Incidence of atypical acute nerve hyperexcitability symptoms in oxaliplatin-treated patients with colorectal cancer
Abstract
Context
Peripheral, acute or chronic, neurotoxicity is one of the main dose-limiting adverse effects of oxaliplatin (OXA). Acute neurotoxicity is typically characterized by distal and perioral cold-induced paresthesias and dysesthesias, but other uncommon symptoms might also be present.
Objectives
The aim of this post hoc analysis of data extracted from a prospective, multicenter study was to assess the incidence of uncommon acute OXA neurotoxicity symptoms in patients undergoing OXA-based chemotherapy.
Methods
One hundred chemotherapy-naïve patients (62 males, 38 females, aged 64.7 ± 8.7 years) with colorectal cancer scheduled to receive OXA-based therapy (FOLFOX-4, FOLFOX-6, and XELOX) underwent neurologic evaluation after the 1st infusion and then after 3 and 6 months of OXA-based chemotherapy (after 6th or 4th and 12th or 8th cycles, respectively, according to regimen). At evaluation, patients were asked to report the presence and characteristics of acute hyperexcitability symptoms.
Results
Eighty-two patients presented typical symptoms of acute OXA neurotoxicity in the form of cold-induced paresthesias and dysesthesias. In 45/82 (54.9 %) of patients, uncommon symptoms were also present; shortness of breath (32 %), jaw spasm (26 %), fasciculations (25 %), cramps (20 %), and difficulty in swallowing (18 %) were more frequently reported, while voice (4 %) and visual changes, ptosis and pseudolaryngospasm (1 %) occurred rarely. No significant correlation was disclosed between acute OXA neurotoxicity and chemotherapy regimen, cumulative dose of OXA or patients’ age.
Conclusions
A high percentage of patients treated with OXA-based chemotherapy develop acute neurotoxicity also with uncommon manifestations. Since OXA acute neurotoxicity might be related to the onset of chronic neurotoxicity, these patients should be closely monitored to avoid this dose-limiting adverse effect.
Keywords
Oxaliplatin Acute neurotoxicity Hyperexcitability Uncommon symptoms Atypical presentationNotes
Acknowledgments
The authors thank Dr. Mario Ermani for statistical analysis. The Spanish participation has been supported by Grant PI070493 from Instituto de Salud Carlos III’ (ISCIII’). Otherwise, no funding source had a role in the preparation of this paper or in the decision to submit it for publication.
Conflict of interest
The authors have declared no conflicts of interest.
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