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Oxaliplatin is an intravenous platinum cytotoxic used mainly in colorectal cancer, almost always as part of the FOLFOX or CAPOX regimens rather than on its own.
- De Gramont's 2000 trial established FOLFOX in metastatic colorectal cancer, improving progression-free survival from 6.2 to 9.0 months and response rate from 22.3% to 50.7% [1].
- MOSAIC (n=2,246) made oxaliplatin part of standard adjuvant therapy for colon cancer, improving three-year disease-free survival from 72.9% to 78.2% [2], with a confirmed overall survival benefit in stage III at six years [4] that persisted at ten years [5].
- The IDEA collaboration pooled six phase 3 trials and showed three months of CAPOX is non-inferior to six months in low-risk stage III colon cancer, with substantially less neuropathy; the first major de-escalation of oxaliplatin exposure [6].
- Peripheral neuropathy is the dose-limiting toxicity and takes two distinct forms: an acute, cold-triggered, rapidly reversible dysaesthesia including pharyngolaryngeal dysaesthesia affecting up to about 90% of patients, and a cumulative, dose-dependent sensory axonopathy that develops beyond roughly 800 mg/m2 [3].
- In MOSAIC grade 3 sensory neuropathy affected 12.4% of patients during treatment but fell to 1.1% at one year of follow-up, so most cumulative neuropathy is slowly reversible [2].
- Unlike cisplatin, oxaliplatin's DACH-platinum adducts escape recognition by mismatch repair, which is why it works in tumours resistant to cisplatin and carboplatin.
Mechanism
The platinum centre forms intrastrand crosslinks between adjacent guanine bases in DNA, which blocks replication and transcription and pushes dividing cells into apoptosis. Its signature toxicity is neurological rather than renal: an acute cold triggered dysaesthesia within hours of an infusion, and a cumulative sensory neuropathy that can persist for years after the last dose.
receptor fingerprint
Genomic DNA (1,2-intrastrand GpG and ApG crosslinks formed by the diaminocyclohexane-platinum moiety)Covalent alkylating-type adduct formation
DNA mismatch repair complex (MLH1/MSH2/MSH6)Fails to recognise DACH-platinum adducts
Ribosome biogenesis and nucleolar rRNA transcriptionInhibited
Voltage-gated sodium channels in dorsal root ganglion sensory neuronsKinetics altered by the oxalate metabolite, prolonging the open state
OCT2 (SLC22A2) and CTR1 (SLC31A1) uptake transportersSubstrate
Safetyrisks and cautions, not medical advice
an intravenous cytotoxic given only in an infusion setting, with a cumulative and often permanent peripheral neuropathy and a real risk of anaphylaxis
Subjective profileweighing the evidence above
The site documents this one and will not answer where to buy it, because no version of a person obtaining platinum chemotherapy outside an oncology service ends well. Its signature harm is neurological rather than renal: a cold triggered nerve pain within hours of the infusion, and a cumulative sensory neuropathy that can outlast treatment by years. The entry exists for someone reading about a regimen they are already on, which is the only use it has on a page like this.
Resources
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Research
- 2000first citedLeucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced col…
- 2020most recentEffect of duration of adjuvant chemotherapy for patients with stage III colon cancer (IDEA coll…
- 1.Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer
- 2.Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer
- 3.A review on oxaliplatin-induced peripheral nerve damage
- 4.Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial
- 5.Adjuvant Fluorouracil, Leucovorin, and Oxaliplatin in Stage II to III Colon Cancer: Updated 10-Year Survival and Outcomes According to BRAF Mutation and Mismatch Repair Status of the MOSAIC Study
- 6.Effect of duration of adjuvant chemotherapy for patients with stage III colon cancer (IDEA collaboration): final results from a prospective, pooled analysis of six randomised, phase 3 trials
6 listed here; entry last updated August 2026
Reviews
My notesprivate to this device
Notes and cautions
- Oxaliplatin's US label has historically carried a boxed warning for serious, sometimes fatal, anaphylactic reactions occurring within minutes of administration, including reactions after prior uneventful cycles; epinephrine, corticosteroids and antihistamines must be immediately available.
- Cumulative sensory peripheral neuropathy is the dose-limiting toxicity and drives most dose reductions and discontinuations, with an acute cold-triggered form that requires patients to avoid cold drinks, cold air and cold objects for several days after each infusion.
- Other important risks are myelosuppression, hepatic sinusoidal obstruction syndrome with nodular regenerative hyperplasia and portal hypertension after prolonged use, pulmonary fibrosis (which mandates stopping the drug for unexplained respiratory symptoms), posterior reversible encephalopathy syndrome, rhabdomyolysis, and QT prolongation with electrolyte disturbance.
- It is embryo-fetal toxic and requires contraception.