Update from 2008 ASCO Meeting in Chicago
A study presented during the American Society of Clinical Oncology meeting showed that adding IV infusions of calcium and magnesium to oxaliplatin treatment reduced peripheral neuropathy.
Eloxatin® (oxaliplatin) is part of the FOLFOX treatments for colorectal cancer. As doses accumulate, patients begin to experience tingling and numbness in their hands and feet. Some patients will find it difficult to use their hands for small tasks like buttoning or will have problems with pain, balance or walking. Often patients have to stop treatment before the full benefit is reached because of this difficult side effect.
In a study with patients who were receiving adjuvant FOLFOX treatment after surgery to prevent colon cancer recurrence, doctors randomly assigned patients to receive an intravenous infusion of calcium and magnesium before and after their oxaliplatin infusion or a placebo IV. Neither oncologist nor patient knew which treatment was being administered.
Although the clinical trial was ended early because of concerns from another study that calcium and magnesium might reduce treatment effectiveness, it was able to show that fewer patients developed grade 2 neuropathy. Two scales were used to measure neurotoxicity.
- The NCI Common Toxicity Criteria measure for neuropathy found that 22 percent of patients on calcium and magnesium developed grade 2 neurotoxicity compared to 38.5 percent who got a placebo.
- With the Oxaliplatin Specific Neurotoxicity (OSN) scale, 28 percent of patients on calcium and magnesium experienced grade 2 sensory neuropathy compared to 52 percent who didn’t receive the active intervention.
- With both scales, the time to when grade 2 sensory neuropathy began was longer when calcium and magnesium were given.
The research team, headed by Daniel A. Nikcevich, M.D. of the Mayo Clinic, pointed out using calcium and magnesium to prevent serious sensory neuropathy was inexpensive and safe. They wrote,
Despite early termination, our study demonstrates the activity of IV CaMg as neuroprotectant against oxaliplatin-induced sensory neurotoxicity in adjuvant colon cancer. If further studies refute the notion that IV CaMg decreases the efficacy of FOLFOX, IV CaMg could be regarded as a standard component of oxaliplatin-based chemotherapy.
SOURCE: Nikcevich et al., Effect of intravenous calcium and magnesium (IV CaMg) on oxaliplatin-induced sensory neurotoxicity (sNT) in adjuvant colon cancer: Results of the phase III placebo-controlled, double-blind NCCTG trial N04C7, 2008 ASCO Abstract #4009.