Oral Calcium Ameliorating Oxaliplatin-Induced Peripheral Neuropathy.

Abstract

Oxaliplatin has become an integral part of the standard treatment for advanced colorectal cancer. While oxaliplatin has only mild hematologic and gastrointestinal side effects, its dose-limiting toxicity is a cumulative sensory neurotoxicity. Oxaliplatin causes a unique, but frequent, acute sensory neuropathy that is triggered or aggravated by exposure to cold but is rapidly reversible, without persistent impairment of sensory function. Various strategies have been proposed to prevent or treat oxaliplatin-induced neurotoxicity. One such strategy is the "Stop-and-Go" concept, which uses the reversibility of neurologic symptoms to aim at delivering higher cumulative oxaliplatin doses, as long as the therapy is still effective and the other is the administration of neuromodulatory agents (ie, calcium-magnesium infusions, carbamazepine, gabapentin, amifostine, alpha-lipoic acid, and glutathione) that could limit the neurotoxic effects of oxaliplatin. Among all of the agents, intravenous calcium and magnesium have shown the most promise in prophylaxis and treatment of oxaliplatin-induced neurotoxicity. We report a case of a patient, in which oral calcium supplements not only were successful in treating his neurotoxicity, but we also were able to administer a cumulative dose of 2500 mg/m(2) (990 mg/m(2) with oral calcium). Although the current recommendations for the management of the acute and cumulative neurotoxicity from oxaliplatin with the use of infusion of Ca/Mg remain valid, our case is the first report demonstrating the role of oral minerals in ameliorating neurotoxicity from oxaliplatin. Future studies to evaluate the role of oral Ca/Mg are warranted, since they could prove to be an effective, less expensive and more convenient way to treat and prevent oxaliplatin-associated toxicity.