Successful Treatment with Modified FOLFOX6 and Panitumumab in a Cecal Cancer Patient Undergoing Hemodialysis

Abstract

Combination chemotherapy of mFOLFOX6 (5-fluorouracil, leucovorin, and oxaliplatin) plus panitumumab, a fully human monoclonal antibody against epidermal growth factor receptor (EGFR), is one of the standard treatments for metastatic colorectal cancer (mCRC) without KRAS mutation. A few reports suggested no need of dose adjustment of cetuximab, a similar chimeric anti-EGFR antibody, in patients with renal impairment. However, panitumumab combined with cytotoxic drugs for hemodialysis patients has not been reported. We herein report a case of a hemodialysis mCRC patient successfully treated with mFOLFOX6 and panitumumab combination therapy.

Pharmacokinetics and safety of panitumumab in a patient with chronic kidney disease

“…The most recent summary of product characteristics (SmPc) of panitumumab states that a population pharmacokinetic analysis (among race, age, gender, hepatic function, concomitant chemotherapy and EGFR membrane-staining intensity in tumor cells) renal function does not influence the pharmacokinetics of panitumumab, however, it is not tested in patients. The only available clinical information concerns a case report showing safety and efficacy of panitumumab (combined with oxaliplatin, folic acid and 5-FU) in a hemodialysis patient [ 3 ]. However, to our knowledge, this is the first case study showing actual pharmacokinetic parameters in a patient with chronic kidney injury without dialysis (CKD).…”

Treatment of Gastric and Gastroesophageal Cancer Patients with Hemodialysis by CapeOX

“…To select the optimum regimen and drug doses for our gastric cancer patients, we searched the literature, as these drugs are secreted by the kidney, and severe adverse events reportedly occur in patients with renal impairment. Among the standard regimens, CapeOX and FOLFOX had been reported useful in colorectal cancer patients receiving hemodialysis, but their efficacy and safety in gastric cancer patients was not mentioned (7,14). The FOLFOX regimen is generally used in colorectal cancer patients with hemodialysis but requires the placement of a central vein catheter.…”

Patient considerations in metastatic colorectal cancer – role of panitumumab

“…As with other mAbs and endogenous immunoglobulins, panitumumab, in addition to EGFR degradation, is eliminated by the reticuloendothelial system; therefore, organ dysfunction administration barriers are unlikely. Case reports have shown successful use in patients undergoing intermittent hemodialysis with panitumumab and in liver dysfunction 18–20. No information on use in human pregnancy is available, and given the mechanism of action of EGFR therapy, this would not be advised.…”