Table 1.
Absolute and relative contraindications to cisplatin therapy. Select comorbidity indices used in recent trials are included
| Absolute contraindications | Relative contraindications |
|---|---|
| Creatinine clearance < 50–60 mL/min | Advanced age (> 70) |
| Grade ≥ 2 tinnitus or pre-existing hearing loss | ECOG Performance Status score ≥ 2 |
| Grade ≥ 2 neuropathy | Weight loss > 10% of baseline body weight in preceding 6 months |
| Hypersensitivity to platinum-based therapies | Low BMI < 16 kg/m2 or body weight (< 30 kg) |
| Pregnancy or lactation | Charlson Comorbidity Index ≥ 1* |
| HIV/AIDS with CD4 count < 200 μL | ACE-27 Index ≥ 1† |
| HNCIG Omega Score < 0.80‡ | |
| G-8 Score ≤ 14‡ | |
| CARG Toxicity Score ≥ 30%§ | |
| CIRS-G Score ≥ 4# |
BMI, body mass index; *Modified Charlson Comorbidity Index: predicts 10-year survival using age (binned) and the presence/absence of cardiac, neurologic, pulmonary, gastrointestinal, endocrinologic, renal, and oncologic diagnoses. †Adult Comorbidity Evaluation-27 (ACE-27): evaluates the presence and severity of cardiovascular, respiratory, gastrointestinal, endocrinologic, neurologic, psychiatric, rheumatologic, immunologic, and oncologic diagnoses in additional substance abuse and BMI. ‡Head and Neck Cancer Intergroup (HNCIG) omega score: predicts the overall event risk attributable to cancer events (as opposed to competing non-cancer mortality) based on age, performance status, sex, tumor site, T and N stage, p16 status, and smoking history. ‡Geriatric 8 (G-8): identifies older patients who could benefit from comprehensive geriatric assessment based on food intake, weight loss, mobility, neuropsychologic problems, BMI, number of prescription drugs, and self-perception of health. §Cancer and Aging Research Group (CARG) Toxicity Score: estimates risk of severe chemotherapy-related side effects in older cancer patients based on age, cancer type, chemotherapy dose/number of agents, renal function, hearing, number of falls, and functional status. #Cumulative Illness Rating Scale for Geriatrics (CIRS-G): quantifies burden of comorbid disease in older patients based on the presence and severity of cardiovascular, hematologic, respiratory, otolaryngologic, gastrointestinal, renal, genitourinary, rheumatologic, neurologic, endocrinologic, and psychiatric diagnoses. Ref: http://comogram.org