P2-34-4 - The Feasibility of Folfox Therapy on Non-Hemodialysis Days for Hemodialysis Patients with Colorectal Cancer

Abstract

Background: In almost all past reports on FOLFOX therapy for hemodialysis (HD) patients with colorectal cancer (CRC), HD was begun two hours after oxaliplatin (L-OHP) infusion was started. The suitability of FOLFOX on HD days has little scientific basis because 95% of L-OHP combines with red blood cells or albumin within 30 minutes of L-OHP administration, and only 5% of free platinum (fPt) can be dialyzed. This study examined the feasibility of FOLFOX on non-HD days (non-HD-FOLFOX) for greater convenience and lower patient burden.Methods: The first FOLFOX cycle was begun two hours before HD as in previous cases (L-OHP 65 mg/m2) and safety was checked. After first-cycle validation, non-HD-FOLFOX (L-OHP 50 mg/m2, bolus 5-FU 300 mg/m2, continuous 5-FU 2,000 mg/m2) was begun 24 hours after L-OHP infusion finished from the second cycle. During the first two cycles, adverse events and serum/urine Pt levels at the baseline, the HD start/middle/end points, and 24/48 hours after HD was finished were recorded.Results: Patient 1 underwent FOLFOX in the adjuvant setting, while Patient 2 underwent FOLFOX plus bevacizumab for unresectable CRC. No severe adverse events arose in either case except a second-cycle grade-3 neutropenia (Patient 1). Cmax for fPt was 300/500 ng/mL (first/second cycle) for Patient 1 and 600/400 ng/mL for Patient 2. AUC 0-50hr (µg/mL/h) for fPt was 10.61/13.9 µg/mL/h (first/second cycle) for Patient 1 and 21.35/7.53 µg/mL/h for Patient 2. Patient 1 completed FOLFOX without recurrence. In Patient 2, tumor shrinkage and surgical resectability of metastasis were observed, which opened up the possibility of curative resection.Conclusions: An anti-tumor effect was seen in both cases with no remarkable rise in the serum concentration of fPt or any severe adverse events except a case of grade-3 neutropenia. Although these results may appear promising for non-HD-FOLFOX in HD patients with CRC, further investigation is needed to fully evaluate feasibility.