Although oxaliplatin is one of the main anticancer agents used against colorectal cancer, data on the pharmacokinetics of oxaliplatin in patients on hemodialysis are limited. In this case study, we evaluated the pharmacokinetics and safety of oxaliplatin in a patient on hemodialysis treated for colon cancer.
A 68-year-old Japanese woman receiving chronic hemodialysis was treated for metastatic colon cancer with modified FOLFOX6 plus bevacizumab every 2 weeks. Initial oxaliplatin dose was reduced to 42.5 mg/m2, which was 50% of the standard dose. 4-hour hemodialysis was begun 1.5 hours after the end of oxaliplatin infusion. Serial plasma concentrations of total and free platinum were measured before and until the first 48 hours after oxaliplatin infusion. Adverse events were evaluated using Common Terminology Criteria for Adverse Events version 4.0.
The pharmacokinetics of free platinum showed a bimodal pattern. Maximum concentrations were 0.73, 0.80, and 1.03 μg/mL after a dose of 42.5, 42.5, and 50 mg/m2 oxaliplatin, respectively. The area under the curve in the first cycle was 14.2 μg*h/mL. No clinically meaningful accumulation of free platinum was seen. No new safety signals were identified, and no Grade 2-4 adverse events were observed.
These pharmacokinetics data for oxaliplatin in a hemodialysis patient were comparable with those in patients with normal renal function. Modified FOLFOX6 plus bevacizumab every 2 weeks could be safely given in a hemodialytic colon cancer patient with a reduction in oxaliplatin dose to 50 mg/m2, if hemodialysis was performed 1.5 hours after the end of oxaliplatin infusion.