Impaired Creatinine Clearance is Associated with Increased Incidence of Oxaliplatin-induced Peripheral Neuropathy

肌酸酐廓清率不佳患者於oxaliplatin治療後引發明顯周邊神經病變之機率較高

王緯書(Wei-Shu Wang) ； 林楨國(Jen-Kou Lin) ； 林資琛(Tzu-Chen Lin) ； 陳維熊(Wei-Shone Chen) ； 姜正愷(Jeng-Kae Jiang) ； 王煥昇(Huann-Sheng Wang) ； 邱宗傑(Tzeon-Jye Chiou) ； 劉俊煌(Jin-Hwang Liu) ； 顏厥全(Chueh-Chuan Yen) ； 陳博明(Po-Min Chen)

《中華民國癌症醫學會雜誌》 23卷4期 (2007/12) Pp. 71-79

https://doi.org/10.6588/JCOS.2007.23.4.1

摘要

Oxaliplatin is very effective in the treatment of metastatic colorectal cancer; however, severe neurotoxicity develops frequently that may remarkably affect patients' quality of life. To assess the influence of impaired creatinine clearance (Ccr) on oxaliplatin-induced peripheral neuropathy, a pilot study was performed. A total of 42 patients with unresectable metastatic colorectal cancer treated at Taipei Veterans General Hospital were enrolled. Oxaliplatin (85mg/m^2, day 1 and 15), plus weekly bolus 5-fluorouracil (5-FU; 500mg/m^2) and folinic acid (FA; 20mg/m^2) on day 1, 8, and 15 were given every 28 days as first-line treatment. Patients should have normal pre-treatment liver and renal functions (total bilirubin＜1.5mg/dl and creatinine＜1.5mg/dl). Patients were divided into Ccr-impaired (60-80ml/min) and Ccr-fair (＞80ml/min) groups according to 24-hour urinary Ccr levels. Twelve (28.6%) patients have an impaired Ccr (60-80ml/min) and the remainders (n=30) were Ccr-fair (＞80ml/min). A significant correlation was identified in impaired Ccr and the severity of neurological symptoms (P=0.02), including 5 out of 12 (41.7%) patients with impaired Ccr accompanied by severe (grade 3 or 4) neuropathy, and 27 out of 30 (90%) patients with fair Ccr without developing severe neurological symptoms. However, there remained 3 patients with a fair Ccr who developed severe (grade 3 or 4) neuropathies, and 7 patients who showed an impaired Ccr without or with only mild neurological symptoms. No grade 3 or 4 non-neurological toxicity was seen in both groups of patients. We conclude that oxaliplatin at 85mg/m^2 every 2 weeks is well tolerated by patients with renal dysfunction. Ccr correlates well with the severity of neurological symptoms that may serve as a useful tool in predicting the severity of oxaliplatin-induced neuropathy.

關鍵字

大腸直腸癌 ； 肌酸酐廓清率 ； 神經病變 ； oxaliplatin

並列摘要

Oxaliplatin is very effective in the treatment of metastatic colorectal cancer; however, severe neurotoxicity develops frequently that may remarkably affect patients' quality of life. To assess the influence of impaired creatinine clearance (Ccr) on oxaliplatin-induced peripheral neuropathy, a pilot study was performed. A total of 42 patients with unresectable metastatic colorectal cancer treated at Taipei Veterans General Hospital were enrolled. Oxaliplatin (85mg/m^2, day 1 and 15), plus weekly bolus 5-fluorouracil (5-FU; 500mg/m^2) and folinic acid (FA; 20mg/m^2) on day 1, 8, and 15 were given every 28 days as first-line treatment. Patients should have normal pre-treatment liver and renal functions (total bilirubin＜1.5mg/dl and creatinine＜1.5mg/dl). Patients were divided into Ccr-impaired (60-80ml/min) and Ccr-fair (＞80ml/min) groups according to 24-hour urinary Ccr levels. Twelve (28.6%) patients have an impaired Ccr (60-80ml/min) and the remainders (n=30) were Ccr-fair (＞80ml/min). A significant correlation was identified in impaired Ccr and the severity of neurological symptoms (P=0.02), including 5 out of 12 (41.7%) patients with impaired Ccr accompanied by severe (grade 3 or 4) neuropathy, and 27 out of 30 (90%) patients with fair Ccr without developing severe neurological symptoms. However, there remained 3 patients with a fair Ccr who developed severe (grade 3 or 4) neuropathies, and 7 patients who showed an impaired Ccr without or with only mild neurological symptoms. No grade 3 or 4 non-neurological toxicity was seen in both groups of patients. We conclude that oxaliplatin at 85mg/m^2 every 2 weeks is well tolerated by patients with renal dysfunction. Ccr correlates well with the severity of neurological symptoms that may serve as a useful tool in predicting the severity of oxaliplatin-induced neuropathy.

並列關鍵字

colorectal carcinoma ； creatinine clearance ； neuropathy ； oxaliplatin