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Rechallenge with oxaliplatin and peripheral neuropathy in colorectal cancer patients

  • Original Article – Clinical Oncology
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

Oxaliplatin (OXA) is a cornerstone in the treatment of colorectal cancer (CRC). Retreatment with OXA is frequently considered as salvage treatment. OXA-induced neuropathy (OIN) is the most frequent and feared long-term side effect.

Patients and methods

CRC patients receiving at least twice OXA-based chemotherapy lines at our institution between June 2000 and July 2016 were reviewed. The aim of this study was to investigate whether retreatment with OXA increases the risk of developing new or worsening previous neuropathy. OIN was assessed by National Cancer Institute-Common Toxicity Criteria for Adverse Events (NCI), Total Neuropathy Score© (TNS) and nerve-conduction studies.

Results

106 patients were included in the analysis. Median age at OXA-based retreatment was 61.5 (20–83) years. After the first OXA-based chemotherapy treatment, 63.4% of patients developed OIN, 30.7 and 8.9% grades 2 and 3, respectively, after a median of 11 (1–17) cycles. After 30 (11–90) months of median to retreatment with a median of 8 (1–14) OXA cycles, 39.6, 22.6, and 0% of patients developed grade 1, 2, and 3 OIN, respectively. Worsening of the previous OIN was observed in one-third (31.1%) of all patients. OXA-cumulative dose was independently associated with greater risk of worsening OIN (p < 0.001). Non-significant trend towards higher TNSc© scores after retreatment was observed [5 (0–11) vs 6 (3–13), p = 0.083].

Conclusion

Retreatment with OXA in CRC patients is a feasible option even in patients who previously developed moderate or severe OIN. One-third of patients’ OIN was worsened by retreatment. Neurological monitoring should be considered.

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Abbreviations

OXA:

Oxaliplatin

CRC:

Colorectal cancer

OIN:

Oxaliplatin-induced neuropathy

PN:

Peripheral neuropathy

NCI:

National Cancer Institute-common toxicity criteria for adverse events

TNS:

Total Neuropathy Score©

5-FU:

5-fluorouracil

FOLFOX:

OXA and 5-FU with leucovorin

XELOX:

OXA and oral capecitabine

EGFR:

Epidermal growth factor receptor

NCS:

Nerve-conduction studies

SNAP:

Sensory nerve action potentials

CMAP:

Compound muscle action potential

DM:

Diabetes mellitus

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Funding

This work was partially supported by grant PI1501303 and INT16/00219 from ISCIII and Fondo Europeo de Desarrollo Regional (FEDER).

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Authors and Affiliations

  1. Neuro-Oncology Unit, Neurology Department, Hospital Universitari de Bellvitge-Institut Català d´Oncologia-IDIBELL, C/Feixa Llarga s/n, L´Hospitalet de Llobregat, 08907, Barcelona, Spain

    Sarah Besora, Cristina Izquierdo, Jordi Bruna & Roser Velasco

  2. Neurology Department, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain

    Sarah Besora

  3. Medical Oncology Department, Institut Català d´Oncologia-IDIBELL, CIBERONC, L’Hospitalet de Llobregat, Barcelona, Spain

    Cristina Santos & Maria Mercedes Martinez-Villacampa

  4. Service de Neuro-Oncologie, Hospices Civils de Lyon, Groupe Hospitalier Est, Lyon Cedex, France

    Cristina Izquierdo

  5. Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain

    Jordi Bruna & Roser Velasco

Authors
  1. Sarah Besora
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  4. Maria Mercedes Martinez-Villacampa
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  6. Roser Velasco
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Corresponding author

Correspondence to Roser Velasco.

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Conflict of interest

Sarah Besora declares that she has no conflict of interest. Cristina Santos declares that she has no conflict of interest. Cristina Izquierdo declares that she has no conflict of interest. Maria Mercedes Martinez-Villacampa declares that she has no conflict of interest. Jordi Bruna declares that he has no conflict of interest. Roser Velasco declares that she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was considered not necessary for the study, as it was a retrospective analysis of our daily routine practice.

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Besora, S., Santos, C., Izquierdo, C. et al. Rechallenge with oxaliplatin and peripheral neuropathy in colorectal cancer patients. J Cancer Res Clin Oncol 144, 1793–1801 (2018). https://doi.org/10.1007/s00432-018-2691-8

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  • DOI: https://doi.org/10.1007/s00432-018-2691-8

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