A case report of an adverse drug reaction with a combination of oxaliplatin and perindopril

Abstract

Introduction: Oxaliplatin is a third-generation platinum compound that is used as a single agent and in combination with fluorouracil (5-FU) to treat a variety of solid organ cancers. Patients treated with Oxaliplatin may develop hypersensitivity reactions. Angiotensin-converting enzyme inhibitors (ACEI) are established to have multiple cardiovascular benefits. Recent studies also suggest that ACEI may have a role in preventing Oxaliplatin-induced peripheral neuropathy. Case Report: We present a case of a patient who presented with adverse reactions on two separate occasions. At the time of the first reaction he had been on an ACEI (Perindopril), which he had used for four years for management of hypertension and was within hours of receiving the seventh cycle of adjuvant modified Fluorouracil, Leucovorin, Oxaliplatin (FOLFOX-6) for ypT3N0 rectal adenocarcinoma. On the second episode, he presented with a reaction before his eighth cycle of chemotherapy, while still taking the ACEI. Determination of the cause of the reactions was challenging and management involved switching from Perindopril to a calcium channel blocker (Amlodipine) and Oxaliplatin desensitization. The patient was able to complete chemotherapy treatment with no further reactions. Conclusion: The combination of Perindopril with Oxaliplatin could increase the risk of adverse reactions. These adverse reactions could be managed by substituting Perindopril with a calcium channel blocker and use of an Oxaliplatin desensitization protocol.