Safety of oxaliplatin in the treatment of colorectal cancer.

The new platinum compound oxaliplatin (Eloxatin) appears to have activity, either alone or in combination, as both first- and second-line therapy for advanced colorectal cancer. Unlike other platinum derivatives, it is not associated with significant nephrotoxicity or ototoxicity. The addition of oxaliplatin at 85 mg/m2 to a fluorouracil/leucovorin-based regimen administered every 2 weeks is well tolerated. The incidence of diarrhea and stomatitis increases with the addition of oxaliplatin, but can be managed by adjusting the dose. There is also a significantly higher incidence of grade 3 or 4 neutropenia with oxaliplatin. Neutropenic febrile complications are rare. The occurrence of other hematologic, hepatic, or renal toxicities does not increase when oxaliplatin is added to fluorouracil-based regimens. Unlike other agents used for the treatment of colorectal cancer, oxaliplatin causes acute and chronic neurosensory symptoms. These acute symptoms are managed by taking precautions (e.g., avoid cold drinks/food for a few days following treatment). Cumulative neurotoxicity is the dose-limiting toxicity associated with oxaliplatin treatment. This toxicity appears reversible with discontinuation of the drug and typically occurs well after the onset of tumor response.