Limited Differences Between Standard, Rapid Infusion Rates for Oxaliplatin Administration

In a retrospective, single-center, observational cohort study, researchers found no differences in most safety outcomes between standard vs rapid infusion rates for the chemotherapy medication, oxaliplatin.

Oxaliplatin is one part of a drug combination that includes leucovorin calcium (folinic acid) and fluorouracil (a combination known as FOLFOX). This drug combination treats patients with advanced cancers, including colon cancer. Although this platinum-based chemotherapy is used to treat advanced cancers, oxaliplatin is associated with adverse drug effects (ADEs), including peripheral sensory neuropathy (PN).

According to the National Comprehensive Cancer Network guidelines, an 85 mg/m2 dose of oxaliplatin used in FOLFOX may be infused over 85 minutes (rapid infusion) instead of 120 minutes (standard infusion).

In December 2019, the University of New Mexico Comprehensive Cancer Center (UNMCCC) started administering oxaliplatin over 90 minutes in FOLFOX and two other drug combination regimens: folinic acid, fluorouracil (5FU), oxaliplatin, and irinotecan (FOLFOXIRI) and folinic acid, fluorouracil, irinotecan hydrochloride, and oxaliplatin (FOLFIRINOX).

The objective of the current study, one which the authors believe has not been done before, was to evaluate the safety outcomes of oxaliplatin in patients receiving the chemotherapy medication at UNMCC. The primary outcomes evaluated were hypersensitivity reaction (HSR) and dose-delay, dose-reduction, or discontinuation of oxaliplatin due to ADE. Secondary outcomes included PN, myelosuppression, and oxaliplatin-related emergency department and/or hospital admission.

The authors included 178 adult patients who received oxaliplatin chemotherapy as part of a FOLFOX, FOLFOXIRI or FOLRINOX regimen from January 1, 2018 through June 30, 2021. The patients were divided into two cohorts: rapid (n = 90) and standard (n = 88) oxaliplatin infusion rate groups. The baseline characteristics were similar between both groups.

After comparing treatment interventions and ADEs in patients who received oxaliplatin at the standard infusion rate vs those who received the rapid rate, researchers found no differences in HSR, dose-delay, dose-reduction, or discontinuation of oxaliplatin due to ADE between the two groups. However, PN occurred in 72.2% of patients in the rapid infusion rate group compared with 42.0% of patients in the standard infusion rate group (relative risk = 2.09; 95% CI; 1.43-3.04, P < .001). But beyond PN, there were no differences in any other ADEs.

“Although the rapid infusion rate of oxaliplatin saved thirty-minutes of administration time and was not associated with treatment modifications or difference in HSR, there was an increase in risk of PN,” the authors concluded. “Given the lack of available data, thorough evaluation of each patient's risks for PN along with shared-decision making remain paramount when determining oxaliplatin administration rate.”