Background Oxaliplatin is an effective medicine for adjuvant or metastatic treatment of patients with colorectal cancer (CRC). Common side-effects include acute cold-induced as well as chronic neurotoxicity resulting in dose reduction or even complete oxaliplatin discontinuation and treatment modification. For patients receiving high cumulative doses of oxaliplatin (780 to 850 mg/m2), the incidence of grade 2 or 3 neurotoxicity has been shown to be 12% to 18%.1
Purpose The aim of our study was to investigate both the incidence and significance of neurotoxicity in patients receiving cumulative oxaliplatin doses of 1000 mg/m2 or higher. We could then determine whether the pre-emptive intervention of a clinical pharmacist is justified.
Material and methods In the period from January 2016 to July 2017, 484 patients diagnosed with CRC received oxaliplatin as part of their treatment regimen. Among them, 40 patients who had received cumulative doses of 1000 mg/m2 or more were selected for evaluation of neurotoxicity symptoms based on their clinical records. An oxaliplatin-specific scale (NCI-CTC 2.0) was used to assess the level of neurotoxicity.2
Results Symptoms presented as moderate paraesthaesia (grade 1) occurred in 11 patients (28%), while six patients (15%) reported mild or moderate objective sensory loss (grade 2). Dose-limiting neurotoxicity (grade 2 and 3) was observed in nine patients (22.5%) with a complete oxaliplatin discontinuation being required in three patients (7.5%) due to sensory loss, polyneuropathy and pain (grade 3). Eleven patients (27.5%) remained asymptomatic according to the NCI-CTC scale.
Conclusion The results of our study are in agreement with published data. Based on the findings that over one-fifth of patients receiving high cumulative doses of oxaliplatin experience significant neurotoxicity, a clinical pharmacist’s intervention in the form of a consultation with the physician is thereby warranted in order to re-evaluate the benefit of chemotherapy treatment versus the impact on a patient’s quality of life.
References and/or Acknowledgements 1. de Gramont A, Figer A, Seymour M, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol2000;18:2938–2947.
2. Greothey A. Oxaxliplatin-safety profile: neurotoxicity. Seminars in OncologyAugust 2003;30(No. 4, Suppl. 15):5–13.
No conflict of interest
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