Calcium gluconate and magnesium sulfate in preventing neurotoxicity in patients receiving oxaliplatin-based combination chemotherapy-capeOX

Kiladze, Ivane; Sharikadze, Nino; Esakia, Tamar

doi:10.1093/annonc/mdw370.52

Cited by 2 publications

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“…The use of intravenous calcium and magnesium has also been tested for the prevention of CIPN, 16 but there are no large prospective trials that show a substantial decrease in the occurrence of CIPN and specifically oxaliplatin-induced neurotoxicity by any of these measures. 17 The latest American Society of Clinical Oncology (ASCO) guidelines 18,19 also support this paradigm highlighting the absence of agents for neurotoxicity prevention.…”

Section: Introductionmentioning

confidence: 99%

Effect of cannabis on oxaliplatin-induced peripheral neuropathy among oncology patients: a retrospective analysis

et al. 2021

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Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and dosage-limited oxaliplatin-related toxicity. To date, there are no successful interventions for CIPN prevention or treatment. A therapeutic role for cannabis in diabetic and HIV-related peripheral neuropathy and a protective role in CIPN have been suggested. We examined the effect of cannabis on oncologic patients with CIPN. Methods: Medical records of 768 consecutive patients treated with oxaliplatin and 5-fluorouracil-based combinations at a tertiary medical center from October 2015 to January 2018 were reviewed. Excluded patients were those with pre-existing neuropathy or patients who received fewer than two cycles of oxaliplatin treatment. CIPN grade, oxaliplatin cumulative dose, and neuropathy-free survival were evaluated. The patients were divided based upon the exposure to cannabis: prior to oxaliplatin (cannabis-first), cannabis following the initiation of oxaliplatin treatment (oxaliplatin-first), and no exposure (control). Results: In total, 513 patients met the inclusion criteria, of whom 248 were treated with cannabis and 265 served as controls. The cannabis-first group included 116 (46.7%) patients and the oxaliplatin-first group included 132 (53.3%) patients. Demographic parameters were comparable between groups. There was a significant difference in CIPN grade 2–3 between cannabis-exposed patients and controls (15.3% and 27.9%, respectively, p < 0.001). The protective effect of cannabis was more pronounced among cannabis-first patients compared to oxaliplatin-first patients (75% and 46.2%, respectively, p < 0.001). The median oxaliplatin cumulative doses were higher in the cannabis-first versus the oxaliplatin-first versus the control groups (545 mg/m2, 340 mg/m2, and 425 mg/m2 respectively, p < 0.001). Conclusion: The rate of neuropathy was reduced among patients treated with cannabis and oxaliplatin. This reduction was more significant in patients who received cannabis prior to treatment with oxaliplatin, suggesting a protective effect. A large prospective trial is planned.

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Section: Introductionmentioning

confidence: 99%

Effect of cannabis on oxaliplatin-induced peripheral neuropathy among oncology patients: a retrospective analysis

et al. 2021

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“…A total of seven trials examined the effect of intravenous Ca/Mg infusions versus placebo on the prevention of OIPN (3,30,(38)(39)(40)(41)75). Of these, only Gobran et al (40) reported a statistically significant reduction in OIPN incidence using Chi-square test.…”

Section: Calcium and Magnesium (Ca/mg)mentioning

confidence: 99%

“…Six of the trials used CTCAE to assess outcome and their results were pooled in a Forest plot (Figure 3) (3,30,(38)(39)(40)(41). Ca/ Mg infusion was associated with a statistically significant reduction in the risk of CTCAE grade 2 and above neuropathy (RR, 0.74; 95% CI, 0.55-0.99).…”

Section: Calcium and Magnesium (Ca/mg)mentioning

confidence: 99%

“…In a network of seven trials (Figure S5B), six trials assessed Ca/Mg versus placebo (3,30,(38)(39)(40)(41) while one trial assessed a combination of glutamine and Ca/Mg versus Ca/Mg alone (65). The resultant RR comparing the combination of glutamine and Ca/Mg versus placebo was not statistically significant (RR, 0.76; 95% CI, 0.43-1.35) (Figure 7), and the trial by Samson et al (65) also used an open label design instead of blinding.…”

Section: Network Meta-analysismentioning

confidence: 99%

“…In another network of seven trials (Figure S5C), six trials compared Ca/Mg versus placebo (3,30,(38)(39)(40)(41) while one trial compared the combination of vitamin E and Ca/Mg versus Ca/ Mg alone (74). This combination of vitamin E and Ca/Mg was also rated "Not Recommended" since the indirect comparison showed RR of 1.98 (95% CI, 0.22-17.95) between the combination of Vitamin E and Ca/Mg against placebo (Figure 8 and Table 1).…”

Section: Network Meta-analysismentioning

confidence: 99%

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Prevention of Oxaliplatin-Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis

et al. 2022

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BackgroundOxaliplatin-induced peripheral neuropathy (OIPN) has significant clinical impact on the quality of life for cancer patients and is a dose limiting toxicity. Trials studying preventive measures have been inconclusive. A systematic review and meta-analysis were conducted to evaluate the existing pharmacological and non-pharmacological interventions to prevent chronic OIPN.MethodsLiterature databases PubMed-MEDLINE, Embase and Scopus, were searched from 1 Jan 2005 to 08 Aug 2020 and major conferences’ abstracts were reviewed for randomized controlled trials that examined the efficacy of any preventive measure for OIPN. The primary outcome measure was the incidence of chronic OIPN with a preventive intervention as compared to placebo or no intervention. The pooled risk ratio and its 95% confidence interval were calculated using a random effects model. A network meta-analysis was conducted to derive indirect evidence of any preventive effect of an intervention against placebo when original trials compared one intervention against another.ResultsForty-four trials were analyzed describing 29 chemoprotective interventions, including combinations, and 1 non-pharmacological intervention. Ratings were assessed via a combination of outcomes with quality assessment using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. Of the 30 interventions examined, there were six interventions supporting potential efficacy, 11 interventions with insufficient evidence and 13 interventions not recommended.ConclusionCurrently, there is insufficient certainty to support any intervention as effective in preventing OIPN. Of note is that most of these studies have focused on pharmacological interventions; non-pharmacological interventions are underexplored. Further research on ways to limit OIPN is needed.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=225095, Prospero Registration Number: CRD42021225095.

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Calcium gluconate and magnesium sulfate in preventing neurotoxicity in patients receiving oxaliplatin-based combination chemotherapy-capeOX

Cited by 2 publications

References 0 publications

Effect of cannabis on oxaliplatin-induced peripheral neuropathy among oncology patients: a retrospective analysis

Effect of cannabis on oxaliplatin-induced peripheral neuropathy among oncology patients: a retrospective analysis

Prevention of Oxaliplatin-Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis

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