Oxaliplatin

Key Terms: Anemia, Chemotherapy, DNA, Food and Drug Administration, Intravenous, Metastatic.

Definition

Oxaliplatin is an investigational chemotherapy medicine used to treat certain types of cancer by destroying cancerous cells. Oxaliplatin is also known in other countries by its brand names Eloxatin and Transplatine. Other names for oxaliplatin include Oxalatoplatin, Oxalatoplatinum, 1-OHP or L-OHP, PR-54780.

Purpose

Oxaliplatin is not yet approved by the Food and Drug Administration in the United States. It is commercially available in Europe. Oxaliplatin has been used to treat metastatic colorectal cancer, and advanced ovarian cancer and has been tested with some results in head and neck cancers, skin cancer, lung cancer, and non-Hodgkin's lymphomas.

Description

Oxaliplatin is an analog of cisplatin, the first successful platinum-containing anticancer drug. It is one of the so-called DACH (1,2-Diamincyclohexane)-containing platinum complexes that exhibited activity in Murine L1210 leukemia tumor models possessing acquired resistance to cisplatin. These platinum-containing drugs interfere with the genetic material, or DNA, inside the cancer cells and prevent them from further dividing and growing more cancer cells.

Oxaliplatin has been used to treat cancer in clinical trials in the United States. It can be used alone to treat cancer or in combination with other chemotherapy medicines. Some of the other chemotherapy medicines that Oxaliplatin is commonly combined with include the drugs fluorouracil and calcium leucovorin and used in combination with cisplatin.

Recommended Dosage

An oxaliplatin dose can be determined using a mathematical calculation that measures a person's body surface area (BSA). This number is dependent upon a patient's height and weight. The larger the person the greater the body surface area. Body surface area is measured in the units known as square meter (m²). The body surface area is calculated and then multiplied by the drug dosage in milligrams per square meter (mg/m²). This calculates the actual dose a patient is to receive.

Oxaliplatin is a clear colorless solution administered by an infusion into a vein. The infusion time period can vary. It can be given as a one-time dose every three weeks infused over 20 minutes up to six hours. There are multiple doses of oxaliplatin used in clinical trials dependent upon the type of cancer being treated. The doses have ranged from 20 mg per square meter daily for several days to 130 mg per square meter for one day every three weeks. Listed below are example dose recommendations for colorectal cancer and ovarian cancer.

To Treat Metastatic Colorectal Cancer

Oxaliplatin alone has been given at 130 mg per square meter administered into a vein for one day every three weeks. This did not have very good response rates.

Oxaliplatin is also given at a dose of 130 mg per square meter administered into a vein as a two- to six-hour infusion for one day every three weeks in combination with the chemotherapy drug fluorouracil.

To Treat Advanced Ovarian Cancer

Oxaliplatin alone has been given at 59 mg to 130 mg per square meter administered into a vein for one day as a 20-minute or two-hour infusion every three weeks.

Combination treatment of oxaliplatin at a dose of 130mg per square meter administered into a vein as a two-hour infusion every three weeks. The oxaliplatin must immediately follow a two hour-infusion of the chemotherapy drug cisplatin at a dose of 100 mg square meter every three weeks.

Precautions

When receiving the drug oxaliplatin it is important to avoid cold food and drinks.

Blood counts will be monitored regularly while on oxaliplatin therapy. During a certain time period after receiving oxaliplatin there is an increased risk of getting infections. Caution should be taken to avoid unnecessary exposure to germs.

Patients with a known previous allergic reaction to chemotherapy drugs should tell their doctors.

Patients who may be pregnant or trying to become pregnant should tell their doctors before receiving oxaliplatin.

Chemotherapy can cause men and women to be sterile or not able to have children.

Patients with existing or previous tingling or numbness in their hands and feet should tell their doctor before receiving oxaliplatin.

Patients should check with their doctors before receiving live virus vaccines while on chemotherapy.

Side Effects

One of the most common side effects from receiving oxaliplatin is nausea and vomiting. Patients will be given medicines known as antiemetics before receiving oxaliplatin to help prevent or decrease this side effect. Diarrhea and mouth sores have also been known to occur. The chance of these increase if the oxaliplatin is given along with the chemotherapy drug fluorouracil.

Oxaliplatin can commonly cause damage to nerves and nervous system tissues. Patients may feel tingling, numbness, and sometimes burning of the fingers and toes. This side effect is common, can be severe, and gets worse in the cold. The patient must inform the doctor if any of these symptoms are present. In addition, the patient may experience a tightness or spasm in their throat. The chance that this will happen increases if the patient is exposed to cold food or drinks while receiving oxaliplatin.

Low blood counts, referred to as myelosuppression, are expected due to oxaliplatin. The extent to which the blood counts fall due to oxaliplatin has been minimal. When the white blood cell count is low, this is called neutropenia and patients are at an increased risk of developing a fever and infections. There is a drug called Neupogen (filgrastim) that can be used to increase the white blood cell count.

Platelets are blood cells in the body that allow for the formation of clots. When the platelet count is low, patients are at an increased risk for bruising and bleeding. If the platelet count remains too low a platelet blood transfusion is an option. Low red blood cell counts, referred to as anemia, may also occur due to cisplatin administration. Low red counts make people feel tired and lacking energy. There is a drug called erythropoietin that can be used to increase the red blood cell count.

Oxaliplatin has caused severe allergic reactions known as anaphylaxis. The symptoms include difficulty breathing, drop in blood pressure, sweating, redness of the face, dizziness, headache, and a fast heart beat. This appears to be more common after several treatments with the drug oxaliplatin.

Less common side effects include hair loss (alopecia), fever, rash on hands and feet when given with fluorouracil, and fatigue. Oxaliplatin rarely causes kidney damage or hearing damage, unlike cisplatin chemotherapy.

All side effects a patient experiences should be reported to his or her doctor.

Interactions

Patients should avoid cold food and drinks while receiving oxaliplatin.

Oxaliplatin immediately followed by the chemotherapy drug irinotecan has caused overproduction of saliva and pain in the abdomen.

—Nancy J. Beaulieu, RPh., BCOP

Brand names: Eloxatin™Eloxatin®

Chemical formula:

Drug Forms:
• Oxaliplatin Solution for injection (below)
• Oxaliplatin Injection

Español:
• Oxaliplatino, Solución para inyección
• Inyección de oxaliplatino

Oxaliplatin Solution for injection

What is this medicine?

OXALIPLATIN is a chemotherapy drug. It targets fast dividing cells, like cancer cells, and causes these cells to die. This medicine is used to treat cancers of the colon and rectum, and many other cancers.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:
•kidney disease
•an unusual or allergic reaction to oxaliplatin, other chemotherapy, other medicines, foods, dyes, or preservatives
•pregnant or trying to get pregnant
•breast-feeding

How should I use this medicine?

This drug is given as an infusion into a vein. It is administered in a hospital or clinic by a specially trained health care professional.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.

What may interact with this medicine?

•medicines to increase blood counts like filgrastim, pegfilgrastim, sargramostim
•probenecid
•some antibiotics like amikacin, gentamicin, neomycin, polymyxin B, streptomycin, tobramycin
•zalcitabine

Talk to your doctor or health care professional before taking any of these medicines:
•acetaminophen
•aspirin
•ibuprofen
•ketoprofen
•naproxen

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Your condition will be monitored carefully while you are receiving this medicine. You will need important blood work done while you are taking this medicine.

This medicine can make you more sensitive to cold. Do not drink cold drinks or use ice. Cover exposed skin before coming in contact with cold temperatures or cold objects. When out in cold weather wear warm clothing and cover your mouth and nose to warm the air that goes into your lungs. Tell your doctor if you get sensitive to the cold.

This drug may make you feel generally unwell. This is not uncommon, as chemotherapy can affect healthy cells as well as cancer cells. Report any side effects. Continue your course of treatment even though you feel ill unless your doctor tells you to stop.

In some cases, you may be given additional medicines to help with side effects. Follow all directions for their use.

Call your doctor or health care professional for advice if you get a fever, chills or sore throat, or other symptoms of a cold or flu. Do not treat yourself. This drug decreases your body's ability to fight infections. Try to avoid being around people who are sick.

This medicine may increase your risk to bruise or bleed. Call your doctor or health care professional if you notice any unusual bleeding.

Be careful brushing and flossing your teeth or using a toothpick because you may get an infection or bleed more easily. If you have any dental work done, tell your dentist you are receiving this medicine.

Avoid taking products that contain aspirin, acetaminophen, ibuprofen, naproxen, or ketoprofen unless instructed by your doctor. These medicines may hide a fever.

Do not become pregnant while taking this medicine. Women should inform their doctor if they wish to become pregnant or think they might be pregnant. There is a potential for serious side effects to an unborn child. Talk to your health care professional or pharmacist for more information. Do not breast-feed an infant while taking this medicine.

Call your doctor or health care professional if you get diarrhea. Do not treat yourself.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:
•allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
•low blood counts - This drug may decrease the number of white blood cells, red blood cells and platelets. You may be at increased risk for infections and bleeding.
•signs of infection - fever or chills, cough, sore throat, pain or difficulty passing urine
•signs of decreased platelets or bleeding - bruising, pinpoint red spots on the skin, black, tarry stools, nosebleeds
•signs of decreased red blood cells - unusually weak or tired, fainting spells, lightheadedness
•breathing problems
•chest pain, pressure
•cough
•diarrhea
•jaw tightness
•mouth sores
•nausea and vomiting
•pain, swelling, redness or irritation at the injection site
•pain, tingling, numbness in the hands or feet
•problems with balance, talking, walking
•redness, blistering, peeling or loosening of the skin, including inside the mouth
•trouble passing urine or change in the amount of urine

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
•changes in vision
•constipation
•hair loss
•loss of appetite
•metallic taste in the mouth or changes in taste
•stomach pain

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

This drug is given in a hospital or clinic and will not be stored at home.

Last updated: 7/1/2002

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

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