USES AND CLINICAL INDICATIONS OF CISPLATIN

Cisplatin (cis-diamminedichloroplatinum II) is one of the first platinum-based chemotherapeutic agents introduced into clinical oncology and has been widely used in the treatment of solid tumors due to its potent cytotoxic activity mediated by inhibition of deoxyribonucleic acid synthesis. Following cellular uptake, cisplatin is converted into its active form and covalently binds to purine bases of deoxyribonucleic acid, leading to the formation of intra-strand and inter-strand cross-links. These structural alterations result in disruption of deoxyribonucleic acid replication and transcription processes, arrest of the cell cycle at the transition between the second growth phase and mitosis, and subsequent activation of programmed cell death. This mechanism produces pronounced cytotoxic effects, particularly in rapidly proliferating malignant cells. In clinical oncology, cisplatin is administered both as monotherapy and, more commonly, in combination with other cytotoxic agents or radiotherapy. It is considered a core component of standard chemotherapy protocols for a wide range of solid malignancies, including cancers of the testis, ovary, urinary bladder, lung, head and neck region, and uterine cervix. Cisplatin-based treatment regimens have been shown to improve local tumor control as well as disease-free and overall survival outcomes. Moreover, when administered concurrently with radiotherapy, cisplatin exhibits radiosensitizing properties that enhance the therapeutic effectiveness of radiation treatment. Despite its substantial antitumor efficacy, the clinical use of cisplatin is limited by dose-related toxicities, including nephrotoxicity, ototoxicity, peripheral neuropathy, and gastrointestinal adverse effects. Consequently, careful patient selection, appropriate dose modification, and the implementation of supportive care strategies are essential to optimize therapeutic outcomes. Although newer-generation platinum compounds such as carboplatin and oxaliplatin have been developed to improve tolerability, cisplatin continues to retain significant therapeutic importance due to its superior antineoplastic activity in many malignancies. This review aims to comprehensively evaluate the clinical applications, major indications, and current role of cisplatin in cancer treatment based on available evidence from the literature.