Oxaliplatin is a cytotoxic agent which, like other platinum compounds, acts 
primarily by causing inter- and intra-strand cross-links in DNA, thereby 
inhibiting DNA synthesis. Oxaliplatin has a bulky carrier ligand which is 
thought to enhance cytotoxicity and abolish cross-resistance between oxaliplatin 
and other platinum compounds. Phase II and III clinical trials have found 
oxaliplatin combined with fluorouracil/calcium folinate (leucovorin/folinic 
acid) to be an effective first- and second-line treatment for patients with 
metastatic colorectal cancer. First-line triple therapy with oxaliplatin and 
fluorouracil/calcium folinate achieved significantly higher response rates than 
fluorouracil/calcium folinate alone in 2 phase III studies (objective response 
rates 59 vs 23% and 50.7 vs 22.3%). In addition, median progression-free 
survival was longer with triple therapy in both studies (8.9 vs 5.2 and 8.75 vs 
6.0 months). However, there was no significant difference in median duration of 
survival between treatment groups, although this may be a consequence of the 
subsequent use of oxaliplatin and/or surgery in patients who relapsed during 
therapy with fluorouracil/calcium folinate alone. About 30 to 45% of patients 
(whose disease progressed during or after fluorouracil-based therapy) responded 
to second-line combination therapy with oxaliplatin and fluorouracil/calcium 
folinate. Median progression-free survival ranged from 7 to 10 months and the 
median duration of survival from 10 to 17 months. Objective responses were 
achieved in 20 and 24% of patients in 2 small trials of first-line oxaliplatin 
monotherapy and in about 10% of patients given the drug as a second-line option. 
Peripheral sensory neuropathy is the dose-limiting toxicity associated with 
oxaliplatin. Severe neurotoxicity has been estimated to occur in 10% of patients 
after 6 treatment cycles and in 50% after 9 cycles of an oxaliplatin dosage of 
130 mg/m2 once every 3 weeks. It is cumulative, but reversible on 
discontinuation of therapy. Nausea, vomiting and diarrhoea are common, but are 
usually mild to moderate. Myelosuppression is also observed, but is usually 
mild.
CONCLUSION: oxaliplatin is a promising treatment option for patients with 
metastatic colorectal cancer. It appears to be particularly advantageous (in 
terms of response rate and duration of progression-free survival) when used in 
combination with fluorouracil/calcium folinate as both a first- and second-line 
option, although preliminary studies have failed to show any survival advantage 
over fluorouracil/calcium folinate alone. Promising results have been found in 
studies of the drug as monotherapy, and oxaliplatin may also prove useful in the 
neoadjuvant setting in patients with unresectable liver metastases; however, 
data are limited at present.