Power of Platinum: Why These Chemotherapies Still Matter

In an era of breakthrough immunotherapy and targeted treatments, platinum-based chemotherapy continues to be a cornerstone of cancer care. Cisplatin (Platinol and Platinol-AQ; Bristol-Myers Squibb), carboplatin (Paraplatin; Bristol-Myers Squibb), and oxaliplatin (Eloxatin; Sanofi-Aventis US LLC) remain integral to treatment regimens across multiple cancer types, prompting research into how these longstanding drugs are evolving alongside modern oncology.

The FDA approved cisplatin, the first widely used metal-based anticancer drug, in the late 1970s.¹ Despite initial skepticism, cisplatin became the foundation for the development of numerous analogs used to treat a range of cancer types. Cisplatin, carboplatin, and oxaliplatin bind to DNA, disrupt its structure, and trigger apoptosis (programmed cell death) in rapidly proliferating cells.²

However, the platins' anticancer activity is accompanied by clinically important toxicities, including nephrotoxicity, neurotoxicity, and ototoxicity. Differences in tolerability can influence drug selection and underscore the need for research into optimizing platinum-based regimens.

Evaluating Platinum's Current Role

Researchers from the Medical University of Sofia in Bulgaria and the University of Innsbruck in Austria examined the current clinical role and future development of platinum-based anticancer drugs. In their work, published in the Journal of Biological Inorganic Chemistry, they compared international clinical guidelines, synthesized real-world utilization data, and evaluated clinical trials.³

The researchers grouped cancer cases into 18 ICD-O categories to facilitate a concise comparison across cancer sites. Across all 5 guideline sources, platinum-based therapies were recommended in more than half of the 18 ICD-O categories evaluated, ranging from 55.6% to 83.3% depending on the source. The European Society for Medical Oncology (ESMO) guidelines are a collection of documents covering many major tumor types and are used internationally for treatment recommendations. Of the 80 cancer-specific documents that make up the ESMO guidelines, platinum agents were included in 53 (66.3%). Similarly, platinum agents were included in 46 of the 66 cancer types covered by the National Comprehensive Cancer Network (NCCN) guidelines (69.7%) and 30 of the 40 cancer types in the Bulgarian guidelines (75%).³

Real-World Use on the Rise

The broad representation of platinum-based therapies in clinical guidelines was also reflected in real-world utilization data from Bulgaria. Platinum-drug package reimbursement was used as a proxy for real-world utilization, illustrating changes in the volume of medication being paid for by insurers. Data from the Bulgarian National Health Insurance Fund showed that the number of reimbursed platinum-drug packages increased from 75,275 in 2021 to 96,840 in 2024. Oxaliplatin demonstrated the greatest increase, which the authors attribute to the growing burden of digestive-system cancers for which oxaliplatin is an important component of treatment.³ However, this metric requires careful interpretation because it does not account for drug waste or dose variations, creating the potential to overestimate actual drug consumption and the true number of patients receiving therapy.

Clinical Trials Focus on Combination Approaches

The researchers also identified 121 ongoing or not-recruiting clinical trials involving cisplatin, carboplatin, or oxaliplatin between 2022 and 2025, with roughly half including a phase 2 component. Non-small cell lung cancer was the most frequently studied malignancy (n = 22), followed by gastric (n = 11) and colorectal cancer (n = 9). Carboplatin was the most frequently investigated agent, followed by oxaliplatin.³

Notably, 82 of 121 trials (68%) evaluated platinum drugs in combination with newer therapies, including monoclonal antibodies (n = 25) and tyrosine kinase inhibitors (n = 15).³ This suggests that current research is focused less on replacing platinum chemotherapy and more on optimizing its role.

Implications for Pharmacists

For pharmacists, the continued use of platinum therapy reinforces the importance of staying current with the evolving oncology landscape. Understanding how patient characteristics and agent selection influence toxicity, dosing, and monitoring will help ensure that these therapies remain both effective and safely integrated into modern cancer care.

About the Author

Marissa Hurd is a 2027 PharmD candidate at the University of Connecticut in Storrs, CT

REFERENCES

1. The "Accidental" Cure—Platinum-based Treatment for Cancer: The Discovery of Cisplatin.News release. National Cancer Institute. Published May 30, 2014. Accessed September 28, 2026. https://www.cancer.gov/research/progress/discovery/cisplatin

2. Zhang C, Xu C, Gao X, Yao Q. Platinum-based drugs for cancer therapy and anti-tumor strategies. Theranostics. 2022;12(5):2115-2132. Published 2022 Feb 7. doi:10.7150/thno.69424

3. Kamusheva MS, Varbanov HP. Current clinical applications and future developments of platinum-based anticancer drugs. J Biol Inorg Chem. Published online 2026. doi:10.1007/s00775-026-02172-x