Haller D G
University of Pennsylvania Cancer Center, Philadelphia, Pennsylvania, USA.
Oncology (Williston Park). 2000 Dec;14(12 Suppl 11):15-20.
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.
新型铂类化合物奥沙利铂（乐沙定）似乎具有活性，无论是单独使用还是联合使用，都可作为晚期结直肠癌一线和二线治疗方案。与其他铂类衍生物不同，它不会引起明显的肾毒性或耳毒性。每2周给予一次基于氟尿嘧啶/亚叶酸的方案，并添加85mg/m²的奥沙利铂，耐受性良好。添加奥沙利铂后腹泻和口腔炎的发生率增加，但可通过调整剂量来控制。奥沙利铂导致3级或4级中性粒细胞减少的发生率也显著更高。中性粒细胞减少伴发热并发症很少见。当在基于氟尿嘧啶的方案中添加奥沙利铂时，其他血液学、肝脏或肾脏毒性的发生率不会增加。与用于治疗结直肠癌的其他药物不同，奥沙利铂会引起急性和慢性神经感觉症状。这些急性症状可通过采取预防措施来处理（例如，治疗后几天避免饮用冷饮/食用冷的食物）。累积性神经毒性是与奥沙利铂治疗相关的剂量限制性毒性。停药后这种毒性似乎是可逆的，并且通常在肿瘤反应开始后很久才会出现。
