Analysis of oxaliplatin-related neurotoxicity in a medical oncology department

• Autores: I. Ormazabal Goicoechea, María del Mar Polanco Paz, P. Sanmartín Fenollera, Visitación López-Miranda González, Montserrat Pérez Encinas
• Localización: European journal of clinical pharmacy: atención farmacéutica, ISSN 2385-409X, Vol. 18, Nº. 2, 2016, págs. 82-89
• Idioma: inglés
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• Resumen

  • Background: Oxaliplatin-related neurotoxicity is the main limitation for its use in adjuvant and palliative chemotherapy. The management of such neurotoxicity presents controversy in clinical practice.

    Purpose: To assess the oxaliplatin-related neurotoxicity in combination with other chemotherapeutic agents or radiation in the Department of Medical Oncology in our hospital.

    Method: Retrospective observational study of patients treated with oxaliplatin from January 2011-January 2013. The variables evaluated were: age, sex, càncer type, oxaliplatin-related neurotoxicity and its grade, initial and final functionality measured by ECOG scale, chemotherapy regimens, oxaliplatin dose (mg/m2), number of oxaliplatin cycles, oxaliplatin dose reduction or discontinuation, prescription of preventive measures and specific treatment for neurotoxicity.

    Results: The study included 243 patients treated with oxaliplatin, causing neurotoxicity in 66.66% (162/243), being 14.81% (36/243) and 31.69% (77/243) grade 3 and 4, respectively. In patients older than 70 years, 37.02% presented neurotoxicity grade 4 (p = 0.01). Regimens with more than four cycles and those associated with 5FU presented a high percentage of grade 3 and grade 4 neurotoxcity.Of the 162 patients with neurotoxicity, performance status worsened at least in one point in 72.83% (118/162). This percentage was increased to 76.8% and 87.01% in patients with neurotoxicity grade 3 and 4, respectively (p <0.001). Because of neurotoxicity, 31.68% (77/243) of patients discontinued oxaliplatin therapy and 60.9% (148/243) reduced the dose. 10.28% (25/243) received Ca/Mg infusions to prevent the neurotoxicity, being effective in 92% (23/25) of them. Another preventive measure was the reduction of oxaliplatin infusion rate, applied in 5.34% (13/243), that was effective in all the cases. In no case specific drug therapy was prescribed to prevent or treat neurotoxicity.

    Conclusions: Oxaliplatin-related neurotoxicity worsened the performance status and was the cause of the reduction or discontinuation of chemotherapy. In the absence of additional studies, Ca/Mg infusions could decrease the incidence of oxaliplatin-related neurotoxicity