Oxaliplatin — Drug Monograph

Brand names: Eloxatin

Drug class: Alkylating Agent

Mechanism of Action

Third-generation platinum compound forming bulky DNA adducts that are less efficiently repaired than cisplatin adducts. Unlike cisplatin, oxaliplatin adducts are not recognized by mismatch repair (MMR) proteins — explaining lack of cross-resistance. Also inhibits topoisomerase I and II.

FDA Indications

• Stage III colon cancer — adjuvant treatment (FOLFOX4)
• Advanced colorectal cancer — first-line with 5-FU/leucovorin (FOLFOX4)

Common Side Effects

• Peripheral neuropathy: two distinct types — acute cold-triggered dysesthesia (during/immediately after infusion) and cumulative sensory neuropathy
• Cold-triggered dysesthesia of hands, feet, and perioral area
• Nausea and vomiting (moderate emetic risk)
• Myelosuppression (less than cisplatin)
• Diarrhea
• Fatigue
• Elevated liver enzymes (transient)

Clinical Pearl

Oxaliplatin is oxalate-based — patients may have elevated urinary oxalate levels. Acute laryngopharyngeal dysesthesia sounds alarming but is a sensory phenomenon, not true airway compromise; slow the infusion rate and reassure the patient. Calcium gluconate and magnesium infusions before oxaliplatin DO NOT reduce neuropathy despite historical use. In GI NETs and carcinoids, FOLFOX (oxaliplatin + leucovorin + 5-FU) is an off-label cytotoxic option for high-grade (G3) or rapidly progressive…

Related Therapies & Mechanisms

• Mitomycin (Mitosol) — Alkylating Agent · CRC
• Capecitabine (Xeloda) — CRC
• CAPTEM Regimen (Capecitabine + Temozolomide) (Xeloda + Temodar) — Alkylating Agent · NET
• Cisplatin (Platinol) — Alkylating Agent · Gastric