CCoPE
Date: 2011-01-05

Question:
I would like to know if there is any risk of breastfeeding a newborn whose mother received Oxaliplatin 130 mg/m2 about 5 weeks before the cesarean and finished a cycle of Capecitabine (2.000 mg/m2 D1 to D14) 3 weeks before. Thank you very much

Answer:

Oxaliplatin is a platinum compound similar to cisplatin. Oxaliplatin is extensively bound in peripheral tissues, which accounts for its long half-life. While breast milk levels are unavailable, but are probably low, breastfeeding is not advisable for many days (>20-30) and should be discontinued until milk platinum levels can be measured.

In cisplatin studies, excretion of platinum into milk was observed in 2 of the 3 cases reported, with the 3rd reporting no breast milk levels. The exact form and toxicity of platinum excreted into breastmilk is not known. The nursing infant would receive any platinum compounds orally rather than intravenously and oral absorption of oral platinum compounds by infants is not known.

Options:

1. Breastmilk levels should be tested for platinum and not used as long as they are measurable
2. Interruption of breastfeeding for >20-30 days

Capecitabine is converted to the active drug 5-fluorouracil (5-FU). It is readily absorbed orally and rapidly metabolized in most tissues to 5-FU in about 2 hours following administration. No intact fluorouracil can be detected in the plasma three hours after an IV injection. No data are available on the transfer of 5-FU to human milk. Mothers receiving injected 5-FU should withhold breastfeeding for a minimum of 24 hours after exposure.

Because platinum is not absorbed orally, and due to the time that has elapsed, there is no reason not to breastfeed in this case.