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Systematic review of long-term chemotherapy-induced peripheral neuropathy (CIPN) following adjuvant oxaliplatin for colorectal cancer

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Abstract

Purpose

Chemotherapy-induced peripheral neuropathy (CIPN) is the most common dose-limiting side effect of oxaliplatin. It often persists and can adversely affect quality of life of colorectal cancer (CRC) survivors. This systematic review explored the proportions of patients with persistent CIPN and the reporting methods used.

Methods

MEDLINE, EMBASE, Web of Science and CINAHL were searched up to March 2021 for publications reporting CIPN outcomes following adjuvant oxaliplatin-containing chemotherapy at prespecified timepoints in participants with CRC. Secondary outcomes assessed the tools used to measure CIPN. Two authors reviewed full text publications for eligibility, data extraction and appraisal. Meta-analysis was performed where Common Terminology Criteria for Adverse Events (any grade) was reported at the most frequent timepoints.

Results

From 7895 citations identified, 27 studies met the eligibility criteria: six were randomised control trials, and 21 were non-randomised studies. Pooled prevalence of CIPN at 6, 12, 24 and 36 months after chemotherapy were 58%, 45%, 32% and 24% respectively. The average prevalence of CIPN decreased by 26% per year after chemotherapy (pooled RR = 0.74; 95% CI 0.72–0.75). Across all studies, ten separate tools were used as the primary measure of CIPN. Quality appraisal identified open-label design and inadequate reporting of participants lost to follow-up as the main methodological limitations.

Conclusion

Our summary of reported rates of persistent CIPN indicates substantial long-term toxicity affecting CRC survivors, and will help clinicians estimate CIPN risk and its change over time. The heterogeneity of CIPN measures identified in the review highlights the need for a standardised CIPN assessment.

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Data availability

Any data sharing will be at the discretion of the corresponding author following a written request.

Code availability

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Acknowledgements

We thank Elaine Tam (Librarian of Faculty of Medical and Health, University of Sydney) for her valuable guidance and expertise.

Funding

No funding was received for conducting this study. Dr Janette Vardy is supported by a National Health Medical Research Council Investigator Grant (APP1176221).

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Authors and Affiliations

  1. Concord Cancer Centre, Concord Repatriation and General Hospital, Concord, NSW, Australia

    Christina Teng, Jordan Cohen, Prunella L. Blinman & Janette L. Vardy

  2. Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

    Christina Teng, Prunella L. Blinman & Janette L. Vardy

  3. Central Coast Cancer Centre, Gosford, NSW, Australia

    Christina Teng

  4. Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney, NSW, Australia

    Sam Egger

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Contributions

Christina Teng, Prunella Blinman and Janette Vardy were responsible for the study concept. Christina Teng designed the review and performed the literature search. Christina Teng and Jordan Cohen selected the articles for inclusion, and performed data extraction. Christina Teng and Sam Egger performed data analysis. Manuscript was drafted by Christina Teng with critical revisions by Sam Egger, Jordan Cohen, Prunella Blinman and Janette Vardy. All authors read and approved the final manuscript.

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Correspondence to Janette L. Vardy.

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Teng, C., Cohen, J., Egger, S. et al. Systematic review of long-term chemotherapy-induced peripheral neuropathy (CIPN) following adjuvant oxaliplatin for colorectal cancer. Support Care Cancer 30, 33–47 (2022). https://doi.org/10.1007/s00520-021-06502-4

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