oxaliplatin

Oxaliplatin is a platinum-based chemotherapy agent used primarily for colorectal cancer. It is a third-generation platinum compound that contains a diaminocyclohexane (DACH) carrier ligand, which influences its DNA-binding properties.

Oxaliplatin forms platinum-DNA adducts, creating crosslinks that block DNA replication and transcription, leading to cancer cell death. Its activity is enhanced when used in combination regimens.

In colorectal cancer, oxaliplatin is commonly combined with 5-fluorouracil and leucovorin in the FOLFOX regimen, or with capecitabine in CapeOx. It is also studied in other gastrointestinal cancers and in various settings of chemotherapy.

Oxaliplatin is given by intravenous infusion, typically every two weeks as part of a multi-agent regimen. Dosing depends on the regimen, the patient’s body surface area, and renal function. Hydration is usually maintained during administration; premedication is not routinely required.

The most characteristic and dose-limiting toxicity is cumulative peripheral sensory neuropathy that can be worsened by cold exposure. Acute neuropathic symptoms may occur after infusion and with exposure to cold. Other common toxicities include fatigue, nausea, and diarrhea or vomiting; myelosuppression is less pronounced than with some other platinum drugs. Hypersensitivity reactions can occur with cumulative exposure and may require discontinuation. Nephrotoxicity and ototoxicity are less common than with cisplatin.

The drug is eliminated primarily by the kidneys; a portion is excreted unchanged in urine. It forms active platinum species in the body; hepatic metabolism is not the primary pathway. Dose adjustments may be considered in significant renal impairment.

Oxaliplatin, marketed as Eloxatin, was developed in the 1990s and approved for colorectal cancer in the early 2000s.