The Basics
What is Cisplatin?
Has been used for treatment of numerous human cancers including bladder, head and neck, lung, ovarian, and testicular cancers.
Brand names for Cisplatin
Platinol
How Cisplatin is classified
Antineoplastic Agents
Cisplatin During Pregnancy
Cisplatin pregnancy category
Category N/ANote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Cisplatin while pregnant
N/A
Taking Cisplatin While Breastfeeding
What are recommendations for lactation if you're taking Cisplatin?
Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy, especially alkylating agents such as cisplatin.[1] Excretion of platinum into milk occurs, but results from 3 cases are inconsistent. The exact form and toxicity of platinum excreted into breastmilk are also not known. The nursing infant would receive any platinum compounds orally rather than intravenously and oral absorption of oral platinum compounds by infants is not known. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk.[2] Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
Maternal / infant drug levels
Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy, especially alkylating agents such as cisplatin.[1] Excretion of platinum into milk occurs, but results from 3 cases are inconsistent. The exact form and toxicity of platinum excreted into breastmilk are also not known. The nursing infant would receive any platinum compounds orally rather than intravenously and oral absorption of oral platinum compounds by infants is not known. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk.[2] Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
Possible effects of Cisplatin on milk supply
A study of adolescent males who had received chemotherapy for childhood malignancies found that having received cisplatin was associated with elevated serum prolactin concentrations.[9] Another study of survivors of testicular cancer found that about 6% of those treated with cisplatin had abnormally high prolactin levels and 2% had abnormally low prolactin levels.[10]
A telephone follow-up study was conducted on 74 women who received cancer chemotherapy at one center during the second or third trimester of pregnancy to determine if they were successful at breastfeeding postpartum. Only 34% of the women were able to exclusively breastfeed their infants, and 66% of the women reported experiencing breastfeeding difficulties. This was in comparison to a 91% breastfeeding success rate in 22 other mothers diagnosed during pregnancy, but not treated with chemotherapy. Other statistically significant correlations included: 1. mothers with breastfeeding difficulties had an average of 5.5 cycles of chemotherapy compared with 3.8 cycles among mothers who had no difficulties; and 2. mothers with breastfeeding difficulties received their first cycle of chemotherapy on average 3.4 weeks earlier in pregnancy. Of the 3 women who received a cisplatin-containing regimen, 1 had breastfeeding difficulties.[11]
Possible alternatives to Cisplatin
None listed
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. Pistilli B, Bellettini G, Giovannetti E et al. Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: How should we counsel cancer patients about breastfeeding? Cancer Treat Rev. 2013;39:207-11. PMID: 23199900
2. Urbaniak C, McMillan A, Angelini M et al. Effect of chemotherapy on the microbiota and metabolome of human milk, a case report. Microbiome. 2014;2:24. PMID: 25061513
3. Egan PC, Costanza ME, Dodion P et al. Doxorubicin and cisplatin excretion into human milk. Cancer Treat Rep. 1985;69:1387-9. PMID: 4075315
4. de Vries EG, van der Zee AG, Uges DR, Sleijfer DT. Excretion of platinum into breast milk. Lancet. 1989;1 (8636):497. Letter. Erratum in Lancet 1989 Apr 8;1(8641):798. PMID: 2563865
5. Ben-Baruch G, Menczer J, Goshen R et al. Cisplatin excretion in human milk. J Natl Cancer Inst. 1992;84:451-2. Letter. PMID: 1538424
6. Lanowska M, Kohler C, Oppelt P et al. Addressing concerns about cisplatin application during pregnancy. J Perinat Med. 2011;39:279-85. PMID: 21391877
7. Tesfaye H, Halaska MJ, Branova P et al. Breast-fed infants whose mothers were on platinum based chemotherapy: Cases with promising outcomes. Ther Drug Monit. 2013;35:693. Abstract. DOI: doi:10.1097/FTD.0b013e3182a8ef2b
8. Hays KE, Ryu RJ, Swisher EM et al. Duration of cisplatin excretion in breast milk. J Hum Lact. 2013;29:469-72. PMID: 23492761
9. Siimes MA, Ropponen P, Aalberg V et al. Prolactinemia in adolescent males surviving malignancies in childhood: impaired dating activity. J Adolesc Health. 1993;14:543-7. PMID: 8312290
10. Wiechno P, Demkow T, Kubiak K et al. The quality of life and hormonal disturbances in testicular cancer survivors in cisplatin era. Eur Urol. 2007;52:1448-54. PMID: 17544206
11. Stopenski S, Aslam A, Zhang X et al. After chemotherapy treatment for maternal cancer during pregnancy, is breastfeeding possible? Breastfeed Med. 2017;12:91-7. PMID: 28170295
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
