Infusions of calcium and magnesium can reduce numbness and tingling caused by oxaliplatin without affecting survival, according to a recent study in the Netherlands. But the infusions didn’t affect treatment success.
Most colorectal cancer patients being treated with oxaliplatin chemotherapy experience some sensory peripheral neuropathy that may vary from mild tingling in their hands and feet to pain and difficulty walking. Although peripheral neuropathy usually gets better within a few months after treatment ends, it can last years for some patients.
Sometimes patients need to stop oxaliplatin treatments before they get full advantage from them because of this troublesome side effect.
Researchers evaluated how infusions of calcium and magnesium during oxaliplatin chemotherapy affected patients enrolled in a randomized clinical trial (CAIRO 2) that tested adding Erbitux to a combination of CAPOX (Xeloda® and oxaliplatin) and Avastin. Patients were not randomized to get calcium/magnesium (Ca/Mg) infusions, but about 3 out of 4 got at least one infusion during their first treatment cycle.
Impact on Peripheral Neurotoxicity
- All grades of neurotoxicity were 85 percent in the group of patients that got Ca/Mg infusions versus 92 percent in those who didn’t.
- Grades 2 or greater neurotoxicity occurred in 40 percent of patients receiving Ca/Mg versus 45 percent of those who didn’t.
Impact on Treatment Efficacy
- Tumors shrank (response rate) in 43 percent of those getting Ca/Mg compared to 50 percent of those who didn’t.
- Median time before cancer got worse (progression-free survival) was 10.1 months in the Ca/Mg group and 10.7 months in those without it.
- Median time until death was 10.1 months in the Ca/Mg group and 10.7 months in the group that didn’t receive the protective treatment.
Nikki Knijn from Nijmegen Medical Centre in the Netherlands and her team concluded,
In this largest retrospective analysis to date we observed that Ca/Mg infusions significantly reduced all grade oxaliplatin-related neurotoxicity. Ca/Mg infusions did not affect the clinical efficacy of treatment.
What This Means for Patients
There has been concern that calcium and magnesium infusions, while helpful in reducing neuropathy during oxaliplatin (FOLFOX) chemotherapy, might reduce the effectiveness of treatment.
In June of 2007, we reported the closure of a clinical trial testing the effectiveness of Ca/Mg infusions when it appeared that they make treatment less effective. However, further analysis at ASCO in 2008 didn’t find this connection to be true.
The new study from the Netherlands appears to confirm the facts that Ca/Mg does reduce peripheral neuropathy and does not impact survival — either in the time before cancer gets worse or in overall survival time.
Patients receiving oxaliplatin should talk to their doctors about Ca/Mg infusions.