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Research Article

Cancer Research Frontiers. 2015 Feb; 1(1): 60-74. doi: 10.17980/2015.60

Impact of CAPOX or FOLFOX4 on Spleen size, Platelet Count and Liver Function when Partnered Cetuximab as First-line Treatment for KRAS Wild-type Metastatic Colorectal Cancer

Victor HF Lee1*, Wei-Jia Fang2, Ka-On Lam1, Cheuk-Wai Choi3, Sherry CY Ng1, Garrett CL Ho4, Thomas KC Cheng4, Patty PY Ho1, Rico KY Liu1, To-Wai Leung1, Dora LW Kwong1, Shu-Sen Zheng2*

1 Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
2 The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China
3 Department of Community Medicine, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
4 Department of Nuclear Medicine & Positron Emission Tomography, Hong Kong Sanatorium & Hospital, Hong Kong

*Corresponding author: Victor HF Lee and Shu-Sen Zheng, Department of Clinical Oncology, 1/F, Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong. Email: vhflee@hku.hk and shusenzheng@zju.edu.cn

Citation: Lee VH, et al. Impact of CAPOX or FOLFOX4 on Spleen size, Platelet Count and Liver Function when Partnered Cetuximab as First-line Treatment for KRAS Wild-type Metastatic Colorectal Cancer. Cancer Research Frontiers. 2015 Feb; 1(1): 60-74. doi: 10.17980/2015.60

Copyright: @ 2015 Lee VH, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Competing Interests: The authors declare that they have no competing interests.

Received Nov15, 2014; Revised Jan 11, 2015; Accepted Feb 16, 2015; Published Feb 28, 2015.

 

 

Abstract

Objectives: Oxaliplatin can cause hepatic sinusoidal injury and splenomegaly. It remains unknown if the magnitude of injury would differ when oxaliplatin is combined with capecitabine or 5-FU with/without cetuximab. We investigated the impact of 1st line CAPOX or FOLFOX4 and the additional cetuximab on spleen size, platelet count and liver function in patients with KRAS wild-type metastatic colorectal cancer (mCRC).

Methods: 101 Patients planned to receive either CAPOX or FOLFOX4 with/without cetuximab as first-line treatment were prospectively recruited. Changes in spleen size by volumetric measurement after treatment were determined. Correlation studies were performed for factors associated with changes in spleen size, thrombocytopenia and impaired liver function.

Results: The spleen enlarged (median +17.9%, P < 0.001) after treatment. Multivariable analysis revealed that capecitabine, its dose intensity and cumulative dose (per 10000mg increase) correlated with splenomegaly (P = 0.01, P = 0.02 and P = 0.006, respectively). Increase in spleen size (P = 0.004) and splenomegaly (P = 0.002) correlated with thrombocytopenia. Dose intensity and cumulative dose of capecitabine (per 10000mg increase) and increase in spleen size correlated with grade ≥1 impaired liver function (P = 0.01, P = 0.003 and P = 0.04, respectively). Use of cetuximab correlated with less splenic enlargement (+13.7% vs. +22.7%; P = 0.04), especially when coupled with FOLFOX4 rather than CAPOX (+1.1% vs. + 23.0%; P = 0.003).

Conclusions: Capecitabine was associated with more splenomegaly which in turn correlated with thrombocytopenia and impaired liver function. Cetuximab offered some protection from further splenic enlargement especially when combined with FOLFOX4.

Keywords: cetuximab, fluoropyrimidine, impaired liver function, splenomegaly, thrombocytopenia

 

 

 

 

 

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