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Oxaliplatin SOS — SCE Medical Oncology MCQ

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ModerateGI CancersOxaliplatin SOSSCE Medical Oncology

A 55-year-old man with CRC liver metastases undergoes hepatic resection after neoadjuvant FOLFOX. Pathology shows sinusoidal obstruction syndrome (blue liver). What chemotherapy agent caused this?

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Correct answer: B — Oxaliplatin — sinusoidal obstruction syndrome (SOS/veno-occlusive disease) is a characteristic hepatotoxicity of oxaliplatin causing sinusoidal dilatation, hepatic congestion and the 'blue liver' appearance

Oxaliplatin causes sinusoidal obstruction syndrome (SOS) in approximately 20-50% of patients receiving ≥6 cycles. SOS damages sinusoidal endothelial cells, causing perisinusoidal fibrosis, sinusoidal dilatation and portal hypertension (manifesting as splenomegaly, thrombocytopenia). The 'blue liver' is a classical intraoperative finding. This increases perioperative morbidity (bleeding, liver failure). In contrast, irinotecan causes steatohepatitis ('yellow liver'). This is why preoperative chemotherapy duration should be minimised (3-4 months maximum before liver surgery).

Reference: ESMO 2024 mCRC; Rubbia-Brandt et al Ann Oncol 2004