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Effect of Standard vs. Rapid Infusion Oxaliplatin on Neuropathy and Patient Outcomes in Colorectal Cancer
Thursday April 24, 2025 12:20pm - 12:35pm EDT
Olympia 2
Title: Effect of Standard vs. Rapid Infusion Oxaliplatin on Neuropathy and Patient Outcomes in Colorectal Cancer


Authors: Sara Niazi, PharmD; Matthew Zakhari, PharmD; Courtney Mallon, PharmD, BCOP; Stephen Aiken, PharmD, BCOP


Objective: The purpose of this study is to assess the impact of oxaliplatin infusion rate on incidence of early oxaliplatin discontinuation due to neuropathy and patient outcomes in colorectal cancer.


Self Assessment Question:
Which is a well-known side effect of oxaliplatin treatment, sometimes leading to discontinuations/dose reductions of the medication?
  1. Cardiac toxicity
  2. Hyperglycemia
  3. Rash
  4. Peripheral Neuropathy
Background: National Comprehensive Cancer Network guidelines state oxaliplatin may be administered at 1 mg/m2/min in gastrointestinal-related malignancy treatment regimens, based on results by Cercek et al. in 2016. A study in 2023 by Huynh et al. found increased incidence of peripheral neuropathy and oxaliplatin discontinuation with rapid compared with standard-rate oxaliplatin infusions. There is a lack of studies evaluating patient outcomes secondary to early discontinuation of oxaliplatin associated with rapid-infusion rates.


Methods: This was a retrospective chart review of adult patients receiving oxaliplatin at the standard-infusion vs. rapid-infusion rate at a single institution academic medical center from January 2016 - December 2024. The primary endpoint was incidence of early oxaliplatin discontinuation due to neuropathy. Secondary outcomes included incidence of oxaliplatin dose reductions due to neuropathy and time to progression after starting an oxaliplatin-containing regimen. Patients were included if they received an oxaliplatin-containing regimen for colorectal cancer. Patients were excluded if they were treated with >1 active chemotherapy regimen, in a vulnerable population, and had a clearly documented transition of care to a different facility.  


Results: The percentage of patients with colon cancer studied was higher than those with rectal cancer in both the standard infusion rate (66.9% and 33.1%, respectively) and the rapid infusion group (70.5% and 29.5%, respectively). The distribution of cancer regimens used in the rapid vs standard infusion groups was similar, with the most common being mFOLFOX6 (74.7% in the standard rate group and 91.7% in the rapid rate group). Rapid rate oxaliplatin was not associated with a statistically significant increase in incidence of oxaliplatin discontinuation due to peripheral neuropathy compared to standard-rate oxaliplatin, (23.7% versus 16.5%, p = 0.11). There was a difference between the percentage of dose reductions due to peripheral neuropathy between the rapid infusion rate and the standard-rate (18.7% versus 10.1%, p = 0.03). There was no significant difference in documented disease progression between the rapid versus standard-rate oxaliplatin (32.7% versus 34.8%, respectively, p = 0.69). 
 
Conclusion: There was a clinically but not statistically significant increase in incidence of oxaliplatin discontinuation due to peripheral neuropathy in the rapid infusion rate group compared to the standard infusion rate group. However, there was a clinically and statistically significant increase in the incidence of dose reductions due to peripheral neuropathy in the rapid compared to the standard rate oxaliplatin infusion groups. Further studies need to be done to include various races, a means to gather data that may not have been documented or available in the electronic medical record, and on a larger scale.
Moderators
avatar for Sheema Hallaji

Sheema Hallaji

PGY1 Residency Director, Cone Health- Alamance Regional Medical Center
Presenters
SN

Sara Niazi

PGY-2 Heme/Onc Pharmacy Resident, University of Tennessee Medical Center
Sara Niazi, PharmD is a PGY-2 Oncology Pharmacy at the University of Tennessee Medical Center. Dr. Niazi completed her PGY-1 at Phoebe Putney Memorial Hospital/University of Georgia College of Pharmacy. She has an interest in academia, inpatient, and outpatient oncology and most enjoys... Read More →
Evaluators
EO
Thursday April 24, 2025 12:20pm - 12:35pm EDT
Olympia 2
  Oncology (ONC), University of Tennessee Medical Center
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