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Acute Oxaliplatin Neuropathy — SCE Medical Oncology MCQ

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EasyGI CancersAcute Oxaliplatin NeuropathySCE Medical Oncology

A 65-year-old man with metastatic CRC on FOLFOX develops cold-induced paraesthesia in his hands and feet, with jaw tightness when drinking cold liquids. This occurs immediately during oxaliplatin infusion. What type of oxaliplatin neuropathy is this?

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Correct answer: E — Acute cold-triggered neurotoxicity — a distinct oxaliplatin toxicity caused by altered sodium channel function; it occurs during or shortly after infusion, is triggered by cold exposure, and is transient (resolving in days); it is NOT the same as cumulative chronic neuropathy

Oxaliplatin causes two distinct types of neurotoxicity: (1) ACUTE (during/immediately after infusion): cold-triggered distal and perioral paraesthesia, jaw tightness, muscle cramps — caused by oxaliplatin-induced sodium channelopathy affecting voltage-gated Na+ channels. It is self-limiting (hours-days) and prevented by avoiding cold exposure for 3-5 days post-infusion. (2) CHRONIC cumulative: dose-dependent persistent sensory neuropathy (similar to cisplatin). Only the chronic form is dose-limiting and may be irreversible. Patients should be counselled to avoid cold drinks and cold exposure.

Reference: BNF Oxaliplatin; ESMO Supportive Care; NICE NG151