Oxaliplatin (Specialist drug)

How it works

It forms platinum-DNA adducts that produce inter- and intra-strand cross-links, inhibiting DNA replication and transcription and triggering apoptosis.

Prescribing in practice

• It causes a characteristic cumulative sensory peripheral neuropathy and an acute cold-induced neuropathy; patients must avoid exposure to cold during and shortly after infusion to prevent triggering laryngopharyngeal dysaesthesia.
• Severe hypersensitivity and anaphylactic reactions can occur, so administer with resuscitation facilities available.
• Myelosuppression and diarrhoea are common, and the risk increases when combined with fluorouracil.

Monitoring

Monitor full blood count, renal and liver function, and assess neurological symptoms before each cycle.

Counselling the patient

• Avoid cold drinks, cold food and exposure of skin to cold air or water for a few days after each infusion.
• Report numbness, tingling or difficulty with fine tasks, and any breathing difficulty or rash during infusion.

Evidence & guidelines

Use in colorectal cancer is supported by NICE guidance and pivotal trials of oxaliplatin-fluoropyrimidine combination regimens.