Question

Which of the following is a platinum-based drug used in the treatment of carcinoma?

• A. Cisplatin
• B. Methotrexate
• C. Vincristine
• D. Doxorubicin

Hint:

This drug is notorious for nephrotoxicity and ototoxicity and is used in testicular and ovarian carcinomas.

Answer 1

The Correct Option is A

Platinum-based drugs are an important class of antineoplastic agents in NEET PG pharmacology.

Members of the platinum group:
1. Cisplatin (1st generation) -- prototype; testicular, ovarian, head and neck, cervical, lung, bladder cancers
2. Carboplatin (2nd generation) -- less nephrotoxic; ovarian, lung cancers
3. Oxaliplatin (3rd generation) -- colorectal cancer (FOLFOX/CAPOX regimens)

Mechanism:
After entering the cell, the chloride leaving groups are displaced by water (aquation), forming a reactive $\text{Pt}^{2+}$ species. This covalently crosslinks DNA strands, primarily forming $\text{d(GpG) intrastrand crosslinks}$, blocking DNA replication and transcription, and triggering apoptosis.

Toxicity of Cisplatin:
- Nephrotoxicity (dose-limiting; prevented by IV saline hydration + amifostine)
- Ototoxicity (irreversible high-frequency hearing loss)
- Peripheral neuropathy
- Most emetogenic agent -- requires 5-HT3 antagonist + NK1 antagonist prophylaxis
- Hypomagnesemia, hypokalemia

Carboplatin vs Cisplatin:
Carboplatin has less nephrotoxicity and ototoxicity but more myelosuppression.

\[\boxed{\text{Cisplatin}}\]