title: Oxaliplatin-free interval as a risk factor for hypersensitivity reaction among colorectal cancer patients treated with FOLFOX.
abstract: BACKGROUND
  Hypersensitivity reaction (HSR) and sensory neuropathy are major complications of oxaliplatin-based chemotherapy. Preplanned withdrawal of oxaliplatin after the first six cycles and reintroduction at the time of disease progression (stop-and-go strategy) may reduce neurotoxicity. However, the effect of an oxaliplatin-free interval on HSR occurrence remains poorly understood.
  
  
  METHODS
  Data on patients with colorectal cancer who received FOLFOX (5-fluorouracil, leucovorin and oxaliplatin) treatment between June 2005 and June 2009 were retrieved from the prospective cohort database of the Outpatient Oncology Unit of the Kyoto University Hospital. Factor analysis was performed.
  
  
  RESULTS
  Among patients who received six or fewer cycles of FOLFOX, the incidence of HSR was low (7/99, 7.1%). For patients who received more than six cycles, the incidence of HSR was higher among patients treated with stop-and-go FOLFOX than among patients treated with continuous FOLFOX (25/61, 41.0% vs. 13/63, 20.6%; p = 0.019). Interestingly, most cases of HSR during stop-and-go FOLFOX occurred during the second or third cycle of the reintroduction phase (21/25, 84%). Multivariate analysis identified undergoing an oxaliplatin-free interval as an independent risk factor (p = 0.016).
  
  
  CONCLUSIONS
  An oxaliplatin-free interval may increase the risk of HSR. Special vigilance is needed during the second and third cycles after reintroduction of oxaliplatin.
authors.affiliation: Department of Translational Clinical Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan. yukimori@kuhp.kyoto-u.ac.jp
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Mori
authors.forename: Takafumi
authors.initials: T
authors.lastname: Nishimura
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kitano
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Shigemi
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Masashi
authors.initials: M
authors.lastname: Kanai
authors.forename: Megumi
authors.initials: M
authors.lastname: Hazama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishiguro
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nagayama
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yanagihara
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teramukai
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Chiba
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Sakai
authors.forename: Masanori
authors.initials: M
authors.lastname: Fukushima
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D004334:Drug Administration Schedule; D004342:Drug Hypersensitivity / Q000209:etiology*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D016015:Logistic Models; D008175:Lung Neoplasms / Q000188:drug therapy / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage* / Q000009:adverse effects*; D000077150:Oxaliplatin; D012307:Risk Factors; D013997:Time Factors
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D002955:Leucovorin; D005472:Fluorouracil