Key points
- Oxaliplatin is a platinum-based chemotherapy drug used with fluorouracil and leucovorin in bowel cancer (after surgery and in advanced disease) [1].
- After surgery for bowel cancer, adding oxaliplatin lowered the chance of the cancer coming back and helped patients live longer [2].
- It is also part of standard combinations for stomach and pancreatic cancer [3, 4].
- Its hallmark side effect is numbness and tingling in the hands, feet and around the mouth, made worse by cold; almost every patient has some degree of it [1].
- It can cause a severe allergic reaction at any infusion; report itching, shortness of breath or dizziness straight away [1].
What is this drug and how does it work?
For physicians
Oxaliplatin (brand name Eloxatin) is a platinum-based compound first approved in the United States in 2002 [1]. In the body it loses its oxalate group and turns into active "DACH-platinum" derivatives that bind to DNA and form cross-links within and between DNA strands; these cross-links stop DNA replication and transcription, and the drug's effect does not depend on a particular phase of the cell cycle [1].
In laboratory models, oxaliplatin combined with fluorouracil had a greater antiproliferative effect than either drug alone [1]; this is why it is almost always given with fluorouracil (the FOLFOX regimen) or capecitabine (the CAPOX regimen) [1, 5].
Which cancers is it used for?
Your doctor may prescribe this drug for:
- Stage 3 colon cancer [1, 5]
- Advanced or spread bowel cancer [1, 5]
- Cancer of the stomach, oesophagus or the junction between them [3, 9]
- Pancreatic cancer [4, 10]
Whether it suits you depends on the type and stage of your cancer and your test results. Details of each use are in the section for doctors.
For physicians
| Cancer | Treatment setting |
|---|---|
| Stage 3 colon cancer | Adjuvant treatment after complete removal of the tumour, with fluorouracil and leucovorin (FOLFOX) or capecitabine (CAPOX) [1, 5] |
| Advanced or metastatic colorectal cancer | With fluorouracil and leucovorin, or with capecitabine [1, 5] |
| Gastric, oesophageal and gastro-oesophageal junction cancer | The FLOT regimen before and after surgery [3] and platinum-based regimens in advanced disease [9] (this use is not in the FDA label for oxaliplatin) |
| Pancreatic cancer | Part of FOLFIRINOX in metastatic disease [4] and as adjuvant treatment [10] (this use is not in the FDA label for oxaliplatin) |
| Cancer | Key evidence |
|---|---|
| Stage 3 colon cancer | MOSAIC (stage 3): 5-year disease-free survival 66.4% vs 58.9% (HR 0.78) [1]; MOSAIC (all stage 2 and 3 patients): 5-year disease-free survival 73.3% vs 67.4% and 6-year overall survival 78.5% vs 76.0% [2]; NO16968: CAPOX vs fluorouracil/leucovorin, HR for disease-free survival 0.80 [6]; IDEA: 3 months of CAPOX was non-inferior to 6 months (HR 0.95), but this was not shown for FOLFOX (HR 1.16) [7] |
| Advanced or metastatic colorectal cancer | First line: median progression-free survival 9.0 vs 6.2 months and response 50.7% vs 22.3% with added oxaliplatin [8] |
| Gastric, oesophageal and gastro-oesophageal junction cancer | FLOT4: median overall survival 50 vs 35 months (HR 0.77) [3]; REAL-2: oxaliplatin was non-inferior to cisplatin (HR for death 0.92) [9] |
| Pancreatic cancer | ACCORD 11: median overall survival 11.1 vs 6.8 months (HR 0.57) [4]; PRODIGE 24: median disease-free survival 21.6 vs 12.8 months (HR 0.58) [10] |
HR: hazard ratio; a value below 1 favours the oxaliplatin-containing regimen.
How it is given and dose
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Treatment regimens and doses: index5 regimens
Oxaliplatin is given at the treatment centre as an intravenous infusion over about 2 hours [1].
- In the FOLFOX regimen it is given once every 2 weeks with leucovorin and fluorouracil; after surgery, for up to 12 cycles (about 6 months) [1].
- In the CAPOX regimen it is given once every 3 weeks with capecitabine tablets; after surgery, for up to 8 cycles [5].
- If non-life-threatening reactions happen during the infusion, your doctor may lengthen the infusion to 6 hours [1]. Do not stop treatment without talking to your doctor; the decision to lower the dose or stop the drug (for example because of neuropathy) is made by your doctor [1].
Before starting and before each cycle: CBC, liver tests and electrolytes (correct electrolyte disturbances before starting); creatinine clearance; ECG in heart failure, bradyarrhythmia, electrolyte disturbance or use of QT-prolonging drugs. Avoid in congenital long QT syndrome. Delay the next cycle until neutrophils are 1.5×10⁹/L or more and platelets 75×10⁹/L or more [1].
Administration: dilute only in 250 to 500 mL of 5% dextrose (not sodium chloride or chloride-containing solutions); do not give at the same time through the same line as alkaline drugs such as fluorouracil, and flush the line with 5% dextrose before any other drug; do not use needles or sets containing aluminium. Stop immediately and permanently for an allergic reaction (boxed warning). Lengthening the infusion from 2 to 6 hours may reduce acute toxicities (such as non-life-threatening infusion reactions) [1].
Kidney: CLcr below 30 mL/min (Cockcroft-Gault): dose 65 mg/m² [1]. Capecitabine at CLcr 30 to 50: reduce the dose by 25%; at CLcr below 30 no dose has been established [5].
Oxaliplatin dose adjustment (FOLFOX) [1]:
- Peripheral sensory neuropathy: persistent grade 2, consider a dose reduction (adjuvant to 75, advanced to 65 mg/m²); persistent grade 3, consider stopping; grade 4, stop.
- Grade 4 neutropenia, febrile neutropenia or grade 3 to 4 thrombocytopenia: delay until counts recover and reduce the dose to 75 (adjuvant) or 65 mg/m² (advanced). Stop treatment in sepsis or septic shock.
- Grade 3 to 4 gastrointestinal toxicity: after recovery, reduce oxaliplatin to 75 (adjuvant) or 65 mg/m² (advanced) and fluorouracil to a 300 mg/m² bolus and a 500 mg/m² 22-hour infusion.
- Stop permanently: allergic reaction, PRES, confirmed interstitial lung disease or pulmonary fibrosis, rhabdomyolysis. With unexplained respiratory symptoms, hold treatment until ILD is excluded.
Capecitabine (CAPOX): before starting capecitabine, testing for DPYD gene variants is recommended unless immediate treatment is needed; avoid capecitabine in complete DPD deficiency [5]. Missed or vomited doses are not made up. Grade 2 toxicity: first time, interrupt until grade 0 to 1 and resume at 100%; second time 75%; third time 50%; fourth time stop permanently. Grade 3: first time 75%, second time 50%, third time stop permanently. Grade 4: stop permanently or (after recovery to grade 0 to 1) 50%. Concomitant warfarin needs frequent INR monitoring [5].
Liver monitoring: with abnormal liver tests or unexplained portal hypertension, look for hepatic vascular disorders (such as sinusoidal obstruction syndrome) [1].
For physicians
Standard doses and combination regimens (FDA label and key trials)
FOLFOX4
Stage III colon cancer after complete resection (adjuvant); advanced colorectal cancerCycle length: Every 14 days
Stage III colon cancer after complete resection (adjuvant); advanced colorectal cancer
Before prescribing: Prescribing notes| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Day 1 | |||
| Oxaliplatin | 85 mg/m² | IV infusion over 120 minutes (at the same time as leucovorin, in a separate bag) | Day 1 |
| Days 1 and 2 | |||
| Leucovorin | 200 mg/m² | IV infusion over 120 minutes | Days 1 and 2 |
| Fluorouracil bolus | 400 mg/m² | IV over 2 to 4 minutes, after leucovorin | Days 1 and 2 |
| Fluorouracil infusion | 600 mg/m² | Continuous 22-hour infusion | Days 1 and 2 |
The only oxaliplatin regimen in the FDA label [1].
CAPOX (XELOX)
Adjuvant colon; unresectable or metastatic colorectal cancerCycle length: Every 21 days
Adjuvant colon; unresectable or metastatic colorectal cancer
Before prescribing: Prescribing notes| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Oxaliplatin | 130 mg/m² | IV infusion | Day 1 |
| Capecitabine | 1000 mg/m² twice a day | Oral, within 30 minutes after a meal, about 12 hours apart | Days 1 to 14 |
Doses from the capecitabine label [5]. In the IDEA trial, in low-risk stage III colon cancer (T1-3 N1), 3 months of CAPOX was non-inferior to 6 months for disease-free survival and caused much less neuropathy [7].
Evidence: IDEA (2018)
CAPOX in gastric, oesophageal or gastro-oesophageal junction cancer
Unresectable or metastatic diseaseCycle length: Every 21 days
Unresectable or metastatic disease
Before prescribing: Prescribing notes| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Oxaliplatin | 130 mg/m² | IV infusion | Day 1 |
| Capecitabine | 850 or 1000 mg/m² twice a day | Oral | Days 1 to 14 |
As in the capecitabine label; the capecitabine dose is chosen according to the patient's risk factors [5].
FLOT (before and after surgery)
Resectable gastric or gastro-oesophageal junction adenocarcinoma (cT2 or higher, or cN+)Cycle length: Every 14 days
Resectable gastric or gastro-oesophageal junction adenocarcinoma (cT2 or higher, or cN+)
Before prescribing: Prescribing notes| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Docetaxel | 50 mg/m² | IV | Day 1 |
| Oxaliplatin | 85 mg/m² | IV | Day 1 |
| Leucovorin | 200 mg/m² | IV | Day 1 |
| Fluorouracil | 2600 mg/m² | Continuous 24-hour infusion | Day 1 |
The FLOT4 trial regimen; not in the FDA label for oxaliplatin [3].
Evidence: FLOT4 (2019)
FOLFIRINOX and modified FOLFIRINOX
Metastatic pancreatic cancer (ECOG 0 to 1); adjuvant treatment after pancreatic resectionCycle length: Every 14 days
Metastatic pancreatic cancer (ECOG 0 to 1); adjuvant treatment after pancreatic resection
Before prescribing: Prescribing notes| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Metastatic | |||
| Oxaliplatin / irinotecan / leucovorin | 85 / 180 / 400 mg/m² | IV | Day 1 |
| Fluorouracil | 400 mg/m² bolus, then 2400 mg/m² | IV bolus, then continuous 46-hour infusion | Days 1 to 3 |
| Adjuvant (modified) | |||
| Oxaliplatin / irinotecan / leucovorin | 85 / 150 (initially 180) / 400 mg/m² | IV | Day 1 |
| Fluorouracil | 2400 mg/m², no bolus | Continuous IV infusion | Day 1 |
The regimens of the PRODIGE 4/ACCORD 11 and PRODIGE 24 trials; not in the FDA label for oxaliplatin. In PRODIGE 24 the irinotecan dose was reduced from 180 to 150 mg/m² after a pre-specified safety analysis [4, 10].
Evidence: PRODIGE 4 / ACCORD 11 (2011), PRODIGE 24 / CCTG PA.6 (2018)
Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.
Side effects
The most common side effects:
- Numbness and tingling in the hands, feet, around the mouth or in the throat in most patients, especially with cold; for a few days after the infusion avoid cold drinks and food and keep your hands warm [1].
- With continued treatment this numbness may last longer and make tasks such as writing or doing up buttons difficult; tell your team early so the dose can be adjusted. In most patients it slowly improves after treatment ends [1, 2].
- Nausea, diarrhoea, vomiting, tiredness, mouth sores and fever [1].
- Mild hair thinning (not complete hair loss) and changes in taste [1].
For physicians
| Side effect | All grades | Grade 3 or 4 |
|---|---|---|
| Peripheral sensory neuropathy (numbness, tingling) | 92% | 12% |
| Nausea | 74% | 5% |
| Diarrhoea | 56% | 11% |
| Vomiting | 47% | 6% |
| Tiredness | 44% | 4% |
| Mouth sores and inflammation | 42% | 3% |
| Hair loss (no cases of complete hair loss were reported) | 30% | — |
| Fever | 27% | 1% |
| Taste changes | 12% | — |
| Allergic reaction | 10% | 3% |
Source: FDA label for oxaliplatin [1]. Grade 3–4 neutropenia occurred in 41 to 44% of colorectal cancer patients receiving oxaliplatin with fluorouracil/leucovorin [1].
Two kinds of neuropathy are seen with oxaliplatin [1]:
- Acute neuropathy: within hours to 2 days of the infusion, made worse by cold, appearing as tingling or numbness of the hands, feet, around the mouth or in the throat; sometimes it causes a feeling of difficulty swallowing or shortness of breath without real airway obstruction. It usually resolves within 14 days and occurred in about 56% of patients.
- Persistent (delayed) neuropathy: lasts more than 14 days and may make tasks such as writing, doing up buttons or walking difficult. In MOSAIC, 60% of patients had some neuropathy 28 days after the end of treatment, 39% after 6 months and 21% after 18 months, mostly mild [1].
In long-term follow-up of MOSAIC, grade 3 neuropathy persisted in 1.3% of patients at 12 months after treatment and in 0.7% at 48 months [2].
Serious side effects
These side effects are less common but serious; if you notice any sign of them, tell your team early:
- A severe allergic reaction within minutes of starting the infusion, at any cycle: itching, hives, shortness of breath, dizziness; tell the nurse straight away [1].
- Infection because of low white blood cells: a temperature of 38 °C or chills [1].
- Severe headache with confusion, seizures or blurred vision [1].
- A new cough or shortness of breath, palpitations or fainting, severe muscle pain, and bleeding [1].
- Harm to an unborn baby [1].
For physicians
Boxed warning: serious and fatal allergic reactions, including anaphylaxis, can occur within minutes of starting the infusion and at any cycle. Grade 3–4 reactions were seen in 2 to 3% of colon cancer patients. Use is contraindicated with a history of allergy to oxaliplatin or other platinum drugs [1].
Other warnings in the label [1]:
- Severe bone marrow suppression and infection, sepsis and septic shock (sometimes fatal).
- Posterior reversible encephalopathy syndrome (PRES) in fewer than 0.1% of patients: headache, altered mental state, seizures and visual disturbance.
- Pulmonary toxicity: pulmonary fibrosis (less than 1%), which may be fatal.
- Hepatotoxicity: raised liver enzymes (57% vs 34% in the adjuvant setting) and hepatic sinusoidal injury.
- QT prolongation and ventricular arrhythmias, including fatal torsade de pointes.
- Rhabdomyolysis (muscle breakdown), sometimes fatal.
- Bleeding (gastrointestinal, urinary, nose), immune thrombocytopenia and raised INR with concomitant anticoagulants.
- Embryo-fetal toxicity.
When should I call my doctor?
Get emergency help straight away if you have breathing problems, a feeling that your throat is closing, chest pressure or pain, wheezing, dizziness or feeling faint, or swelling of the face, eyelids or lips [1].
Also call your doctor straight away for [1]:
- Fever or signs of infection, especially with persistent diarrhoea
- Any bleeding
- A persistent or recurring dry cough or shortness of breath
- Headache with confusion, seizures, or disturbed or reduced vision
- Fainting (syncope)
- New muscle pain or weakness, dark urine, passing less urine or being unable to pass urine
- Persistent vomiting or diarrhoea, or signs of dehydration
- Signs of liver damage, such as yellowing of the skin or eyes
Interactions, pregnancy and precautions
- Cold: avoid cold drinks, ice and contact with cold objects or cold air. Using ice in the mouth to prevent mouth sores is not recommended with oxaliplatin, because cold makes the acute nerve symptoms worse [1].
- Other medicines: avoid taking medicines that prolong the QT interval and medicines that harm the kidneys at the same time; if you take an oral anticoagulant, your INR should be checked often [1]. Give your doctor a full list of your medicines [1].
- Pregnancy and contraception: pregnancy should be checked before starting. Women should use effective contraception for 9 months, and men whose partner could become pregnant for 6 months, after the last dose. The drug may reduce fertility [1].
- Breastfeeding: do not breastfeed during treatment and for 3 months after the last dose [1].
- Driving: temporary visual disturbance may affect your ability to drive [1].
- Older people (65 and over) had slightly more severe diarrhoea and severe drops in white blood cells [1].
Frequently asked questions
Why shouldn’t I drink cold water after an oxaliplatin infusion?
The short-term nerve effect of oxaliplatin (acute neuropathy) is set off or made worse by cold, and it can cause tingling in the hands and mouth or an uncomfortable feeling in the throat; that is why you should avoid cold drinks, ice and touching cold things [1].
Will the numbness in my hands and feet be permanent?
Will oxaliplatin make my hair fall out?
Hair loss happened in about 1 in 3 patients, about the same as when oxaliplatin was not given, and no one lost all their hair [1].
Are 3 months of chemotherapy after surgery enough?
In an analysis of several large studies, 3 months of capecitabine with oxaliplatin (CAPOX) worked about as well as 6 months, but this was not shown for the drip-only regimen FOLFOX [7]. Your doctor decides how long the treatment lasts, based on your risk of the cancer coming back and how well you cope with the treatment.
If I had no allergy in earlier cycles, can an allergic reaction still happen?
Yes. A severe allergic reaction can happen in any cycle, within a few minutes of starting the infusion; tell the nurse straight away about any symptom such as itching, hives, shortness of breath or a swollen face [1].
Scientific evidence
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Key studies
13 itemsDuration of Adjuvant Chemotherapy for Stage III Colon Cancer
Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial
FOLFIRINOX versus Gemcitabine for Metastatic Pancreatic Cancer
Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial
Atezolizumab plus FOLFOX for Stage III Mismatch Repair-Deficient Colon Cancer
Encorafenib, Cetuximab, and mFOLFOX6 in BRAF-Mutated Colorectal Cancer
NALIRIFOX versus nab-paclitaxel and gemcitabine in treatment-naive patients with metastatic pancreatic ductal adenocarcinoma (NAPOLI 3): a randomised, open-label, phase 3 trial
Zolbetuximab plus mFOLFOX6 in patients with CLDN18.2-positive, HER2-negative, untreated, locally advanced unresectable or metastatic gastric or gastro-oesophageal junction adenocarcinoma (SPOTLIGHT): a multicentre, randomised, double-blind, phase 3 trial
Zolbetuximab plus CAPOX in CLDN18.2-positive gastric or gastroesophageal junction adenocarcinoma: the randomized, phase 3 GLOW trial
Pembrolizumab plus chemotherapy versus placebo plus chemotherapy for HER2-negative advanced gastric cancer (KEYNOTE-859): a multicentre, randomised, double-blind, phase 3 trial
FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer
Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial
First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial
Clinical guidelines
4 itemsLocalised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
Localised rectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up
Gastric cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up
Pancreatic cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up
Related cancer types
Treatment regimens (physicians)
References
10 referencesShow all references, 8 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
- 1
- 2
- 3Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial
- 4
- 5
- 6Capecitabine Plus Oxaliplatin Compared With Fluorouracil and Folinic Acid As Adjuvant Therapy for Stage III Colon Cancer
- 7
- 8Leucovorin and Fluorouracil With or Without Oxaliplatin as First-Line Treatment in Advanced Colorectal Cancer
- 9
- 10
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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