Cancer and Clinical Oncology; Vol. 1, No. 2; 2012 ISSN 1927-4858 E-ISSN 1927-4866 Published by Canadian Center of Science and Education 45 Is there a Diference between Brand and Generic Oxaliplatin? Kakil I. Rasul 1 , A. Sadig Kamal 1 , Nahla M. Al-Najjar 1 & Muhammad H. Oculalan 1 1 Prem Chandra, Al-Amal Hospital/Doha, Qatar Correspondence: Kakil Ibrahim Rasul, CABM, FRCP Edin, ESMO, Senior Consultant Hematology/Oncology, Al-Amal Hospital, P.O. Box 3050, Doha, Qatar. E-mail: kakil954@yahoo.com Received: February 16, 2011 Accepted: March 1, 2012 Online Published: June 18, 2012 doi:10.5539/cco.v1n2p45 URL: http://dx.doi.org/10.5539/cco.v1n2p45 Abstract Oxaliplatin-based chemotherapy is the preferred first-line combination chemotherapy for metastatic colorectal cancer. In the last few years the generic oxaliplatin had been introduced, some personal observation that there may be difference in the spectrum of the side effects of this compound generic and the brand preparations. The use of generic drugs has become increasingly common in clinical practice. The generic drugs are chemical medicines have simple and well-defined structures that are manufactured after the patency of the medicine is over. We collected data from two group of patient who had colorectal cancer, 1 st group received the brand oxaliplatin based chemotherapy and 2 nd group received the generic oxaliplatin based chemotherapy. The hematological adverse effect was not significantly different between the 2 groups but the generic oxaliplatin is associated with higher non hematological side effect than the brand oxaliplatin, both peripheral sensory neuropathy and the hand- foot syndrome. Larger prospective randomised study needed to prove these data. Keywords: oxaliplatin, FOLFOX, colorectal cancer, chemotherapy 1. Introduction In the late 1980s, oxaliplatin (Eloxatin) was found to have activity in advanced CRC, and it is the only platinum derivative with activity against advance colorectal cancer (CRC) (Raymond et al., 1998; Rixe et al., 1996). It is mechanism of action is that it binds and cross-links strands of DNA, forming DNA adducts—thus inhibiting DNA replication and transcription. Oxaliplatin also displays synergistic in vitro cytotoxicity with 5-FU against human colorectal cell lines (de Gramont et al., 2000). A potential mechanism for this synergism is the down regulation of thymidylate synthase by oxaliplatin, which thereby potentiates the efficacy of 5-FU (Fischel et al., 1998; Meyerhardt & Mayer, 2005). The combination of oxaliplatin plus 5-FU/leucovorin is known as the FOLFOX regimen, and it has become a standard regimen for CRC, both as adjuvant therapy and as treatment for metastatic disease (Meyerhardt & Mayer, 2005). Oxaliplatin is a platinum derivative in which the platinum atom is complexed with1, 2 diaminocyclohexane (DACH) and with an oxalate ligand as a leaving group. It was synthesized with the goal of trying to overcome resistance to first- and second generation platinum compounds (Giacchetti et al., 2000). The use of generic drugs has become increasingly common in clinical practice. The generic drugs are chemical medicines have simple and well-defined structures that are manufactured after the patency of the medicine is over. Oxaliplatin is one of the medicine which have both the brand and the generic preparation are available in the market. The mechanism of action of oxaliplatin is similar to that of cisplatin as well as other platinum compounds. Studies conducted to date indicate that the types and percentages of Pt-DNA adducts formed by oxaliplatin are qualitatively similar to those formed by cisplatin, but preclinical data suggest several unique attributes of the cytotoxic/antitumor activity of oxaliplatin. Oxaliplatin demonstrates a broad spectrum of in vitro cytotoxic and in vivo antitumor activity that differs from that of either cisplatin or carboplatin. Oxaliplatin is active against several cisplatin-resistant cell lines, colon carcinoma, and other solid tumours that are not responsive to cisplatin. In addition, oxaliplatin in combination with 5-FU leads to synergistic antiproliferative activity in several in vivo tumour models (Raymond, Chaney, Taamma, & Cvitkovic, 1998). Oxaliplatin has been used showed efficacy in treatment of many cancers like colon, gastric, pancreatic, and liver. In phase III studies, oxaliplatin in combination with 5-FU/LV (FOLFOX-4) has demonstrated superiority in terms of response rate and progression-free survival versus 5- FU/LV (De Gramont et al., 2000). Furthermore, the FOLFOX-4 regimen has shown superiority in RR, TTP and OS vs the Saltz regimen of irinotecan in combination with bolus 5-FU/LV. Oxaliplatin has been