Chemotherapy: Alkylating Agents (carboplatin, cisplatin, lurbinectedin)
Reviewed by: HU Medical Review Board | Last reviewed: July 2022 | Last updated: July 2022
Alkylating agents are chemotherapy drugs that are used to kill lung cancer (malignant) cells. Alkylating agents interfere with the lung cancer cells’ DNA and inhibit growth. As a chemotherapy drug, alkylating agents are a systemic treatment, able to travel throughout the body to kill cancer cells anywhere in the body.1,2 Alkylating agents used for lung cancer include carboplatin (Paraplatin®), cisplatin (Platinol®), and lurbinectedin (ZepzelcaTM).
Carboplatin is an anticancer chemotherapy drug that is classified as an alkylating agent. It is used to treat several types of cancer, including lung, head and neck, endometrial, esophageal, bladder, breast, and cervical. Carboplatin is given to the patient through an IV (intravenous) line, although in some cases (generally for ovarian cancer) it is given directly into the peritoneal cavity in the abdomen (the space between the membranes that separate the organs in the abdominal cavity from the abdominal wall). The dosage and schedule of carboplatin is determined by several factors, such as the patient’s height and weight, general health, and how the patient’s body responds to the drug.3
Carboplatin side effects
Carboplatin may cause side effects. Common side effects (experienced by greater than approximately 30 percent of patients receiving carboplatin) include low blood counts (red blood cells, white blood cells, and/or platelets), nausea, vomiting, taste changes, hair loss, weakness, and abnormal magnesium levels as seen on blood tests. Less common side effects occurring in approximately 10-29 percent of patients include burning sensation at the injection site, abdominal pain, diarrhea, constipation, mouth sores, infection, peripheral neuropathy (decreased sensation, numbness and tingling of the hands and feet), central neurotoxicity (dizziness, confusion, visual changes or ringing in the ears), hearing loss, kidney problems, abnormal electrolyte levels in the blood (sodium, potassium, and/or calcium), abnormal liver enzymes, cardiovascular events (heart failure, blood clots or stroke), or allergic reaction to carboplatin. For most people side effects from carboplatin are reversible and tend to go away after treatment is finished. However, some side effects may not go away or may appear later on after treatment is finished.3 Tell your healthcare provider about all conditions, medications, and health history before beginning treatment with carboplatin.
Cisplatin is another alkylating agent that is used to treat lung cancer, as well as other types of cancer including testicular, ovarian, bladder, head and neck, esophageal, breast, cervical, stomach, and prostate cancers. Cisplatin is also used in the treatment of lymphomas, neuroblastoma, sarcomas, multiple myeloma, melanoma, and mesothelioma. Cisplatin is generally given to the patient through an IV line, although it may also be infused into the abdominal cavity (generally for ovarian cancer). Cisplatin is a chemical that can cause irritation and inflammation of the vein in which it is administered, and patients experiencing any pain, redness, or swelling at the injection site should alert a health care professional immediately. The dosage and frequency of cisplatin is determined by several factors, such as the patient’s height and weight, general health, and the type of cancer.3
Cisplatin side effects
Cisplatin may cause side effects. Common side effects (experienced by greater than approximately 30 percent of patients receiving cisplatin) include nausea, vomiting, kidney toxicity, blood test abnormalities (lowered amounts of magnesium, calcium, and/or potassium), low white blood cells (increasing the risk of infection), high frequency hearing loss, low platelets (increasing the risk of bruising and bleeding), and low red blood cells (anemia). Less common side effects occurring in approximately 10-29 percent of patients include peripheral neuropathy, loss of appetite, taste changes, increases in the enzymes that measure liver function, and hair loss. Fertility may also be affected by cisplatin. For most people side effects from cisplatin are reversible and tend to go away after treatment is finished. However, some side effects may not go away or may appear later on after treatment is finished.3 Tell your healthcare provider about all conditions, medications, and health history before beginning treatment with cisplatin.
Lurbinectedin (ZepzelcaTM) is an alkylating agent that is a small cell lung cancer (SCLC) treatment option used for adults whose cancer has progressed while on or after taking platinum-based chemotherapy. It is used for SCLC that has metastasized (spread) to other parts of the body as a second-line treatment.5
Lurbinectedin side effects
Common side effects of lurbinectedin include nausea, vomiting, or decreased appetite, constipation or diarrhea, muscle or joint pain, low white and red blood cell counts, tiredness, trouble breathing or cough, changes in liver or kidney function tests, and changes in the levels of sugar, protein, sodium, or magnesium in the blood. Tell your healthcare provider about all conditions, medications, and health history before beginning treatment with lurbinectedin.
Managing side effects from chemotherapy
There are many options available to help manage side effects from chemotherapy, and patients should talk to their health care professional about all side effects they experience. Hydration (fluid intake) is very important while receiving chemotherapy, and patients are generally encouraged to drink an adequate amount of fluids every day, which may vary patient to patient (patients should check with their doctor if they have a fluid restriction). To lower the risk of infection, patients receiving chemotherapy may be advised to avoid crowds, people with colds, and wash their hands often.3