Following the successful introduction of
oxaliplatin into the management of advanced
colorectal cancer, its clinical utility is currently being investigated in a variety of other
malignancies, including
cancers of the upper gastrointestinal tract. In advanced
pancreatic cancer,
oxaliplatin has been found to be clinically effective in phase II trials in which it was combined with either
5-fluorouracil (5-FU) or
gemcitabine, the current standard
chemotherapy for this disease. In a phase II trial involving 67 patients, the combination of
oxaliplatin and
5-FU in a high dose infusional regimen (n = 31) achieved an objective response rate of 9.7%, stable disease for at least three cycles in 48.4% of patients, tumour growth control in 58% of patients, a median time to progression of 4.9 months and median overall survival reaching 9.2 months. In combination with
gemcitabine in a phase II trial involving 64 patients with metastatic (n = 34) or locally advanced (
n = 30)
pancreatic cancer, there was an objective response rate of 30.6%, treatment benefit in 39.7%, a median progression-free survival of 5.3 months and again a median overall survival of 9.2 months. Response rates and survival times did not differ between locally advanced and metastatic disease. On the basis of these encouraging results, phase III studies of
oxaliplatin in advanced
pancreatic cancer are now in progress in Europe and the United States. In metastatic
gastric cancer, a phase II study investigated the combined use of
oxaliplatin and
5-FU using the FOLFOX6 regimen in 53 patients, of whom 49 were evaluable for efficacy. The objective response rate was 44.9% and the median duration of response was 7.9 months. Large phase III trials of
oxaliplatin-based treatment for advanced
gastric cancer are now in progress.
Oxaliplatin is also being investigated in oesophageal
cancer and several other gastrointestinal tumours. In summary,
oxaliplatin is emerging as an effective and highly promising chemotherapeutic agent for the treatment of upper gastrointestinal
malignancies.