Dexamethasone as a means for controlling vascular pain caused by the administration of oxaliplatin via the peripheral vein and also for controlling oxaliplatin-induced hypersensitivity reactions.

Abstract

662 Background: With the recent development of XELOX therapy involving oral administration of drug preparations, etc., implantation of a CV port can be now avoided. However, vascular pain (pain in the peripheral veins) occasionally requires switching of the drip infusion route during XELOX therapy. Some investigators reported that addition of steroids to oxaliplatin drip infusion is useful in controlling vascular pain. However, the pharmacological use of steroids can make oxaliplatin unstable due to the elevation of pH; further, the effectiveness of oxaliplatin in this therapy is unknown because of lack of published data. This study was undertaken to evaluate the effectiveness of dexamethasone (DEX) in infusion solution containing oxaliplatin for controlling vascular pain caused by the administration of oxaliplatin via the peripheral vein. Methods: The study included 47 patients (33 males and 14 females; median age, 64) who received XELOX + bevacizumab for metastatic colorectal cancer without implantation of a CV port. In all the patients, oxaliplatin (130 mg/m2) was administered in combination with DEX (6.6 mg) via the peripheral vein. Results: Vascular pain developed in 34 patients (72.3%), but it was transient. In only 1 of the 34 patients, the drip infusion route had to be switched to the opposite side because of vascular pain. No patients required CV port implantation. Grade 3 or higher hemotoxicity was noted in 14.9% of the patients, and grade 3 or higher nonhematological toxicity was noted in 21.2% of the patients. The response rate was 61.7%. Among 47 patients, no patients experienced hypersensitivity reactions to oxaliplatin. Conclusions: Addition of DEX to oxaliplatin drip infusion controlled vascular pain caused by the administration of oxaliplatin via the peripheral vein. The response rate to this therapy combined with the use of DEX suggests that DEX probably does not exert adverse effects on the therapy, ie, it does not affect the stability of oxaliplatin by elevating the pH. Furthermore, coinfusion of DEX to oxaliplatin may be a useful preventive method for oxaliplatin-induced hypersensitivity.