During cycle 1, 43% reported mild symptoms and 46% reported moderate-to-severe symptoms; during cycle two, these percentages were 15% and 84%, indicating an overall increase in symptom severity that then remained stable during subsequent cycles.

All but three patients who did not develop acute symptoms with cycle one developed symptoms, usually mild in severity, during subsequent cycles.

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Chronic neurotoxicity symptoms generally worsened for up to 3 months after treatment before showing improvement.

However, 19% of patients still had severe symptoms 18 months after treatment completion. Researchers found that patients who experienced more severe acute symptoms during cycle one were more likely to develop more severe chronic neurotoxicity.

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Of note, sensory symptoms involving the fingers or hands were more severe during treatment, but symptoms involving the toes and feet were more severe in the months after treatment completion.

In summary, this prospective study found that acute peripheral neuropathy, a nearly universal occurrence with FOLFOX, often did not resolve before the next cycle of treatment and symptoms substantially increased in severity between cycles one and two before stabilizing.

Additionally, the severity of acute symptoms in cycle one predicted the severity of acute symptoms in cycles three to 12 and appeared to predict the development and severity of chronic neurotoxicity during the 18 months following treatment completion.


  1. Pachman DR, Qin R, Seisler DK, et al. Clinical course of oxaliplatin-induced neuropathy: results from the randomized phase III trial N08CB (Alliance). J Clin Oncol. 2015. [published online ahead of print August 17, 2015]. doi: 10.1200/JCO.2014.58.8533.