Management of acute oxaliplatin-related peripheral sensory neuropathy with magnesium and calcium

Abstract

3715 Background: Oxaliplatin is an effective anticancer agent in the treatment of colorectal cancer. However, it is associated with chronic peripheral sensory neuropathy, an often dose-limiting side effect, which occurs after 4–6 cycles of chemotherapy. Furthermore, an acute, cold-induced syndrome with dysesthesia and sometimes myoclonia occurs in most patients (85–95%) which is reversible but possibly very painful. Recent data showed that magnesium- and calcium-infusions (mg/ca-) before oxaliplatin reduce the acute neuropathy1. Methods: We administered magnesiumsulfat (mg) 1.25g (= 5 mmol = 24.3mg ionised Mg) and calciumgluconat (ca) 1.375g (= 90mg ionised Calcium) infusions (mixed in 100ml normal saline over 30 min before chemotherapy) in 11 patients with acute sensory neuropathy receiving an oxaliplatin-based chemotherapy. Results: 11 patients received 3–18 doses of oxaliplatin (median =10) preceeded by mg/ca-infusions. There were no side effects nor changes in electrolytes caused by the mg/ca-infusions. Only minimal neuropathy was reported by the patients with mg/ca-infusions. In patients with marked acute neuropathy during previous cycles, the pretreatment with mg/ca-infusions dramatically reduced the dysesthesias (e.g. during exposure to cold in the refrigerator). In one of the patients the infusion of oxaliplatin had to be interrupted because of severe acute neuropathy but could be resumed without any problems after application of a mg/ca-infusion (up to now for a total of 18 doses of oxaliplatin). However, the mg/ca-infusions do not influence the cumulative and often dose-limiting chronic neuropathy. Discussion: Our data indicate that the prophylactic treatment of acute sensory neuropathy with mg/ca-infusions is safe, inexpensive and effective. There is no change in blood electrolytes. However, this treatment does not seem to prevent the oxaliplatin-related chronic neuropathy. 1 Lainé-Cessac P et al. Acute oxaliplatin neurotoxicity dramatically improved with intravenous calcium and magnesium salts. Ileme Congrés Annuel de la Société Francaise de Pharmacologie, Nancy, France, 1998. No significant financial relationships to disclose.