Dosing oxaliplatin in a haemodialysis patient with metastatic rectum cancer monitored by free platinum concentrations

Laar, I. R.F. van Berlo – van de; Brummelhuis, W. J.; Imholz, Alexander L.T.; Schellens, Jan H.M.; Huitema, Alwin D. R.; Jansman, Frank G A

doi:10.1111/jcpt.12661

Cited by 7 publications

(9 citation statements)

References 8 publications

(35 reference statements)

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“…Table 1 lists the published cases involving FOLFOX therapy for colorectal cancer in patients receiving chronic hemodialysis [4, 5, 6, 7, 8, 9, 10, 11, 12, 13]. In all listed cases, the L-OHP dose was reduced to 50–80% of the standard dose (85 mg/m 2 ) and in most, hemodialysis was initiated immediately after L-OHP infusion.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Modified FOLFOX-6 Plus Bevacizumab Chemotherapy for Metastatic Colorectal Cancer in Patients Receiving Hemodialysis: A Report of Three Cases and Review of the Literature

Funasaka¹,

Kanemasa²,

Shimoyama³

et al. 2019

Case Rep Oncol

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Fluorouracil plus oxaliplatin (L-OHP) (FOLFOX) plus bevacizumab (BV) therapy is commonly administered to patients with metastatic colorectal cancer. However, few reports have described L-OHP therapy in hemodialysis patients, and the efficacy and safety remain uncertain in this population. Here, we report three cases of hemodialysis patients with colorectal cancer who received a modified FOLFOX-6 (mFOLFOX-6, or FOLFOX plus folinic acid) plus BV regimen every 3 weeks. One patient, a 65-year-old man with chronic renal failure consequent to diabetic nephropathy, underwent hemodialysis 3 times/week. He exhibited a partial response after 7 cycles of mFOLFOX-6 plus BV, with the major adverse events of Grade 1 peripheral neuropathy and Grade 2 thrombocytopenia. He died of perforation-related septic shock. A 71-year-old man previously treated with bosutinib for chronic myelocytic leukemia received 9 cycles of mFOLFOX-6 plus BV and achieved stable disease. Chemotherapy was administered every 4 weeks, and the 5-fluorouracil dose was reduced after he developed Grade 4 neutropenia. A 71-year-old woman with chronic renal failure consequent to diabetic nephropathy underwent hemodialysis 3 times a week. She received 3 cycles of mFOLFOX-6 plus BV, but exhibited disease progression and developed Grade 4 neutropenia, which necessitated a reduced 5-fluorouracil dose. After completing FOLFOX therapy, she began second-line irinotecan/5-fluorouracil/leucovorin (FOLFIRI) plus BV therapy. In two cases, bone marrow suppression increased the difficulty of L-OHP dose escalation. We conclude that mFOLFOX-6 plus BV, with appropriate dose reduction, is acceptable for patients with chronic renal failure. Further data are needed to determine the adequate chemotherapy dose.

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Section: Discussion/conclusionmentioning

confidence: 99%

Modified FOLFOX-6 Plus Bevacizumab Chemotherapy for Metastatic Colorectal Cancer in Patients Receiving Hemodialysis: A Report of Three Cases and Review of the Literature

Funasaka¹,

Kanemasa²,

Shimoyama³

et al. 2019

Case Rep Oncol

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“…Oxaliplatin is a platinum drug that is mainly secreted from the kidney and, therefore, generally contraindicated in patients with severe renal impairment. Pharmacokinetic studies have revealed no accumulation of free platinum detectable in patients with hemodialysis (8). The FOLFOX regimen, which includes a dose of 70 mg/m 2 oxaliplatin, is effective and safe in colorectal cancer patients with hemodialysis (8).…”

Section: Discussionmentioning

confidence: 99%

“…Pharmacokinetic studies have revealed no accumulation of free platinum detectable in patients with hemodialysis (8). The FOLFOX regimen, which includes a dose of 70 mg/m 2 oxaliplatin, is effective and safe in colorectal cancer patients with hemodialysis (8). Based on these previous and present findings, we conclude that a half-dose of the CapeOX regimen is optimal for gastric cancer patients on hemodialysis.…”

Section: Discussionmentioning

confidence: 99%

“…We decided to administer the CapeOX regimen to our gastric cancer patients undergoing hemodialysis based on a case report of a previous CapeOX regimen [capecitabine 1,250 mg/m 2 /day (full dose: 2,000 mg/m 2 /day) from days 1 to 14 plus oxaliplatin 70 mg/m 2 (full dose: 130 mg/m 2 ) on day 1] in colorectal cancer patients undergoing hemodialysis (7). After referencing published pharmacokinetic data and case reports, we decided to commence hemodialysis 1 hour after the completion of oxaliplatin administration and to continue hemodialysis for as long as is routine (8,9).…”

Section: Case Reportsmentioning

confidence: 99%

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Treatment of Gastric and Gastroesophageal Cancer Patients with Hemodialysis by CapeOX

et al. 2019

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Two patients underwent hemodialysis. Case 1 with stage IV gastric cancer was treated with reduced doses of capecitabine (1,000 mg/m2/day, days 1 to 14) and oxaliplatin (65 mg/m2, day 1). Although grade 1 thrombocytopenia occurred in the first cycle, grade 3 thrombocytopenia developed in the second cycle because of increasing dosage. After the dosage was reduced, chemotherapy was continued safely. Case 2 with stage IA gastroesophageal cancer was treated with radiotherapy followed by chemotherapy. Treatment with the same dose of CapeOX therapy as in case 1 resulted in no severe toxicity. We conclude that a half-dose of the CapeOX regimen is safe for gastric cancer patients undergoing hemodialysis.

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“…[2] To date, only a few case reports of dosing oxaliplatin in hemodialysis patients have been published. [3][4][5][6][7] In this study, we report the case of a hemodialysis patient with metastatic colon cancer who was safely treated with FOLFOX therapy by monitoring total and free platinum concentrations in plasma.…”

Section: Introductionmentioning

confidence: 99%

Dose-escalation of oxaliplatin in hemodialysis patient treated with FOLFOX therapy

Wang¹,

Li²,

Xu³

et al. 2019

Medicine

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Rationale: Oxaliplatin is a key part of the standard treatment for colorectal cancer which is formally contraindicated in patients with severe renal dysfunction. Here, we investigated a safe and efficient dosing schedule of oxaliplatin in folinic acid, fluorouracil, and oxaliplatin (FOLFOX) regimen by monitoring total and free platinum concentrations in plasma.Patient concerns: A 47-year-old female with chronic hemodialysis was diagnosed with left-sided colon cancer and underwent colectomy. One year later, she was presented with omentum metastasis and needed further treatment.Diagnoses: The computed tomography (CT) scanning revealed multiple omental nodules. Positron emission tomography-CT (PET-CT) showed increased uptake of the nodules. Interventions:The patient was treated with FOLFOX therapy every 3 weeks. The oxaliplatin began with 50 mg/m 2 and gradually increased 85 mg/m 2 as in the standard regimen. A 4-hour dialysis was started 1 hour after the end of oxaliplatin infusion.Outcomes: The free platinum concentration time curve showed a biomodel pattern. The C max of the 1st peak we observed in our patients at the standard dose is comparable to patients with normal renal function. This patient was treated with FOLFOX for 12 courses. No apparent adverse effect was observed during the treatment.Lessons: The FOLFOX can be safely administered in hemodialysis patients on a long-term basis. Dose reduction of oxaliplatin is not necessarily needed if hemodialysis is performed soon after the infusion. Further studies are needed to distinguish between active and inactive oxaliplatin products during the 2nd peak of the free platinum concentration curve in this population.Abbreviations: CT = computed tomography, FOLFOX = folinic acid, fluorouracil, and oxaliplatin, PET-CT = positron emission tomography-computed tomography, RPM = revolutions per minute.

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Dosing oxaliplatin in a haemodialysis patient with metastatic rectum cancer monitored by free platinum concentrations

Cited by 7 publications

References 8 publications

Modified FOLFOX-6 Plus Bevacizumab Chemotherapy for Metastatic Colorectal Cancer in Patients Receiving Hemodialysis: A Report of Three Cases and Review of the Literature

Modified FOLFOX-6 Plus Bevacizumab Chemotherapy for Metastatic Colorectal Cancer in Patients Receiving Hemodialysis: A Report of Three Cases and Review of the Literature

Treatment of Gastric and Gastroesophageal Cancer Patients with Hemodialysis by CapeOX

Dose-escalation of oxaliplatin in hemodialysis patient treated with FOLFOX therapy

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