Presenters: Nick Crozier, PharmD, BCOP, BCPS, MBA, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM; Thao Huynh, PharmD, University of New Mexico Hospital, Albuquerque, NM
BACKGROUND: Oxaliplatin is an important part of chemotherapy regimens for colon cancer, but it is associated with significant adverse drug events (ADEs). The National Comprehensive Cancer Network guidelines state that the oxaliplatin dose of 85 mg/m2 used in FOLFOX may be infused over 85 minutes instead of the standard time of 120 minutes to reduce chair time. To our knowledge, the safety of the rapid-rate infusion has not been fully evaluated. In December 2019, the University of New Mexico Comprehensive Cancer Center (UNMCCC) transitioned to the rapid infusion of oxaliplatin and began administering oxaliplatin over 90 minutes in FOLFOX, FOLFOXIRI, and FOLFIRINOX regimens.
OBJECTIVE: To evaluate the safety outcomes of the rapid administration of oxaliplatin by comparing treatment interventions and ADEs in patients who received oxaliplatin at the standard-rate infusion versus those who received the rapid-rate infusion.
METHOD: We performed a retrospective, single-center, observational cohort study at the UNMCCC by chart review. Eligibility included adult patients who received oxaliplatin chemotherapy as part of a FOLFOX, FOLFOXIRI, or FOLFIRINOX regimen from January 1, 2018, through June 30, 2021. Patients who were administered other oxaliplatin-containing regimens or who had a prolonged oxaliplatin infusion rate were excluded. The primary outcomes included the incidence of hypersensitivity reaction (HSR) and dose delay, dose reduction, or discontinuation of oxaliplatin because of an ADE. The secondary outcomes included peripheral neuropathy (PN), myelosuppression, and an oxaliplatin-related emergency department visit and/or hospital admission. Research Electronic Data Capture was used for the data collection of the patients’ demographics and clinical characteristics, including cancer type and stage, comorbid conditions, medication list, oxaliplatin regimen, infusion rate, oxaliplatin treatment interventions, end-organ function, and ADEs. Statistics were analyzed using SPSS version 126.96.36.199 software.
RESULTS: A total of 178 patients were included. The baseline characteristics were similar between the rapid-rate infusion (N = 90) and standard-rate infusion (N = 88) groups. Compared with standard-rate infusion, rapid-rate infusion showed no difference in HSR, dose delay, dose reduction, or the discontinuation of oxaliplatin as a result of ADEs. PN occurred in 72.2% and 42% of patients in the rapid-rate and standard-rate infusion groups, respectively (relative risk for PN, 2.09; 95% confidence interval, 1.43-3.04; P <.001), but there were no differences in any other ADE measured.
CONCLUSION: Although the rapid infusion of oxaliplatin saved 30 minutes of administration time and was not associated with treatment modifications or a difference in HSR, there was an increase in the risk for PN. Given the lack of available data, the thorough evaluation of each patient’s risks for PN along with shared decision-making remain paramount when determining the administration rate for oxaliplatin.
Supported by funding from the University of New Mexico Comprehensive Cancer Center.
Previously presented, in part, at Vizient resident poster session, December 2021, and Western States, May 2022.
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Colon Cancer. Version 1.2022. May 1, 2022. www.nccn.org/professionals/physician_gls/pdf/colon.pdf. Accessed September 13, 2022.
- Cercek A, Park V, Yaeger R, et al. Faster FOLFOX: oxaliplatin can be safely infused at a rate of 1 mg/m2/min. J Oncol Pract. 2016;12:e548-e553.