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The Feasibility of Folfox Therapy on Non-Hemodialysis Days for Hemodialysis Patients with Colorectal Cancer
Annals of Oncology 25 (Supplement 5): v75–v109, 2014 doi:10.1093/annonc/mdu436.119
Poster Session (Poster presentations categorized by each organ) P2
34
4
THE FEASIBILITY OF FOLFOX THERAPY ON NON-HEMODIALYSIS DAYS FOR HEMODIALYSIS PATIENTS WITH COLORECTAL CANCER
Taichi Murai, Michio Nakamura, Taku Shigesawa, Yuta Koike, Yomo Fujita, Ayana Endo, Yuji Ono, Toshihiko Kudo, Atsushi Nagasaka, Shuji Nishikawa Department of Gastroenterology, Sapporo City General Hospital
abstracts
Background: In almost all past reports on FOLFOX therapy for hemodialysis (HD) patients with colorectal cancer (CRC), HD was begun two hours after oxaliplatin (L-OHP) infusion was started. The suitability of FOLFOX on HD days has little scientific basis because 95% of L-OHP combines with red blood cells or albumin within 30 minutes of L-OHP administration, and only 5% of free platinum (fPt) can be dialyzed. This study examined the feasibility of FOLFOX on non-HD days (non-HD-FOLFOX) for greater convenience and lower patient burden.
Methods: The first FOLFOX cycle was begun two hours before HD as in previous cases (L-OHP 65 mg/m2) and safety was checked. After first-cycle validation, non-HD-FOLFOX (L-OHP 50 mg/m2, bolus 5-FU 300 mg/m2, continuous 5-FU 2,000 mg/m2) was begun 24 hours after L-OHP infusion finished from the second cycle. During the first two cycles, adverse events and serum/urine Pt levels at the baseline, the HD start/middle/end points, and 24/48 hours after HD was finished were recorded. Results: Patient 1 underwent FOLFOX in the adjuvant setting, while Patient 2 underwent FOLFOX plus bevacizumab for unresectable CRC. No severe adverse events arose in either case except a second-cycle grade-3 neutropenia (Patient 1). Cmax for fPt was 300/500 ng/mL (first/second cycle) for Patient 1 and 600/400 ng/mL for Patient 2. AUC 0-50hr (µg/mL/h) for fPt was 10.61/13.9 µg/mL/h (first/second cycle) for Patient 1 and 21.35/7.53 µg/mL/h for Patient 2. Patient 1 completed FOLFOX without recurrence. In Patient 2, tumor shrinkage and surgical resectability of metastasis were observed, which opened up the possibility of curative resection. Conclusions: An anti-tumor effect was seen in both cases with no remarkable rise in the serum concentration of fPt or any severe adverse events except a case of grade-3 neutropenia. Although these results may appear promising for non-HD-FOLFOX in HD patients with CRC, further investigation is needed to fully evaluate feasibility.
© The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: [email protected]. Downloaded from https://academic.oup.com/annonc/article-abstract/25/suppl_5/v101/2240379 by guest on 12 August 2018
Poster Session (Poster presentations categorized by each organ) P2
34
4
THE FEASIBILITY OF FOLFOX THERAPY ON NON-HEMODIALYSIS DAYS FOR HEMODIALYSIS PATIENTS WITH COLORECTAL CANCER
Taichi Murai, Michio Nakamura, Taku Shigesawa, Yuta Koike, Yomo Fujita, Ayana Endo, Yuji Ono, Toshihiko Kudo, Atsushi Nagasaka, Shuji Nishikawa Department of Gastroenterology, Sapporo City General Hospital
abstracts
Background: In almost all past reports on FOLFOX therapy for hemodialysis (HD) patients with colorectal cancer (CRC), HD was begun two hours after oxaliplatin (L-OHP) infusion was started. The suitability of FOLFOX on HD days has little scientific basis because 95% of L-OHP combines with red blood cells or albumin within 30 minutes of L-OHP administration, and only 5% of free platinum (fPt) can be dialyzed. This study examined the feasibility of FOLFOX on non-HD days (non-HD-FOLFOX) for greater convenience and lower patient burden.
Methods: The first FOLFOX cycle was begun two hours before HD as in previous cases (L-OHP 65 mg/m2) and safety was checked. After first-cycle validation, non-HD-FOLFOX (L-OHP 50 mg/m2, bolus 5-FU 300 mg/m2, continuous 5-FU 2,000 mg/m2) was begun 24 hours after L-OHP infusion finished from the second cycle. During the first two cycles, adverse events and serum/urine Pt levels at the baseline, the HD start/middle/end points, and 24/48 hours after HD was finished were recorded. Results: Patient 1 underwent FOLFOX in the adjuvant setting, while Patient 2 underwent FOLFOX plus bevacizumab for unresectable CRC. No severe adverse events arose in either case except a second-cycle grade-3 neutropenia (Patient 1). Cmax for fPt was 300/500 ng/mL (first/second cycle) for Patient 1 and 600/400 ng/mL for Patient 2. AUC 0-50hr (µg/mL/h) for fPt was 10.61/13.9 µg/mL/h (first/second cycle) for Patient 1 and 21.35/7.53 µg/mL/h for Patient 2. Patient 1 completed FOLFOX without recurrence. In Patient 2, tumor shrinkage and surgical resectability of metastasis were observed, which opened up the possibility of curative resection. Conclusions: An anti-tumor effect was seen in both cases with no remarkable rise in the serum concentration of fPt or any severe adverse events except a case of grade-3 neutropenia. Although these results may appear promising for non-HD-FOLFOX in HD patients with CRC, further investigation is needed to fully evaluate feasibility.
© The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: [email protected]. Downloaded from https://academic.oup.com/annonc/article-abstract/25/suppl_5/v101/2240379 by guest on 12 August 2018