Journal of Clinical Oncology, Vol 21, Issue 21
(November), 2003: 4068-4069
© 2003 American Society for Clinical Oncology
Extravasations of Oxaliplatin
Albrecht Kretzschmar1,
Daniel Pink1,
Peter Thuss-Patience1,
Bernd Dörken1,
Peter Reichart1,
Robert Eckert2
1 Department of Medical Oncology, Robert Roessle Klinik, HELIOS Klinikum Berlin, Berlin
2 Department of Medicine, Staedtische Kliniken, Esslingen, Germany
To the Editor: Oxaliplatin is a platinum compound that has been used for about 8 years in Europe for the treatment of advanced colorectal cancer in combination with fluorouracil, but little information is available on the consequence of extravasation of oxaliplatin. The drug is considered to be nonvesicant, as stated in the manufacturer’s summary of product characteristics. The parent compound cisplatin and its derivate carboplatin do not cause relevant problems after introduction into subcutaneous tissue.
Since the approval of oxaliplatin in Europe, hundreds of thousands of applications of the drug must have led to quite a number of accidental extravasations. There is, however, only one published case report of an extravasation of oxaliplatin from a peripheral vein, describing a severe oxaliplatin induced tissue necrosis.1 The authors recommend a central venous catheter for any therapy with oxaliplatin. More information on the outcome of extravasation of oxaliplatin would be helpful for clinicians who use this drug.
We retrospectively collected data of all patients with documented extravasations of oxaliplatin in our institutions from August 1996 through March 2002. The circumstances of the extravasation, treatments used, clinical courses, and outcomes were recorded. Eleven patients with an extravasation of oxaliplatin were identified. In six cases, the amount of the drug leaking from a displaced cannula in a peripheral vein was small. The incident was noticed early due to swelling or a light burning sensation, and the infusion was stopped. Hardly any symptoms occurred, according to documentation by the treating physicians.
In five patients, however, moderate- to high-doses of oxaliplatin (more than 40 mg) were accidentally infused into the subcutaneous tissue and led to more pronounced symptoms of inflammation, usually starting 2 days after the event (Table 1 ). In all of these cases, the clinical picture initially resembled an erysipelas (Fig 1), leading to the administration of clindamycin in two patients with no effect at all. A biopsy of the involved tissue was not performed in any of the patients. Ultrasound (three patients), magnetic resonance imaging (one patient) and the clinical courses were compatible with edema and inflammation without proof of necrosis or abscess. High-dose oral dexamethason was given for several days in two patients and seemed to have a positive influence on the severity of the inflammatory reaction.
In conclusion, we cannot confirm the observation by Bauer et al1 that the extravasation of larger amounts of oxaliplatin leads to tissue necrosis requiring plastic surgery. In our experience, the clinical picture resembles an erysipelas, and we assume that an aseptic inflammation of the involved subcutaneous tissue is responsible for the symptoms. Anti-inflammatory drugs are useful for symptomatic treatment. The early administration of high-dose dexamethason seems to have a positive influence on the further course and should be considered a therapeutic intervention in cases of extravasation of oxaliplatin. The long-term outcome was good and without sequelae in all our patients; plastic surgery was not necessary in any of the cases. The harm of extravasation of even greater amounts ofoxaliplatin is not comparable to that of classic vesicants like anthracyclines or vinca alkaloids.
AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST
The authors indicated no potential conflicts of interest.
REFERENCE
1. Baur M, Kienzer HR, Rath T, et al: Extravasation of oxaliplatin (Eloxatin): Clinical course. Onkologie 23:468–471, 2000[CrossRef][Medline]
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