A COMPREHENSIVE REVIEW: PLATINUM BASED CHEMOTHERAPY IN LUNG CANCER

Lung cancer continues to represent the leading cause of cancer-related mortality worldwide and remains a major challenge for health care systems despite advances in prevention and treatment strategies. While molecularly targeted therapies and immune checkpoint inhibitors have significantly improved outcomes for selected patient populations, platinum-based chemotherapy remains a fundamental component of lung cancer management. This is particularly evident in non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC), where platinum compounds are routinely incorporated across multiple stages of disease. Cisplatin and carboplatin are the most frequently utilised platinum agents and have been used extensively in systemic chemotherapy regimens for several decades. Their antitumor effects result primarily from the induction of DNA damage through the formation of intra-strand and inter-strand cross-links, leading to disruption of DNA replication and activation of apoptotic pathways. Numerous clinical studies have demonstrated improved survival outcomes and symptomatic benefit when platinum agents are combined with newer cytotoxic drugs compared with non-platinum regimens. However, their clinical use is often constrained by dose-dependent toxicities, including renal impairment, neurotoxicity, ototoxicity, and bone marrow suppression, which necessitate careful patient selection and supportive interventions. In addition, both intrinsic and acquired resistance to platinum chemotherapy pose significant therapeutic challenges and involve complex mechanisms such as enhanced DNA repair capacity, altered drug transport, and tumor microenvironmental influences. Ongoing research efforts are directed toward optimising platinum-based combinations, integrating these agents with immunotherapy, and developing newer platinum compounds with improved efficacy and safety. This review critically examines the pharmacological mechanisms, clinical applications, toxicity profiles, resistance pathways, and future prospects of platinum-based chemotherapy in lung cancer.