Balancing the Benefits and Side Effects of Oxaliplatin
Although oxaliplatin has extended the survival time of patients with colorectal cancer, the drug can also mean debilitating neurological side effects for those receiving treatments. These side effects often begin with a “pins and needles” sensation in the fingers and toes. Over time, a patient’s ability to walk or even dress independently is eventually compromised.
Therefore, “Many patients don’t receive the necessary dose to try to keep their cancer in check, because their symptoms become too debilitating and their quality of life is reduced,” says Andrew Weickhardt, MD, clinical fellow at the University of Colorado Cancer Center.
In a review recently published in the Journal of Oncology, Weickhardt and colleagues recommend 2 approaches for balancing oxaliplatin’s benefits and side effects. One option is what Weickhardt calls a “stop and go” treatment. The second approach involves supplements that may ease the drug’s neurological damage. These methods can be used separately or simultaneously.
The goal of stop and go treatment is to maximize effectiveness of oxaliplatin and also minimize side effects. The patient starts oxaliplatin along with another drug and take both for 2 months. Then, treatment with oxaliplatin is suspended, while treatment with the first drug continues. Finally, oxaliplatin is reintroduced 2 months later or upon disease progression, whichever happens first.
“After about 6 to 9 months of total treatment, metastatic colorectal cancers tend to develop resistance to the drug,” says Weickhardt. “And also, no matter what we do, after this same 6 to 9 months of total treatment, neurological side effects start to rise.” Even with the stop and go treatment schedule, 1 in 20 patients experience significant nerve damage that can last for more than 6 months, Weickhardt says.
Weickhardt believes the use of simple calcium and magnesium supplements may reduce side effects, even though clinical trials involving protective drugs in combination with oxaliplatin have been small.
“An infusion of calcium and magnesium should be used as well because they’ve shown some benefit and they don’t do any harm,” Weickhardt says.
Source: University of Colorado Cancer Center.
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