/12/2025 – WEEK 1 chemotherapy of CISPLATIN- 45mg/IV in NS

Along with few premedications INJ. PALNOX 0.25mg, INJ.DEXA 8mg in 100ml NS, TAB.PERINORM – 10mg, INJ.KCL -2amp +INJ.MGSO4 – 1gm in 1unit NS.

On 02/01/2026 – WEEK 2 chemotherapy of CISPLATIN – 45mg/IV, noted normal parameters.

On 09/01/2026 – WEEK 3 chemotherapy of CISPLATIN – 45mg/IV, noted normal parameters

On 16/01/2026 – WEEK 4 chemotherapy of CISPLATIN – 45mg/IV, The abnormal parameters have been noted; SERUM CREATININE – 1.61 mg/dL, UREA – 48.69mg/dL, Hb – 9.2mg/dL, TOTAL BILIRUBIN – 1.69mg/dL, SGOT – 110U/L, SGPT – 102U/L are the abnormal findings after 3 cycles.

CASE STUDY – 4

A patient of 42 yrs old, female has admitted in oncology department on 24/11/2025 with the chief complaints of PV Bleeding since 2days along with severe pain. Past surgical history of Tubectomy. The patient was thoroughly examined underwent examination under anaesthesia + fractional curettage + cervical biopsy and diagnosed with cervical cancer. On examination the patient is conscious and coherent, Pulse rate – 79bpm, Blood pressure –120/80mmHg, Respiratory rate – 20/min, Temperature – 98.6 F, CVS – S₁S₂+, SPO2 – 98% ra, Lungs – BAE+

BIOSPSY – features suggesting the large cell non-keratinising squamous cell carcinoma.

USG ABDOMEN – cervix appeared bulky in echotexture. Features are suggestive of poorly differentiated squamous cell carcinoma.

PET SCAN – shows metabolically active cervix primary B/L. external iliac nodal metastasis.

After thorough examination, planned with Cisplatin based chemotherapy along with few premedications like INJ.ZOFER – 8mg, TAB.PERINOM-8mg, INJ.KCL 2amp+INJ.MGSO4 1gm in 1 unit. Patient is informed to get the laboratory reports on each follow up.

On 24/11/2025 – WEEK 1 chemotherapy of CISPLATIN – 45mg/IV NS over 2hrs, noted normal findings of parameters.

On 01/12/2025 – WEEK 2 chemotherapy of CISPLATIN – 45mg/IV,

On 08/12/2025 – WEEK 3 chemotherapy of CISPLATIN – 45mg/IV, The patient came with the chief complaints of peripheral neuropathy symptoms and abnormal findings of laboratory parameters are found, Hb- 10.2 mg/dL, WBC – 2300cells/cumm, SERUM CREATININE – 1.7mg/dL are the findings of patient after 2 cycles.

CASE STUDY – 5

A patient of 47 yrs old, female has admitted in oncology department on 21/12/2025, the patient was previously diagnosed with cervical cancer, now came for CCRT chemotherapy based CISPLATIN therapy. On examination the patient is conscious and coherent, Pulse rate – 79bpm, Blood pressure –120/80mmHg, Respiratory rate – 20/min, Temperature – 98.4 F, CVS – S₁S₂+

Investigation’s shown USG ABDOMEN – Hypertrophied distorted cervix

MRI PELVIS – Altered signal intensity lesion epicentered in the left lateral wall of cervix with extension from the internal os up to the level of proximal 2/3^rd vagina with extensions. Features are suggestive that cervix cancer (FIGO stage IIB)

WHOLE PET CT SCAN – FDG avid ill-defined enhancing soft tissue lesion involving cervix, lower uterine segment and upper vagina.

On 21/12/2025 WEEK 1 chemotherapy of CISPLATIN – 55mg/IV in NS over 2hrs.

On 01/12/2025 WEEK 2 chemotherapy of CISPLATIN – 55mg/IV, noted with normal findings.

On 08/12/2025 WEEK 3 chemotherapy of CISPLATIN – 55mg/IV, noted with normal findings.

On 15/12/2025 WEEK 4 chemoetherapy of CISPLATIN – 55mg/IV, noted with normal findings.

On 23/12/2025 WEEK 5 chemotherapy of CISPLATIN – 55mg/IV, identified complaints of peripheral neuropathy and laboratory findings of Hb – 10.0mg/dL, SERUM CREATININE – 1.54 mg/dL, SGOT – 131U/L, SGPT – 130U/L, TOTAL BILIRUBIN – 2.0mg/dL, POTTASIUM – 2.9mEq/L. are found after 4 cycles.

CONCLUSION

Cisplatin remains the cornerstone of cisplatin -based chemoradiotherapy (CCRT)for locally advanced cervical cancer, demonstrating good initial tolerance in the first 2-4 weekly cycles (40-55mg/m² IV) across all the five case studies, with premedications (antiemetics, electrolytes) effectively controlling emesis, nausea. However, cumulative toxicity emerges predictably after 4-5 cycles, manifesting as myelosuppression (anemia, leukopenia, thrombocytopenia), nephrotoxicity (Creatinine). Electrolyte imbalance(sodium, potassium, chlorine levels) and hepatotoxicity, alongside peripheral neuropathy- necessitating vigilant weekly monitoring of CBP, RFT, LFT, Electrolytes, dose adjustments, supportive and palliative care. Early detection through serial labs enables toxicity management , ensuring CCRT completion and optimal survival benefit.

CASE STUDY – 1; 60 yrs old, female with stage IIIC cervix cancer tolerated 4 cisplatin cycles well, week 5 showed myelosuppression, nephrotoxicity, electrolyte imbalance.

CASE STUDY – 2; 50 yrs old, female with metastatic IIIC1 post-paclitaxel + carboplatin; week 3 cisplatin developed hepatotoxicity, anemia, hyponatremia due to liver metastasis.

CASE STUDY – 3; 64 yrs old female, with stage III cervix cancer, shown nephron/hepatotoxicity and anemia.

CASE STUDY – 4; 42 yrs old, female with poorly differentiated squamous cell carcinoma, week 3 cisplatin caused myelosuppression increased creatinine levels, early peripheral neuropathy.

CASE STUDY – 5; 47yrs old, female with stage IIB higher-dose cisplatin of 55mg, week 5 comprehensive toxicity of nephro, hepato, anaemia, hypokalaemia, neuropathy after 4 cycles.

ACKNOWLEDGMENTS

The authors would like to acknowledge the facilities provided by Bharat Institutions Pharmacy in executing this article.

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