Drug type
• An antineoplastic agent containing platinum
Indications
• Lymph node positive colorectal carcinoma
• Metastatic colorectal cancer
— Used in combination therapy with leucovorin and fluorouracil in patients with stage III cancer of the colon who have undergone primary tumor resection
— Used in combination with leucovorin and fluorouracil for advanced cancer of the colon and rectum
Unlabeled uses
• Refractory malignant tumor of testis
• GI carcinomas: pancreatic carcinoma, esophageal cancer, hepatobiliary cancer
• Non-Hodgkin lymphoma
• Ovarian cancer
Mechanism of action
• Cycle-phase nonspecific
• Binds to DNA forming cross-links, which inhibit DNA replication and transcription
• Synergistic antiproliferative activity of oxaliplatin and fluorouracil exhibited in vitro and in vivo
Dosage and administration
• Oxaliplatin is administered IV.
• Should only be given in dextrose-containing solutions, incompatible with normal saline
• Care should be taken to avoid extravasation of the drug
• Adult dose
— 147.05 mg/1.73 m2 to 236.145 mg/1.73 m2
• Pediatric dose
— 213.655 mg/1.73 m2 to 236.145 mg/1.73 m2
— Efficacy not established for patients <18 years
Pregnancy and lactation
• Pregnancy category D
— Oxaliplatin may cause fetal harm when administered to a pregnant woman.
• Lactation
— Absolute contraindication
Cautions and adverse effects
• Precaution: neuropathy
— Acute or persistent peripheral neuropathy consistently associated with oxaliplatin treatment
• Acute neuropathy is reversible and symptoms may be exacerbated by cold
• Adverse effects
— Most frequent: Abdominal pain with cramps, anemia, anorexia, arthralgia, back pain, chest pain, chills, constipation, cough, dehydration, diarrhea, dizziness, dyspepsia, dyspnea, edema, fatigue, fever, headache disorder, injection site sequelae, insomnia, nausea, neuropathy, neutropenic disorder, palmar-plantar erythrodysesthesia, paresthesia, rhinitis, stomatitis, thrombocytopenic disorder, thromboembolic disorder, upper respiratory infection, vomiting
— Less frequent: Allergic reactions, alopecia, anxiety, depression, dysgeusia, dysuria, epistaxis, eye tearing, flatulence, flushing, gastroesophageal reflux, hiccups, hyperglycemia, hyperhidrosis, hypoalbuminemia, hypocalcemia, hypokalemia, hyponatremia, peripheral edema, pharyngitis, pulmonary fibrosis, skin rash
— Rare: Acute pancreatitis, anaphylaxis, angioedema, dysarthria, GI obstruction, granulocytopenic disorder, hearing loss, hemolytic uremic syndrome, hypersensitivity drug reactions, hyporeflexia, hypotension, ileus, increased urinary frequency, leukopenia, Lhermitte sign, metabolic acidosis, muscle weakness, optic neuritis, reduced visual acuity, renal disease, severe diarrhea, twitching, vision loss, visual field defect
Drug interactions
• Anticoagulants
— Prolongation of prothrombin time (PT) and international normalized ratio (INR) sometimes associated with hemorrhage reported in patients treated with oxaliplatin/fluorouracil/leucovorin concomitantly with oral anticoagulant therapy
• Antibiotic: nalidixic acid
• Immunotherapy: live vaccines, immunosuppressives, immunomodulators, and natalizumab (Tysabri)
What to tell your patient
• You have been prescribed oxaliplatin, which is an anti-cancer (antineoplastic or cytotoxic) chemotherapy drug.
• Oxaliplatin is given as an infusion through a vein (intravenously or IV).
• The dose you receive depends on many factors, including your height and weight, your general health, your other health problems, and the type of cancer that you have. Your doctor will determine the dose and schedule.