Cisplatin: The Super Toxic Chemo Drug That Saved My Life

This is not a sad story! Going through chemotherapy was one  of the most interesting experiences   of my life and my most vivid memory is very funny.

In 2018 I was being treated for  stage 3 B testicular cancer that   had metastasized into a few  lymph nodes and my lung. Very serious business unfortunately.

Boys and men, check your testicles tonight. One day my doctor was about to punish  my body with a fresh dose of Cisplatin. A cytotoxic hazardous chemotherapy agent.

One of the absolutely worst ones. Controlled medical violence. The villain and hero of this story.

My buddy Cisplatin came in a green, opaque  two liter bag directly from the fridge. The doctor connected the infusion to  the central venous access in my chest,   a tube that led directly to my heart.

But then… A short moment of inattention and disaster struck: A single drop of the icy liquid escaped.

She panicked for a second, checking frantically   if the liquid had landed on her  doubly gloved hands or her skin. But luckily it had missed.

I had to laugh at the scene. My doctor, who I trusted deeply, was  terrified of a single drop of Cisplatin. And I was about to have a whole bag  flush directly into my heart so it  

would spread to every last  nook and cranny of my body. And then again tomorrow. Yeah sure, let’s go!

But seriously, how absurd is  it that this stuff is medicine? So let me tell you the story of  a revolutionary chemical that was   almost discarded as a failure because it  was too brutal, too toxic, too dangerous.

A molecule that punched me in  the face and wrecked my body. And then saved my life and millions more. Cisplatin - The Super Toxic Wonder Drug

Cisplatin is a heavy metal compound. A tiny molecule with a platinum atom at  its center that looks like a quadcopter. Its success story, like many medical  breakthroughs, began with an accident.

In the 1960s physicist Barnett Rosenberg  wanted to see if he could manipulate living   beings with electricity and learn  interesting things because why not. Well it turns out electricity did nothing  but instead he found something huge: 

The bacteria in a solution with platinum  electrodes turned into spaghetti,   300 times longer – but way more  important: They stopped multiplying. It turned out platinum molecules did that.

At the time chemotherapy was gaining popularity   as a treatment for cancer – any chemical that  stopped cell division was a potential candidate. Rosenberg felt like he should inject Cisplatin  

into mice with cancer to see  what happened because why not. And oh boy, did things happen! While high doses turned out to  be deadly to the poor rodents,  

on lower doses their tumors shrank, did  not come back and the mice survived! Until they were cut open to make sure of course!  But it would be a pretty rocky path  from mice to human medical trials.

Many experts were sceptical: Heavy metals  are notoriously toxic and not worth the risk. But Rosenberg kept pushing and lobbying – at  one point calling drug developers weekly until   Cisplatin was finally tested in humans. And well, things went horribly.

Cisplatin was used on a wide variety of  patients with different cancer types. Not only did the heavy metal not really slow down  most cancers, it kind of killed some patients. In early studies, up to 75% of  patients got severe kidney damage.

It’s hard to prove if that’s what killed them  though, as they were already dying of cancer. And then an astonishing study rocked  the medical world: 11 patients with   advanced testicular cancer, the most common  cancer among young men, received Cisplatin.

6 responded somewhat, and three…  went into complete remission. In more human words: they were cured. This was unheard of.

Until this moment, metastatic testicular cancer  was super deadly, 95% of all men who got it died. 3 out of 11 recoveries, from the very late  stage no less, was a medical breakthrough.  Another one made cisplatin finally bearable: A new  protocol of massive overhydration – basically the  

patient would be flooded with liters and liters of  fluid to flush the Cisplatin out of the kidneys. If you are wondering, yes, this  means that you pee all day and night.  The game for testicular cancer flipped.

Today it has a 95% survival rate, even when  it has spread widely across the body already. And platinum drugs are a backbone of a large  fraction of chemo therapies of all kinds. Ok, but what does Cisplatin actually do that  

makes it so effective against  testicular cancer in particular? What Cisplatin Actually Does Inside Your Body Cisplatin can be injected into  a central venous access, a sort  

of hub that can be inserted easily  and leads straight into the heart. Which means that it is immediately  and rapidly distributed. Because Cisplatin is served ice cold,  

you feel it spread all over your  body, cooling you from the inside. Pretty weird sensation. The immediate effect is… nothing much.

In the first few hours about 90% of  the Cisplatin molecule binds to the   plasma of your blood and is, for now, inactive. Over the next few days it is slowly being released  

from the plasma and showers your body  with a constant barrage of poison.  All while your kidneys are working at maximum  capacity to remove it from your body as quickly   as they can so you can pee it out. The 10% Cisplatin that doesn't bind  

to plasma passes from your blood  into your tissue and organs. Where it finally enters your cells. The membranes of cells are  well protected fortresses that  

carefully monitor who is allowed  in but they can’t stop Cisplatin. It simply diffuses into the cell, with  some of it even actively hauled in.  Inside the cell, it sheds its chloride ions  

and connects to water molecules –  like a grenade ejecting its safety. Cisplatin is now chemically active. Again, this should trigger emergency  protocols – but thanks to its tinyness  

the poison escapes detection and  passes through another line of defense:   the nucleus, home of your DNA – here  it finally causes catastrophic damage.  Your DNA is a two meter long zipper,  bundled up neatly and orderly.

Cisplatin is like chewing gum that  gets inside zipper teeth and hardens,   clumping up parts that don’t belong together. This is an emergency,  

because it critically interrupts the  cell's ability to read and copy DNA. Your cell is now on an urgent  timer: Fix this or die. Repair molecules spring into action but the  chaos and damage is severe and very hard to fix.

Cells that don’t need to divide  quickly, say in your muscles,   can slow down their metabolism, stop  replicating and start repairing. Bit by bit they fix the genetic  damage, removing the cisplatin.

They will mostly be fine. But there are cells that  need to replicate quickly. The cells that make your hair  grow, the lining of your gut,  

the tastebuds of your tongue, your bone  marrow that makes red and white blood cells. All of them are factories producing new  cells constantly and they now have a   fundamental problem: Their internal  replication clock doesn’t stop,  

their DNA needs to be copied and  right now this is not possible. So if the damage is too heavy, apoptosis  is triggered: programmed cell death. If a cell thinks it is damaged  too much and destroys itself,  

this means it is working as intended. It sacrifices itself to protect the larger whole. And now this is happening all over your body. Billions of cells start dying, creating  all the side effects of chemotherapy.

Which is the point, because your cancer cells  are extremely not ready for any of this. As we’ve explained in detail before,  cancer cells are broken cells. In a nutshell, their self destruction  button is broken, they are really bad  

at fixing their own genetic damage  and they literally can’t slow down. The reason Cisplatin is so incredibly  effective against testicular cancer is   because it has an unusual vulnerability  that other cancer types don’t have: 

Most testicular cancer cells  are born from germ cells. Specialists made for the reproduction  of the whole, gigantic organism. Reproduction is the whole point for all  living things, so the responsibility is huge.

For germ cells the integrity of their  DNA is a critical priority – even   small mistakes could introduce genetic  damage into the bloodline and weaken it. So they constantly scan themselves  and tolerate almost no errors.

When Cisplatin wrecks their DNA, testicular  cancer cells still remember their original   purpose of protecting genetic  integrity and destroy themselves. Thinking they are preventing damaged material  being passed on to the next generation.

Your tumors collapse, no matter where in  the body cancer cells have escaped to. And this is what happened inside my body. Over the span of just 6 weeks, the chemo  completely eliminated a cancer that would  

have been a death sentence a few decades earlier. The lymph nodes full of cancer  were completely dissolved. A bit of scar tissue remains in my lung.

The side effects were not fun  and I’ll spare you the details. But I want you to know that just in the last few   years drugs against chemo side  effects have improved massively.

They made the experience bearable. The anti nausea drugs worked so  well I didn’t have to vomit once. If you ever have to go through the  same treatment for testicular cancer,  

please know that you can do it. Just take it day by day. My cancer has not returned since.

Final Thoughts  At no point of this entire ordeal  did I hate my cancer cells. It was not their fault that they were  broken and they didn't know better.

But it also didn’t matter. Cancer never wins because  it can’t live without you. Either you both die – or you live.

8 years have passed since  my meeting with Cisplatin.  Human brains determine your happiness  by comparing your life to your past. I remember one specific day in early  fall, sitting in a cafe in Munich.

My hair was coming back and my sense  of taste had finally fully returned. Feeling the sun while having the most  delicious croissant and cappuccino of   my life, waiting for a close friend to join me.

A sensation of immense gratitude filled my  body and has remained with me ever since. I’m not grateful for having had cancer. Not even a little.

But I’m grateful for how it  changed my outlook on life.  For me the best way to process this extreme   emotional whiplash was to  learn more about my body.

This is why kurzgesagt is  obsessed with disease videos,   why I wrote a book about the immune system. To make disease and medicine less mysterious.

To learn how we are inching relentlessly towards a  world where we will be able to cure all diseases. Cisplatin did cure me – it would  have been nice if it could have   done so without kicking me in the face repeatedly.

But oh well. It did save my life. This strange, wonderful, horrible substance.

Thanks Cisplatin! I hope we never meet again. kurzgesagt isn’t just a YouTube channel.

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