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FEATURE ARTICLE
Hypersensitivity Reactions to Oxaliplatin: What Nurses Need to Know Kathleen Bonosky, RN, BSN, OCN ®, and Rickey Miller, PharmD, BCOP
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decline in the mortality rate for novel antineoplastic Colorectal cancer (CRC) is the third-leading cause of men and women has occurred drug, oxaliplatin (Elox(ACS). When CRC is detected atinTM, Sanofi-Synthecancer death in the United States. With the advent of at an early, localized stage, the labo Inc., New York, NY), was new chemotherapy drugs, such as oxaliplatin, for CRC, five-year relative survival rate approved as a second-line treatdisease-free and long-term survival has improved in is 90%. This rate drops to 67% ment for metastatic colon cancer after the cancer has spread to in 2002 by the U.S. Food and this patient population. As oxaliplatin use increases, adjacent organs or lymph nodes Drug Administration and as a more hypersensitivity reactions may be expected. The and 10% when distant metastafirst-line treatment in 2004. Also etiology of these reactions is unclear but may be a ses develop (ACS). Because of in 2004, Eloxatin was approved combination of immunologic responses. Pretreatment, the decreased survival rate for as an adjuvant therapy when used patients with metastatic CRC, in combination with 5-fluorouratreatment, and desensitization protocols are available researchers have concentrated cil (5-FU) and leucovorin (LV) in to prevent and treat hypersensitivity reactions. Nurses’ on finding new, effective agents patients with stage III colon canrapid assessment and management of infusion-related to fight the disease. cer. This cell-cycle nonspecific hypersensitivity reactions are vital to ensuring the safe Treatment for CRC may inplatinum analog is being used clude surgery, radiation, and with increasing frequency in a administration of oxaliplatin. chemotherapy. The primary variety of drug regimens as a firsttreatment is surgery for removal line agent in metastatic colorectal cancer (CRC), as salvage chemotherapy after newly diagnosed cancers and 57,100 deaths of the tumor and acquisition of samples of the failure of standard chemotherapy agents, annually in the United States (American adjacent tissue and lymph nodes. Pathologic and in node-positive colon cancer. Patients Cancer Society [ACS], 2005). ACS esti- classification with the tumor, node, metasare treated over a longer period of time to mates that in 2005 about 145,290 people tasis (TNM) staging system is important improve progression-free survival rates and will be diagnosed with CRC and 56,290 as a tool to direct physicians in further quality of life. Current research involving will die as a result of the disease. Only 37% management and as a prognostic indicator. oxaliplatin is examining its effectiveness of CRC cases are discovered in the early The Dukes’ system was used in the past, but in treating other malignancies, as well as stage, when the disease is asymptomatic; the American Joint Committee on Cancer extending the data beyond the three-year most patients are diagnosed at later stages (2002) has recommended the TNM sysdisease-free interval in the adjuvant setting and present with symptoms of rectal bleed- tem because it provides greater detail and (Andre et al., 2004). A higher likelihood of ing, abdominal pain, and/or changes in precision in the identification of prognoshypersensitivity reactions (HSRs) exists with bowel habits. The primary risk factor for tic subgroups. Most cancers of the colon oxaliplatin because of its expanded indica- CRC is age, with more than 90% of cases and rectum are grouped after pathologic tions and additional and prolonged treatment diagnosed in individuals older than age 50 examination. Patients are staged by tumor cycles. The purpose of this article is to help (ACS). Other risk factors include a family nurses become more familiar with oxaliplatin history of CRC, polyps, familial syndromes and improve recognition of HSRs, including (i.e., hereditary polyposis), or inflammatory Submitted November 2004. Accepted for the severity and scope of symptoms. bowel disease. Early-detection recommenpublication January 10, 2005. (Mention dations by ACS include annual fecal occult of specific products and opinions related blood testing or sigmoidoscopy every five to those products do not indicate or imply years after age 50. Some provider groups Colorectal Cancer endorsement by the Clinical Journal of disagree regarding which screening tests Oncology Nursing or the Oncology Nursing and Treatment are appropriate (Mahon, 2004). Although Society.) CRC is the third most common cancer in the debate has not altered CRC incidence men and women, accounting for 11% of all rates since 1995, an approximately 1.7% Digital Object Identifier: 10.1188/05.CJON.325-330 CLINICAL JOURNAL OF ONCOLOGY NURSING • VOLUME 9, NUMBER 3 • HYPERSENSITIVITY REACTIONS TO OXALIPLATIN
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