Chemotherapy – Alkylating Agents (carboplatin, cisplatin, mechlorethamine)

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 very rarely, mechlorethamine (Mustargen®).

Carboplatin (Paraplatin)

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 may cause side effects. Common side effects (experienced by greater than 30% of patients taking 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 10-29% 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. Side effects from carboplatin are almost always reversible and tend to go away after treatment is finished.3

Cisplatin (Platinol®)

Cisplatin is another alkylating agent that is used to treat lung cancer, as well as 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 may cause side effects. Common side effects (experienced by greater than 30% of patients taking 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), and low red blood cells (anemia). Less common side effects occurring in 10-29% of patients include peripheral neuropathy, high frequency hearing loss, loss of appetite, taste changes, increases in the enzymes that measure liver function, and hair loss. Fertility may also be affected by cisplatin. Side effects from cisplatin are almost always reversible and tend to go away after treatment is finished.3

Mechlorethamine (Mustargen®)

Mechlorethamine is a chemotherapy drug that is classified as an alkylating agent. It is very rarely used to treat lung cancer, but may be used in Hodgkin lymphoma, non-Hodgkin lymphoma, certain types of leukemia and mycosis fungoides (a type of immune system cancer). Mechlorethamine is generally injected into the patient through an IV line. It may also be given for malignant effusion into the abdominal cavity, into the chest cavity, or into the lining of the heart. The dosage and length of treatment depends on the type of cancer, the route the drug is being given to the patient, and how the patient responds to treatment.3,4

Mechlorethamine may cause side effects. Common side effects (experienced by greater than 30% of patients taking mechlorethamine) include low white blood cells (increasing the risk of infection), low red blood cells (anemia), low platelets (increasing the risk of bleeding), nausea, vomiting, mouth sores, hair loss, darkening of the veins used for injection, and loss of fertility. Less common side effects occurring in 10-29% of patients include fever, diarrhea, poor appetite, taste changes, ringing in the ears (tinnitus), and increased uric acid levels in blood tests. Side effects from mechlorethamine are almost always reversible and tend to go away after treatment is finished.3

Managing Side Effects

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. To lower the risk of infection, patients receiving chemotherapy may be advised to avoid crowds, people with colds, and wash their hands often.3

Written by: Emily Downward | Last reviewed: January 2017.
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