Dosing: ObesityĪSCO Guidelines for appropriate chemotherapy dosing in obese adults with cancer: Utilize patient's actual body weight (full weight) for calculation of body surface area- or weight-based dosing, particularly when the intent of therapy is curative manage regimen-related toxicities in the same manner as for nonobese patients if a dose reduction is utilized due to toxicity, consider resumption of full weight-based dosing with subsequent cycles, especially if cause of toxicity (eg, hepatic or renal impairment) is resolved (Griggs 2012). Sepsis or septic shock: Withhold treatment. Pulmonary toxicity (unexplained respiratory symptoms including nonproductive cough, dyspnea, crackles, pulmonary infiltrates): Discontinue until interstitial lung disease or pulmonary fibrosis have been excluded. Persistent (>7 days) grade 2 neurosensory events:Īdjuvant treatment of stage III colon cancer: Reduce dose to 75 mg/m 2Īdvanced colorectal cancer: Reduce dose to 65 mg/m 2Īdjuvant treatment of stage III colon cancer: Delay next dose until neutrophils recover to ≥1500/mm 3 and platelets recover to ≥75,000/mm 3, then reduce dose to 75 mg/m 2.Īdvanced colorectal cancer: Delay next dose until neutrophils recover to ≥1500/mm 3 and platelets recover to ≥75,000/mm 3, then reduce dose to 65 mg/m 2. Dosing: Adjustment for ToxicityĪcute toxicities: Longer infusion time (6 hours) may mitigate acute toxicities (eg, pharyngolaryngeal dysesthesia). Rhabdomyolysis: Discontinue for signs/symptoms of rhabdomyolysis. Pulmonary toxicity (unexplained respiratory symptoms, including nonproductive cough, dyspnea, crackles, pulmonary infiltrates): Discontinue until interstitial lung disease or pulmonary fibrosis have been excluded. Hematologic toxicity (grade 4 neutropenia, febrile neutropenia, or grade 3/4 thrombocytopenia):Īdjuvant treatment of stage III colon cancer: Delay next dose until neutrophils recover to ≥1,500/mm 3 and platelets recover to ≥75,000/mm 3, then reduce dose to 75 mg/m 2.Īdvanced colorectal cancer: Delay next dose until neutrophils recover to ≥1,500/mm 3 and platelets recover to ≥75,000/mm 3, then reduce dose to 65 mg/m 2. Gastrointestinal toxicity (grade 3/4) occurring despite prophylactic treatment:Īdjuvant treatment of stage III colon cancer: Delay next dose until recovery from toxicity, then reduce dose to 75 mg/m 2.Īdvanced colorectal cancer: Delay next dose until recovery from toxicity, then reduce dose to 65 mg/m 2. Persistent (>7 days) grade 3 neurosensory events: Consider discontinuing oxaliplatin. The mean AUC of unbound platinum increases as renal function decreases: 40% increase with mild (CrCl 50 to 80 mL/minute), 95% increase with moderate (CrCl 30 to 49 mL/minute), and 342% increase with severe (CrCl 7 days) grade 2 neurosensory events:Īdjuvant treatment of stage III colon cancer: Reduce dose to 75 mg/m 2.Īdvanced colorectal cancer: Reduce dose to 65 mg/m 2.Ĭonsider withholding oxaliplatin for grade 2 neuropathy lasting >7 days despite dose reduction. >90% primarily albumin and gamma globulin (irreversible binding to platinum) Use in Specific Populations Special Populations: Renal Function Impairment Urine (~54%) feces (~2%) Half-Life EliminationĬhildren: Oxaliplatin ultrafilterable platinum (terminal): Median: 293 hours range: 187 to 662 hours (Beaty 2010)Īdults: Oxaliplatin ultrafilterable platinum: Distribution: Alpha phase: 0.4 hours Beta phase: 16.8 hours Terminal: 391 hours Protein Binding Nonenzymatic (rapid and extensive), forms active and inactive derivatives Excretion Pharmacokinetics/Pharmacodynamics Distribution Following intracellular hydrolysis, the platinum compound binds to DNA forming cross-links which inhibit DNA replication and transcription, resulting in cell death. Oxaliplatin, a platinum derivative, is an alkylating agent. Generic: 50 mg (1 ea) 100 mg (1 ea) Pharmacology Mechanism of Action Excipient information presented when available (limited, particularly for generics) consult specific product labeling.
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