Severity of Oxaliplatin-induced Neuropathy in Cycle One Predicts Severity, Development of Neurotoxicity
Acute peripheral neuropathy often does not resolve between cycles of treatment and severity often increases between cycles.
Researchers from the North Central Cancer Treatment Group, Alliance have prospectively assessed the timing and course of oxaliplatin-induced neuropathy to elucidate the relationship between severity of acute peripheral neuropathy and chronic neurotoxicity.
Their results, published online in the Journal of Clinical Oncology, indicate that the severity of acute peripheral neuropathy during cycle one of oxaliplatin is predictive of symptom severity in subsequent treatment cycles and the development of chronic neurotoxicity after treatment completion.
Patients with colon cancer scheduled to receive 12 cycles of FOLFOX (fluorouracil, leucovorin, oxaliplatin) following surgery with curative intent were enrolled in the prospective, phase 3 N08CB study, performed in order to determine whether intravenous calcium and magnesium could prevent oxaliplatin-induced neuropathy. The intervention failed to prevent neuropathy.
However, data accrued from the patient questionnaires were used to provide insight into the development and course of peripheral neuropathy.
Acute peripheral neuropathy was assessed using rating scales completed daily for 5 days after initiation of each 2-week FOLFOX cycle.
Chronic neurotoxicity was measured using the 20-item EORTC Quality of Life Questionnaire specific to patients with chemotherapy-induced peripheral neuropathy (EORTC QLQ-CIPN20) at the start of each FOLFOX cycle, before each dose of chemotherapy, and at 1, 3, 6, 12, and 18 months after completion of chemotherapy.1
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The incidence of acute oxaliplatin-induced peripheral neuropathy was very high: 89% (308/346) of patients reported at least one symptom with the first cycle of therapy.
Symptoms appeared as early as day 1 of cycle one and peaked in severity around day 3 before decreasing, although for some patients, symptoms did not resolve prior to the start of cycle two. This pattern was repeated in subsequent cycles.