Wrzesinski Stephen H, McGurk Meghan L, Donovan Constance T, Ferencz Thomas M, Saif Muhammad Wasif
Yale New Haven Hospital and Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Anticancer Drugs. 2007 Jul;18(6):721-4. doi: 10.1097/CAD.0b013e32802ffbcb.
Since the results of the MOSAIC trial demonstrated an improved disease-free survival in stage III colorectal patients treated with oxaliplatin combined with 5-fluorouracil and folinic acid when they were compared with those treated with 5-fluorouracil and folinic acid alone, the addition of this organoplatin to 5-fluorouracil and folinic acid has become first-line adjuvant treatment for stage III colorectal cancer. Unfortunately, there is a small population of patients who develop grade III/IV hypersensitivity reactions to oxaliplatin which, until recently, have interfered with further treatment with oxaliplatin-containing regimens. Successful oxaliplatin desensitization protocols for patients having severe oxaliplatin hypersensitivity reactions have been reported. However, none of these protocols, have incorporated magnesium and calcium salts. Retrospective data has suggested that pretreating colorectal cancer patients with magnesium sulfate and calcium gluconate before the administration of oxaliplatin may reduce the incidence of neurotoxicities induced by this drug. Therefore, we modified a previously published oxaliplatin-desensitization protocol by incorporating intravenous calcium gluconate and magnesium sulfate, and report a patient with stage IIIc colorectal cancer and prior severe hypersensitivity reactions to oxaliplatin who underwent successful oxaliplatin desensitization using this protocol.
由于MOSAIC试验结果表明，与单独接受5-氟尿嘧啶和亚叶酸治疗的III期结直肠癌患者相比，接受奥沙利铂联合5-氟尿嘧啶和亚叶酸治疗的患者无病生存期得到改善，因此在5-氟尿嘧啶和亚叶酸中添加这种有机铂已成为III期结直肠癌的一线辅助治疗方法。不幸的是，有一小部分患者对奥沙利铂产生III/IV级过敏反应，直到最近，这些反应一直干扰含奥沙利铂方案的进一步治疗。已有报道针对严重奥沙利铂过敏反应患者的成功奥沙利铂脱敏方案。然而，这些方案均未纳入镁盐和钙盐。回顾性数据表明，在给予奥沙利铂之前用硫酸镁和葡萄糖酸钙预处理结直肠癌患者可能会降低该药物引起的神经毒性发生率。因此，我们通过纳入静脉注射葡萄糖酸钙和硫酸镁对先前发表的奥沙利铂脱敏方案进行了修改，并报告了一例IIIc期结直肠癌患者，该患者先前对奥沙利铂有严重过敏反应，使用该方案成功进行了奥沙利铂脱敏。
