Reintroduction of oxaliplatin: A viable approach to the long-term management of metastatic colorectal cancer

Oxaliplatin-based chemotherapy is an effective first-line treatment option for patients with metastatic colorectal cancer (mCRC), which, in combination with targeted therapies and a sequential treatment approach using all active agents, has extended median overall survival to 2 years and beyond. Prolonged survival brings into focus the burden of treatment, in terms of associated toxicities and quality of life, and attention is now being paid to lowering the toxicity burden for patients receiving chemotherapy for mCRC without compromising efficacy. The use of oxaliplatin can lead to the development of sensory neuropathy, which commonly limits the dose and/or duration of treatment that can be administered. Temporary withdrawal of oxaliplatin (treatment holidays) has been shown to be an effective strategy for the management of this adverse effect. Data from randomized controlled trials indicate that a formalized stop-and-go approach to the delivery of oxaliplatin does not compromise efficacy, and indeed for some patients may prove beneficial by allowing them to continue treatment for longer periods. This paper presents a critical review of the evidence to support the utility of treatment interruption and reintroduction of oxaliplatin for the long-term management of mCRC.