Comparison of oxaliplatin and paclitaxel-induced neuropathy (Alliance A151505)
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Oxaliplatin and paclitaxel are commonly used chemotherapies associated with acute and chronic neuropathies. There is a need to better understand the similarities and differences of these clinical syndromes.
Neuropathy data were pooled from patients receiving adjuvant oxaliplatin and weekly paclitaxel or every 3 weeks of paclitaxel. Patients completed daily questionnaires after each chemotherapy dose and the European Organization for Research and Treatment of Cancer quality-of-life questionnaire for patients with chemotherapy-induced peripheral neuropathy before each chemotherapy cycle and for 12 months post-treatment.
Acute neuropathy symptoms from both drugs peaked around day 3. Acute symptoms experienced in cycle 1 predicted occurrence in subsequent cycles. Paclitaxel-induced acute symptoms were similar in intensity in each cycle and largely resolved between cycles. Oxaliplatin-induced acute symptoms were about half as severe in the first cycle as in later cycles and did not resolve completely between cycles. Both drugs caused a predominantly sensory chronic neuropathy (with numbness and tingling being more common than pain). Oxaliplatin-induced neuropathy worsened after the completion of treatment and began to improve 3 months post-treatment. In contrast, paclitaxel-induced neuropathy began improving immediately after chemotherapy cessation. During treatment, the incidence of paclitaxel sensory symptoms was similar in the hands and feet; with oxaliplatin, the hands were affected more than the feet. Both paclitaxel- and oxaliplatin-induced acute neurotoxicity appeared to predict the severity of chronic neuropathy, more prominently with oxaliplatin.
Knowledge of the similarities and differences between neuropathy syndromes may provide insight into their underlying pathophysiology and inform future research to identify preventative treatment approaches.
KeywordsChemotherapy-induced peripheral neuropathy Oxaliplatin neuropathy Paclitaxel neuropathy
Dr. Charles Loprinzi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Authors do not have any relevant financial interests, activities, relationships, or affiliations. The authors thank Dr. Nguyet Le-Lindqwister from Heartland Cancer Research NCORP and Dr. Nassim H. Nabbout from Wichita NCI Community Oncology Research Program for accrual of patients to the studies used for this manuscript.
Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under the Award Number UG1CA189823 (to the Alliance for Clinical Trials in Oncology NCORP Grant), and U10CA180882 to the Alliance Statistics and Data Center (Daniel J. Sargent, PhD), and U10CA180858. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This study was conducted as a collaborative trial of the North Central Cancer Treatment Group and Mayo Clinic and was supported in part by Public Health Service grants U10CA025224, U10CA035090, U10CA035101, U10CA035103, U10CA035113, U10CA035267, U10CA035269, U10CA035272, U10CA035415, U10CA035431, U10CA037404, U10CA037417, U10CA052352, U10CA063844, U10CA063848, and K05CA124477.
Compliance with ethical standards
Conflict of interest
Dr. Charles Loprinzi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Authors do not have any relevant financial interests, activities, relationships, and affiliations.
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