Pharmacokinetics of oxaliplatin in a hemodialytic patient treated with modified FOLFOX-6 plus bevacizumab therapy

To establish an appropriate administration schedule for oxaliplatin in FOLFOX plus bevacizumab therapy for a hemodialytic patient. A 50-year-old man on chronic hemodialysis was treated for colon cancer and synchronous hepatic metastasis with modified FOLFOX-6 plus bevacizumab therapy every 3 weeks. The plasma concentration of free platinum was measured at eight points, before and within the first 50 h after oxaliplatin administration. A dose escalation study of oxaliplatin was performed at doses of 60, 70, and 85 mg/m(2). A 4-h dialysis session was begun at the end of the oxaliplatin treatment. The pharmacokinetics of free platinum showed a bimodal pattern at each dose: The serum concentration decreased rapidly soon after dialysis, then increased, and remained at a high level for 24 h. The areas under the curves (AUC) for free platinum were 17.6, 23.6, and 32.6 mu g h/mL after doses of 60, 70, and 85 mg/m(2) oxaliplatin, respectively. These exceeded the AUC when 90 mg/m(2) was given to a patient with normal renal function (7.9 mu g h/mL). Treatment was safely continued for 6 months without severe toxicity. FOLFOX plus bevacizumab therapy can be given safely to hemodialytic patients with no reduction in the dose of oxaliplatin if hemodialysis is performed soon after the administration of oxaliplatin and the dosing interval is extended to 3 weeks.