Least Is Best in CRC Follow-up
Least Is Best in CRC Follow-up
Dr. Kerr: Another thing that I picked up on is this worry about oxaliplatin and peripheral neuropathy. We see our patients' problems with buttoning their coats and other problems in winter. Is there any role for calcium and magnesium in this slaying of peripheral neuropathy: yes, no, or maybe?
Dr. Marshall: The answer is no. This pendulum has swung back and forth over the past several years, where we initially said that you have to keep on pouring in the oxaliplatin in multiple doses, and the only way you can do that is with calcium and magnesium, according to the experience of a few investigators. Everyone is doing it, and then a clinical trial comes along that suggests that maybe it was harmful and that caused a great stir. The data safety and monitoring board said that "upon further review," it may not have been as good a call as it needed to be.
A subsequent study was done and published, involving a very neat data set of patients who were randomized to receive calcium and magnesium or not. The problem that I had with the study presented here is that they focused primarily on the acute hypersensitivity to cold, which is not that big of a deal for patients in our clinics. Patients get over that. It is the chronic, and particularly the unexpected chronic, neuropathy that I would like to see evidence of, and they did not present those data. Needless to say, taking calcium and magnesium throughout an adjuvant run of chemotherapy did not alter the grade or the frequency of neuropathy. A lot of doctors were doing this routinely, keeping patients longer in the infusion units to do this, and this study basically says we don't need to.
Oxaliplatin and Calcium Magnesium Don't Mix
Dr. Kerr: Another thing that I picked up on is this worry about oxaliplatin and peripheral neuropathy. We see our patients' problems with buttoning their coats and other problems in winter. Is there any role for calcium and magnesium in this slaying of peripheral neuropathy: yes, no, or maybe?
Dr. Marshall: The answer is no. This pendulum has swung back and forth over the past several years, where we initially said that you have to keep on pouring in the oxaliplatin in multiple doses, and the only way you can do that is with calcium and magnesium, according to the experience of a few investigators. Everyone is doing it, and then a clinical trial comes along that suggests that maybe it was harmful and that caused a great stir. The data safety and monitoring board said that "upon further review," it may not have been as good a call as it needed to be.
A subsequent study was done and published, involving a very neat data set of patients who were randomized to receive calcium and magnesium or not. The problem that I had with the study presented here is that they focused primarily on the acute hypersensitivity to cold, which is not that big of a deal for patients in our clinics. Patients get over that. It is the chronic, and particularly the unexpected chronic, neuropathy that I would like to see evidence of, and they did not present those data. Needless to say, taking calcium and magnesium throughout an adjuvant run of chemotherapy did not alter the grade or the frequency of neuropathy. A lot of doctors were doing this routinely, keeping patients longer in the infusion units to do this, and this study basically says we don't need to.
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