The experience with oxaliplatin in the treatment of upper gastrointestinal carcinomas.

The treatment for advanced gastroesophageal tumors is still largely based on 5-fluorouracil and cisplatin combinations, and the treatment for advanced pancreatic tumors principally relies on gemcitabine. The need for more active agents is evident in light of the poor outcomes for patients with these tumors. Oxaliplatin is an important chemotherapeutic agent currently being investigated in the treatment of gastrointestinal carcinomas. This diaminocyclohexane-platinum compound has significant differences from cisplatin and carboplatin with respect to its activity and toxicity. It appears to have activity in tumors believed to be marginally sensitive to the other platinum agents, and it is neither ototoxic nor nephrotoxic. The main side effect of oxaliplatin is a sensory neuropathy exacerbated by cold exposure. After extensive clinical development, oxaliplatin has become an important option in the treatment of colorectal cancer. Its role in the treatment of upper gastrointestinal cancers is less well established, but is the focus of intense investigation. Much of what we currently know is based on small phase I and II studies, but knowledge is rapidly accumulating. The fact that cisplatin remains an important drug in the treatment of several upper gastrointestinal cancers raises the hope that oxaliplatin will contribute significantly to the treatment of those malignancies as well. Larger randomized phase III trials are being designed and conducted to fully define the role of oxaliplatin in the treatment of upper gastrointestinal tumors in the relatively near future.