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Background: Platinum-based chemotherapy, a widely used backbone of systemic cytotoxic anticancer treatment, is associated with nephrotoxicity. Currently, renal function is generally assessed prior to each administration of cisplatin or carboplatin, but there is no guideline regarding the frequency of renal function determination. Objective: The primary objective was to determine the median time to a clinically relevant dosage adjustment (>10%) due to change in renal function in patients treated with cisplatin and carboplatin. Secondly, variables influencing changes in renal function were assessed. Methods: We conducted a retrospective analysis of serial renal function assessments in platinum-treated patients with cancer in two academic medical centers, using a query to extract data from the electronic health records between 2017 and 2019. Results: In total, 512 patients receiving cisplatin and 628 patients receiving carboplatin were included. In total, 15% of all cisplatin-treated patients were found to have a renal function less than 60 mL/min at least once during treatment, with a median time to renal function decline of 67 days (range 5-96 days), which did not differ between treatment regimens. For carboplatin 21% of patients were found to have had a dosage variation of more than 10% at least once during treatment, with a median time-to-event period of 64 days (range 5-100 days). Interpretation: Dose adjustments during platinum-based chemotherapy resulting from renal function decline occur after a median time of ≥64 days. Our data provide substantiated guidance to recommend renal function assessment during platinum-based chemotherapy in clinically stable patients to once every 3 weeks.

A 65-year-old man was treated with a course of rituximab, cisplatin, and cytarabine. During the second cycle, a volume of 40–50 mL of 0.3 mg/mL cisplatin was extravasated. The patient was treated with a cold pack multiple times a day and cutaneous application of dimethyl sulfoxide cream three times a day for a week. In the months after the extravasation, the patient suffered from worsened swelling and redness and a black crust had formed on the wound. The patient was diagnosed with chemical phlebitis. After watchful waiting for 3 months, antibiotic therapy was started. After 7 months, the wound had healed. On the contrary to what is described in our case, no extravasation guideline classifies cisplatin in a concentration lower than 0.4 mg/ml as a vesicant. The different guidelines also present conflicting recommendations on how to treat the extravasation of cisplatin. In three previous case reports, severe effects of cisplatin extravasation after infusion at low concentration were described as well. We recommend that the findings from our case report are incorporated into extravasation guidelines to ensure optimal treatment of cisplatin extravasations.

Cytotoxic drugs can be harmful when healthcare workers are exposed to them, because of their carcinogenic, mutagenic and reprotoxic properties. There are many European and national laws and guidelines, plus local protocols that must be complied with, to protect healthcare workers against cytotoxic drugs. In the Netherlands, the current guidelines for hospitals are well structured and have been proven effective. Compliance to these guidelines remains pivotal, and further attempts to improve worker safety should be aimed at established risks, such as contamination on the outside of commercial drug vials. Non-proven and costly extra measures should not be introduced until their effectiveness has been demonstrated through independent research.