Oxaliplatin

Definition

Oxaliplatin is an investigational chemotherapy medicine used to treat certain types of cancer by destroying cancerous cells. Oxaliplatin is also known in other countries by its brand names Eloxatin and Transplatine. Other names for oxaliplatin include Oxalatoplatin, Oxalatoplatinum, 1-OHP or L-OHP, PR-54780.

Purpose

Oxaliplatin is not yet approved by the Food and Drug Administration in the United States. It is commercially available in Europe. Oxaliplatin has been used to treat metastatic colorectal cancer, and advanced ovarian cancer and has been tested with some results in head and neck cancers, skin cancer, lung cancer, and non-Hodgkin's lymphomas.

Description

Oxaliplatin is an analog of cisplatin, the first successful platinum-containing anticancer drug. It is one of the so-called DACH (1,2-Diamincyclohexane)-containing platinum complexes that exhibited activity in Murine L1210 leukemia tumor models possessing acquired resistance to cisplatin. These platinum-containing drugs interfere with the genetic material, or DNA, inside the cancer cells and prevent them from further dividing and growing more cancer cells.

Oxaliplatin has been used to treat cancer in clinical trials in the United States. It can be used alone to treat cancer or in combination with other chemotherapy medicines. Some of the other chemotherapy medicines that Oxaliplatin is commonly combined with include the drugs fluorouracil and calcium leucovorin and used in combination with cisplatin.

Recommended dosage

An oxaliplatin dose can be determined using a mathematical calculation that measures a person's body surface area (BSA). This number is dependent upon a patient's height and weight. The larger the person the greater the body surface area. Body surface area is measured in the units known as square meter (m²). The body surface area is calculated and then multiplied by the drug dosage in milligrams per square meter (mg/m²). This calculates the actual dose a patient is to receive.

Oxaliplatin is a clear colorless solution administered by an infusion into a vein. The infusion time period can vary. It can be given as a one-time dose every three weeks infused over 20 minutes up to six hours. There are multiple doses of oxaliplatin used in clinical trials dependent upon the type of cancer being treated. The doses have ranged from 20 mg per square meter daily for several days to 130 mg per square meter for one day every three weeks. Listed below are example dose recommendations for colorectal cancer and ovarian cancer.

To treat metastatic colorectal cancer

Oxaliplatin alone has been given at 130 mg per square meter administered into a vein for one day every three weeks. This did not have very good response rates.

Oxaliplatin is also given at a dose of 130 mg per square meter administered into a vein as a two- to six-hour infusion for one day every three weeks in combination with the chemotherapy drug fluorouracil.

To treat advanced ovarian cancer

Oxaliplatin alone has been given at 59 mg to 130 mg per square meter administered into a vein for one day as a 20-minute or two-hour infusion every three weeks.

Combination treatment of oxaliplatin at a dose of 130mg per square meter administered into a vein as a two-hour infusion every three weeks. The oxaliplatin must immediately follow a two hour-infusion of the chemotherapy drug cisplatin at a dose of 100 mg square meter every three weeks.

Precautions

When receiving the drug oxaliplatin it is important to avoid cold food and drinks.

Blood counts will be monitored regularly while on oxaliplatin therapy. During a certain time period after receiving oxaliplatin there is an increased risk of getting infections. Caution should be taken to avoid unnecessary exposure to germs.

Patients with a known previous allergic reaction to chemotherapy drugs should tell their doctor.

Patients who may be pregnant or trying to become pregnant should tell their doctor before receiving oxaliplatin.

Chemotherapy can cause men and women to be sterile or not able to have children.

Patients with existing or previous tingling or numbness in their hands and feet should tell their doctor before receiving oxaliplatin.

Patients should check with their doctors before receiving live virus vaccines while on chemotherapy.

Side effects

One of the most common side effects from receiving oxaliplatin is nausea and vomiting. Patients will be given medicines known as antiemetics before receiving oxaliplatin to help prevent or decrease this side effect. Diarrhea and mouth sores have also been known to occur. The chance of these increase if the oxaliplatin is given along with the chemotherapy drug fluorouracil.

Oxaliplatin can commonly cause damage to nerves and nervous system tissues. Patients may feel tingling, numbness, and sometimes burning of the fingers and toes. This side effect is common, can be severe, and gets worse in the cold. The patient must inform the doctor if they have any of these symptoms. In addition the patient may experience a tightness or spasm in their throat. The chance that this will happen increases if the patient is exposed to cold food or drinks while receiving oxaliplatin.

Low blood counts, referred to as myelosuppression, are expected due to oxaliplatin. The extent to which the blood counts fall due to oxaliplatin has been minimal. When the white blood cell count is low, this is called neutropenia and patients are at an increased risk of developing a fever and infections. There is a drug called Neupogen (filgrastim) that can be used to increase the white blood cell count.

Platelets are blood cells in the body that allow for the formation of clots. When the platelet count is low, patients are at an increased risk for bruising and bleeding. If the platelet count remains too low a platelet blood transfusion is an option. Low red blood cell counts, referred to as anemia, may also occur due to cisplatin administration. Low red counts make people feel tired and lacking energy. There is a drug called erythropoietin that can be used to increase the red blood cell count.

Oxaliplatin has caused severe allergic reactions known as anaphylaxis. The symptoms include difficulty breathing, drop in blood pressure, sweating, redness of the face, dizziness, headache, and a fast heart beat. This appears to be more common after several treatments with the drug oxaliplatin.

Less common side effects include hair loss (alopecia), fever, rash on hands and feet when given with fluorouracil, and fatigue. Oxaliplatin rarely causes kidney damage or hearing damage, unlike cisplatin chemotherapy.

All side effects a patient experiences should be reported to his or her doctor.

Interactions

Patients should avoid cold food and drinks while receiving oxaliplatin.

Oxaliplatin immediately followed by the chemotherapy drug irinotecan has caused overproduction of saliva and pain in the abdomen.

KEY TERMS

Anemia

A red blood cell count that is lower than normal.

Chemotherapy

Specific drugs used to treat cancer.

DNA

Genetic material inside of cells that allows for cells to function, separate into two cells and make more cells.

Food and Drug Administration

A government agency that oversees public safety in relation to drugs and medical devices. The FDA gives the approval to pharmaceutical companies for commercial marketing of their products.

Intravenous

To enter the body through a vein.

Metastatic

Cancer that has spread to one or more parts of the body.

Neutropenia

A white blood cell count that is lower than normal.