Is rapid-rate oxaliplatin safer than standard infusion?

Rapid infusion of oxaliplatin appears to have minimal treatment modifications relative to standard administration but may lead to a higher incidence of peripheral neuropathy (PN), according to a study.

This retrospective, cohort study was conducted via chart review. The authors assessed adult patients who received oxaliplatin as part of a FOLFOX, FOLFOXIRI, or FOLRINOX chemotherapy regimen from 1 January 2018 through 30 June 2021.

Primary outcomes included the incidence of hypersensitivity reaction (HSR) and treatment modification of oxaliplatin due to adverse events, while secondary outcomes included PN, myelosuppressive signs, and oxaliplatin-related emergency department visit or hospital admission.

Of the 178 patients included, 90 were in the rapid-rate group and 88 in the standard-rate group). Rapid-rate oxaliplatin showed no correlation with increased HSR or difference in toxicity requiring dose reduction, delayed dose, or slowed infusion rate. However, it was associated with a higher rate of permanent discontinuation of oxaliplatin (7.8 percent vs 1.1 percent; p=0.032).

In addition, the rapid-infusion group had a higher incidence of PN (72.2 percent vs 42.0 percent; relative risk, 2.09, 95 percent confidence interval, 1.43–3.04; p<0.001) than the standard-infusion group. No differences were seen in any other adverse drug events measured between these groups.

“A faster rate of oxaliplatin administration may not be worth the increased risk of PN,” the authors said. 

“The National Comprehensive Cancer Network guidelines state that the oxaliplatin dose of 85 mg/m² used in various gastrointestinal cancer regimens may be infused over a rapid rate of 85 min instead of the standard time of 120 min,” the authors said.