Can Calcium and Magnesium Infusion before and after Oxaliplatin Administration Improves Its Neurotoxic Effect?

Introduction: The oxaliplatin neurotoxicity is one of two distinct phases: an acute and a dose-limiting cumulative phase. Large doses of I.V Ca & Mg is given before and after oxaliplatin in FOLFOX protocol.

Aim: We aimed to evaluate the efficacy of Ca & Mg in improving or eliminating oxaliplatin-induced neurotoxicity.

Study Design: Randomized double controlled placebo study.

Place and Duration of Study: Clinical Oncology department at Mansoura university hospital, Egypt at the period from July 2014 up to December 2016 inclusive.

Methodology: In our study, 140 Patients with adenocarcinoma of the colon received 6 months of FOLFOX protocol. Patients were choiced to receive I.V calcium gluconate plus magnesium sulfate (1 g for both of them) in 100 mL of D5W for about 30 minutes immediately before and after each cycle of oxaliplatin (70 patients ), or an identical looking placebo shortly before and after each cycle of oxaliplatin (70 patients ) in a random manner. The primary end point was a comparison between neurotoxicity assessed by Common Terminology Criteria for Adverse Effects (CTCAE) version 4.0 in both groups.

Results: There was statistically significant difference as regard grade of neuralgia. Grade II neuralgia is higher in the study group II (45.7%) compared to (22.9%) in the study group I. There was statistically significant difference as regard grade of paresthesia. Grade II & III are higher in study group II (51.4%, 14.3%) compared to (30.0%, 4.3%) in study group I.

Conclusion: Ca and Mg administration with oxaliplatin have been well tolerated. Our results support the role of Ca & Mg in decreasing neurotoxicity associated with oxaliplatin.