A descriptive study of persistent oxaliplatin-induced peripheral neuropathy in patients with colorectal cancer
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Prolonged neurotoxicity after systemic chemotherapy has the potential to impact on quality of life. We explored the frequency of persistent peripheral neuropathy in patients who received oxaliplatin for colorectal cancer at two local centres.
Patients and methods
Questionnaires were sent to patients who completed treatment with oxaliplatin for colorectal cancer at least 20 months prior to entering the study. Neuropathy questions were adapted from the FACT/GOG-Ntx (V.4) questionnaire.
Of the 56 eligible patients, 27 returned the questionnaire. Twenty-five patients (93 %) experienced neuropathic symptoms during their treatment; 11 had grade-2, and two had grade-3 symptoms. At the time of completing the questionnaire, 17 patients (63.0 %; 95%CI 43.9–79.4 %) were still symptomatic with 12 patients (44.4 %; 95%CI 26.8–63.3) having grade-2 or grade-3 symptoms and three patients (11.1 %; 95%CI 2.9–27.3) having grade-3 neuropathic symptoms. Participants who received more than 900 mg/m2 oxaliplatin had a significantly higher risk of persistent grade-2 or grade-3 neuropathy (p = 0.031, RR = 8.3 95%CI = 1.2–57.4). There was a trend toward increased risk of persistent neuropathy of any grade among participants with a history of regular alcohol use (p = 0.051; RR = 1.7 95%CI 1.0–2.8).
Persistent oxaliplatin-induced neuropathy is not as uncommon as previously suggested, and the rate of grade-2 and grade-3 symptoms could be considerably higher than previous reports.
KeywordsOxaliplatin Neurotoxicity syndromes Colorectal neoplasms Antineoplastic agents Colonic neoplasms Rectal neoplasms Antineoplastic combined chemotherapy protocols
- 4.Jemal A, Center MM, Desantis C, Ward EM (2010) Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res cosponsored by the Am Soc Prev Oncol 19(8):1893–1907Google Scholar
- 6.De Gramont A, Figer A, Seymour M et al (2000) Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol Off J Am Soc Clin Oncol 18(16):2938–2947Google Scholar
- 17.Grothey A (2005) Clinical management of oxaliplatin-associated neurotoxicity. Clin Color Cancer 5(Suppl 1):S38–S46Google Scholar
- 20.Denlinger CS, Barsevick AM (2009) The challenges of colorectal cancer survivorship. J Nat Compr Cancer Netw JNCCN 7(8):883–893, quiz 894Google Scholar
- 21.Calhoun EA, Welshman EE, Chang CH et al (2003) Psychometric evaluation of the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (Fact/GOG-Ntx) questionnaire for patients receiving systemic chemotherapy. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 13(6):741–748CrossRefGoogle Scholar
- 25.Combination chemotherapy after surgery in treating patients with high-risk stage II or stage III colorectal cancer: clinicaltrials.gov Identifier: NCT00749450. http://clinicaltrials.gov/ct2/show/NCT00749450. Accessed 25 August 2013
- 27.D'amour ML, Bruneau J, Butterworth RF (1991) Abnormalities of peripheral nerve conduction in relation to thiamine status in alcoholic patients. Can J Neurol Sci Le journal canadien des sciences neurologiques 18(2):126–128Google Scholar
- 30.Vincenzi B, Frezza AM, Schiavon G et al (2013) Identification of clinical predictive factors of oxaliplatin-induced chronic peripheral neuropathy in colorectal cancer patients treated with adjuvant Folfox IV. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 21(5):1313–1319Google Scholar
- 32.Gamelin L, Boisdron-Celle M, Delva R et al (2004) Prevention of oxaliplatin-related neurotoxicity by calcium and magnesium infusions: a retrospective study of 161 patients receiving oxaliplatin combined with 5-fluorouracil and leucovorin for advanced colorectal cancer. Clin Cancer Res Off J Am Assoc Cancer Res 10(12 Pt 1):4055–4061CrossRefGoogle Scholar
- 36.Charles L. Loprinzi RQ, Shaker R. Dakhil, Louis Fehrenbacher, Philip J. Stella, Pamela J. Atherton, Drew K. Seisler, Rubina Qamar, Grant Carlton Lewis, Axel Grothey: Phase III randomized, placebo (PL)-controlled, double-blind study of intravenous calcium/magnesium (CaMg) to prevent oxaliplatin-induced sensory neurotoxicity (sNT), N08CB: an alliance for clinical trials in oncology study. http://meetinglibrary.asco.org/content/113106-132. Accessed 25 August 2013
- 37.Bennett BK, Park SB, Lin CS, Friedlander ML, Kiernan MC, Goldstein D (2012) Impact of oxaliplatin-induced neuropathy: a patient perspective. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 20(11):2959–2967Google Scholar