Dose-escalation of oxaliplatin in hemodialysis patient treated with FOLFOX therapy A case report

Rationale: Oxaliplatin is a key part of the standard treatment for colorectal cancer which is formally contraindicated in patients with severe renal dysfunction. Here, we investigated a safe and efficient dosing schedule of oxaliplatin in folinic acid, fluorouracil, and oxaliplatin (FOLFOX) regimen by monitoring total and free platinum concentrations in plasma. Patient concerns: A 47-year-old female with chronic hemodialysis was diagnosed with left-sided colon cancer and underwent colectomy. One year later, she was presented with omentum metastasis and needed further treatment. Diagnoses: The computed tomography (CT) scanning revealed multiple omental nodules. Positron emission tomography-CT (PET-CT) showed increased uptake of the nodules. Interventions: The patient was treated with FOLFOX therapy every 3 weeks. The oxaliplatin began with 50mg/m(2) and gradually increased 85mg/m(2) as in the standard regimen. A 4-hour dialysis was started 1 hour after the end of oxaliplatin infusion. Outcomes: The free platinum concentration time curve showed a biomodel pattern. The C-max of the 1st peak we observed in our patients at the standard dose is comparable to patients with normal renal function. This patient was treated with FOLFOX for 12 courses. No apparent adverse effect was observed during the treatment. Lessons: The FOLFOX can be safely administered in hemodialysis patients on a long-term basis. Dose reduction of oxaliplatin is not necessarily needed if hemodialysis is performed soon after the infusion. Further studies are needed to distinguish between active and inactive oxaliplatin products during the 2nd peak of the free platinum concentration curve in this population.