What can a 40-70 year old patient with colorectal, ovarian, or testicular cancer expect when undergoing oxaliplatin or cisplatin (Platinol) chemotherapy?

What to Expect During Oxaliplatin or Cisplatin Chemotherapy

Most Common and Clinically Significant Side Effects

Patients undergoing oxaliplatin or cisplatin chemotherapy should expect distinct toxicity profiles: oxaliplatin primarily causes peripheral neuropathy (especially cold-triggered symptoms), while cisplatin causes kidney damage, hearing loss, and severe nausea. 1, 2

Oxaliplatin-Specific Effects

Peripheral Neuropathy (Most Important)

• Occurs in approximately 52% of patients, with severe cases (grade 3-4) in 12% 1
• Characterized by distal and perioral tingling/numbness that is triggered or worsened by cold exposure 3
• Acute symptoms appear within hours to days of infusion and typically resolve between treatment cycles 4, 3
• Cumulative chronic neuropathy develops with repeated doses and may persist for months after stopping treatment, though most cases are reversible 5, 4, 3
• Critical pitfall: Patients must avoid cold drinks, cold objects, and cold air exposure during and immediately after infusions 4

Gastrointestinal Effects

• Nausea and vomiting occur in 23-65% of patients (severe in 3-7%) 1
• Diarrhea is common, particularly in elderly patients (>65 years) 5, 1
• These symptoms are moderate and manageable with antiemetics 2, 3

Blood Count Changes

• Thrombocytopenia (low platelets) occurs in 37-65% of patients (severe in 17-27%) 1
• Neutropenia (low white blood cells) in 39-58% (severe in 16%) 1
• Anemia in 37-65% (severe in 5-9%) 1
• Monitoring requirement: Regular blood tests are mandatory throughout treatment 2

Liver Function Changes

• Elevated liver enzymes (ALT/AST) in approximately 24% of patients 1
• Generally mild and reversible 4

Allergic/Hypersensitivity Reactions

• More common with repeated cycles and after treatment breaks 5
• Symptoms include rash, shortness of breath, chest pain, blood pressure changes, and hives 5
• Mild reactions (flushing, rash) can progress to severe reactions even with slow infusion 5
• Management: Infusion rate reduction, premedication, or desensitization protocols may be required 5

Cisplatin-Specific Effects

Kidney Damage (Dose-Limiting)

• Nephrotoxicity is the primary dose-limiting toxicity for cisplatin 2
• Requires aggressive hydration with saline before and after treatment 2
• Monitoring requirement: Kidney function tests before each cycle are essential 2

Hearing Loss (Ototoxicity)

• Permanent hearing damage can occur, particularly at high frequencies 2
• Monitoring requirement: Baseline and periodic hearing tests are necessary 2

Severe Nausea and Vomiting

• More pronounced than with oxaliplatin 2
• Requires prophylactic antiemetic medications 2

Blood Count Suppression

• Similar to oxaliplatin but may be more severe 2

Neuropathy

• Less common than with oxaliplatin but can occur 6
• Not typically cold-triggered like oxaliplatin 6

Age-Related Considerations (40-70 Years)

For Patients ≥65-70 Years

• Increased susceptibility to diarrhea, dehydration, low potassium, fatigue, and low white blood cell counts 1
• For colorectal cancer adjuvant treatment: The benefit of adding oxaliplatin to fluoropyrimidine is uncertain in patients >70 years, with most benefit coming from the fluoropyrimidine component alone 5, 7
• Single-agent capecitabine may be more appropriate than combination therapy for many elderly patients with stage III colon cancer 7
• Dose reductions (starting at 80% of standard dose) are commonly recommended 7, 8

Infusion Reactions and Emergency Preparedness

Immediate Infusion Reactions

• Symptoms usually resolve quickly after stopping infusion 5
• Critical warning: Patients with prior mild reactions may develop severe reactions on rechallenge 5
• Emergency equipment must be available during all infusions 5
• Consultation with an allergist should be considered after any reaction 5

Required Monitoring Throughout Treatment

Essential Tests

• Complete blood counts before each cycle 2
• Kidney function tests (especially for cisplatin) 1, 2
• Liver function tests 1, 2
• Hearing tests (for cisplatin) 2
• Neurological assessment for neuropathy symptoms 4

Supportive Medications Commonly Prescribed

To Manage Side Effects

• Antiemetics for nausea/vomiting 2
• Antidiarrheal medications 2
• Magnesium supplements (may help with neuropathy) 4
• Growth factors for low blood counts if needed 2
• Neuroprotective agents like venlafaxine may reduce chronic neuropathy 4

Duration and Reversibility

Oxaliplatin

• Acute neuropathy symptoms are typically reversible between cycles 3
• Chronic neuropathy is cumulative but reversible within months of stopping treatment in most cases 3
• Long-term concern: Some patients report neuropathy symptoms for years after treatment completion 5

Cisplatin

• Kidney damage may be permanent if severe 2
• Hearing loss is typically permanent 2
• Neuropathy may persist but is generally less problematic than with oxaliplatin 6

Critical Pitfalls to Avoid

• Do not expose yourself to cold during oxaliplatin treatment (avoid cold drinks, ice, cold weather without gloves) 4, 3
• Do not delay reporting symptoms of severe diarrhea, dehydration, fever, or unusual bleeding 2
• Do not skip monitoring appointments or blood tests 2
• Do not assume all platinum drugs are the same—oxaliplatin and cisplatin have distinctly different toxicity profiles 2, 6