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Rationale: Oxaliplatin is a key part of the standard treatment for colorectal cancer which is formally contraindicated in patients with severe renal dysfunction. Here, we investigated a safe and efficient dosing schedule of oxaliplatin in folinic acid, fluorouracil, and oxaliplatin (FOLFOX) regimen by monitoring total and free platinum concentrations in plasma., Patient Concerns: A 47-year-old female with chronic hemodialysis was diagnosed with left-sided colon cancer and underwent colectomy. One year later, she was presented with omentum metastasis and needed further treatment., Diagnoses: The computed tomography (CT) scanning revealed multiple omental nodules. Positron emission tomography-CT (PET-CT) showed increased uptake of the nodules., Interventions: The patient was treated with FOLFOX therapy every 3 weeks. The oxaliplatin began with 50 mg/m and gradually increased 85 mg/m as in the standard regimen. A 4-hour dialysis was started 1 hour after the end of oxaliplatin infusion., Outcomes: The free platinum concentration time curve showed a biomodel pattern. The Cmax of the 1st peak we observed in our patients at the standard dose is comparable to patients with normal renal function. This patient was treated with FOLFOX for 12 courses. No apparent adverse effect was observed during the treatment., Lessons: The FOLFOX can be safely administered in hemodialysis patients on a long-term basis. Dose reduction of oxaliplatin is not necessarily needed if hemodialysis is performed soon after the infusion. Further studies are needed to distinguish between active and inactive oxaliplatin products during the 2nd peak of the free platinum concentration curve in this population.

Rationale: Experience of pharmacotherapy in posttransplantation colorectal cancer (CRC) patients is inadequate., Patient Concerns: A Chinese man had right renal transplantation and began immunosuppressive treatment at the age of 31 in 2009. He was diagnosed with colon cancer and underwent anterior resection in 2014. He was diagnosed with metastatic colon carcinoma by abdomen computed tomography (CT) and positron emission tomography-computed tomography in April 2017., Diagnosis: Metastatic colon carcinoma in posttransplantation patient., Interventions: Three cycles of FLOFOX (5-fluorouracil and leucovorin and oxaliplatin) chemotherapy were given since April 2017., Outcomes: Plasma concentrations of immunosuppressant and kidney function were within normal during the chemotherapy. Abdomen CT revealed the progress of colon cancer at the end of the third course of chemotherapy., Lessons: A few cases about monochemotherapy of posttransplantation CRC have been reported, whereas experience of doublet chemotherapy was currently unavailable. We shared the experience of FOLFOX in a patient with posttransplantation colon cancer. Neither of incompatibility with immunosuppressant nor serious adverse drug reaction was observed. It provides evidence for the pharmacotherapy of posttransplantation CRC.

Background: Hyperammonemia is an infrequent adverse drug reaction (ADR) of chemotherapy. A few cases of 5-fluorouracil (5-FU) related hyperammonemia have been reported. However, hyperammonemia induced by capecitabine, an oral prodrug of 5-FU, has not been reported till date., Case Report: A patient with colon cancer was treated with CapeOx (oxaliplatin 200mg, day 1; capecitabine 1.5g bid, days 1-14). On the fifth day of first cycle chemotherapy, she developed hyperammonemia (245 µmol/L) and psychiatric symptoms. The serum 5-FU level (3.2µg/L) was lower than normal. When the patient recovered with drug treatment, capecitabine was restarted at a lower dose (1g bid). Hyperammonemia (98µmol/L) and psychiatric symptoms reappeared after three days. Serum 5-FU remained at a low level (4.6µg/L). This case highlighted the possibility of hyperammonemia induced by capecitabine. Case reports such as these would make physicians more aware of rare ADR and what to be done in such case., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)