Cisplatin/Epinephrine Injectable Gel
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Drugs & Aging 2001; 18 (10): 794-795 1170-229X/01/0010-0794/$22.00/0 © Adis International Limited. All rights reserved.
Cisplatin/Epinephrine Injectable Gel A Viewpoint by Maurie Markman The Cleveland Clinic Taussig Cancer Center, Department of Hematology/Medical Oncology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
While cytotoxic chemotherapy (e.g. cisplatin) can decrease the size of neoplastic lesions, these agents can be associated with significant systemic toxicity. The local administration of cisplatin (in an epinephrine-containing gel) has the potential to increase the exposure of a symptomatic cancerous mass to the antineoplastic drug, while at the same time decreasing adverse effects. This strategy is particularly relevant in those settings where other local management approaches are unable to be utilised (e.g. surgery, external beam radiation), where cisplatin is known to be an active agent (e.g. breast cancer, head and neck malignancies) and where it is anticipated that systemic drug delivery will be
ineffective due to inadequate blood supply (e.g. tumour exposed to prior radiation therapy, necrotic poorly vascularised tumour). Currently available data demonstrate that in carefully selected patient populations the intratumoural administration of cisplatin/epinephrine injectable gel can provide meaningful symptomatic palliation, particularly a decrease in pain. Of note, systemic adverse effects of cisplatin are not observed, and local toxicity appears to be acceptable. It is critically important to emphasise that the goal of therapy in this setting is not to simply demonstrate tumour shrinkage, but rather objective and hopefully sustained improvement in local cancerrelated symptoms. Thus, the only legitimate test of the effectiveness of truly palliative therapy should be its impact on symptoms and overall quality of life, and not merely the percentage of patients achieving ‘tumour regression’ following local drug delivery.
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