A recent review published in Journal of Oncology addresses the need to achieve a workable balance between the effects and side effects of oxaliplatin, a platinum-based chemotherapeutic agent that is useful in the treatment of advanced colorectal cancer but carries the dose-limiting complication of oxaliplatin-induced neurotoxicity (OXIN). Although various pharmacologic approaches to prevent neurotoxicity have been studied, none has shown sufficient success to use routinely.

In the review (www.hindawi.com/journals/jo/2011/201593/), Andrew Weickhardt, MD, clinical fellow at the University of Colorado Cancer Center in Aurora, and associates recommend two approaches that can be used separately or together.

The stop-and-go approach involves discontinuing oxaliplatin after six cycles of therapy, then reintroducing the agent after a predefined break while continuing other chemotherapy for colorectal cancer. Because metastatic colorectal cancers tend to develop resistance to oxaliplatin after approximately 6 to 9 months of treatment, stop-and-go dosing helps spread the agent’s effectiveness over the maximum possible time with the fewest possible side effects. Nevertheless, 1 in 20 patients following this regimen experience significant nerve damage that can last for 6 months or more.

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In addition, calcium and magnesium infusions have been tried as prophylactic therapy for OXIN, showing some benefit and causing no harm.

The authors contend that the current literature addressing the prevention of OXIN is inadequate to guide clinical decision making, and call for further research to develop rational therapeutic options for countering the significant and often dose-limiting morbidity of this side effect.