A prospective observational study to assess peripheral neuropathy in patients receiving weekly paclitaxel chemotherapy
DOI:
https://doi.org/10.18203/2349-3933.ijam20232916Keywords:
Paclitaxel dosage, Grades of neuropathy, CA breastAbstract
Background: Peripheral neuropathies are disorders of peripheral nerve cells and fibres. Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of anticancer treatment, and it can affect the patient's long-term survival. The prevalence of CIPN is around 38%. Peripheral neurotoxicity (PN) is a side effect of paclitaxel that can lead to treatment discontinuation. The intensity and severity of neuropathy is more with patients receiving weekly paclitaxel chemotherapy.
Methods: 60 patients of CA breast receiving weekly paclitaxel monotherapy who fulfilled inclusion and exclusion criteria were enrolled in the study. Clinical examination and grading of neuropathy was done according to NCI-CTCAE version 4.0. All patient had undergone nerve-conduction studies at baseline and 3 months after baseline.
Results: 50% of patients, developed signs symptoms of peripheral neuropathy, out of which tingling sensation was the most common symptom (40%). The incidence of grade 1 peripheral neuropathy at 3 and 6 months were 35%, and 31.66%, while grade 2 neuropathy was noted in 18.33%, and 14.75% of patients, respectively. There was a significant difference in the SNAP value between baseline and 3 months for right ulnar nerve, right and left sural nerve and CMAP for right median nerve, right ulnar nerve, right and left tibial nerves which suggests development of neuropathy during 3 months of paclitaxel chemotherapy.
Conclusions: This study provides information on the incidence and severity of peripheral neuropathy in patients receiving weekly paclitaxel chemotherapy, which can help physician in further management.
References
Lehmann HC, Wunderlich G, Fink GR, Sommer C. Diagnosis of peripheral neuropathy. Neurol Res Pract. 2020;2:20.
Zajączkowska R, Kocot-Kępska M, Leppert W, Wrzosek A, Mika J, Wordliczek J. Mechanisms of Chemotherapy-Induced Peripheral Neuropathy. Int J Mol Sci. 2019;20(6):1451.
Cioroiu C, Weimer LH. Update on Chemotherapy-Induced Peripheral Neuropathy. Curr Neurol Neurosci Rep. 2017;17(6):47.
Fehrenbacher JC. Chemotherapy-induced peripheral neuropathy. Prog Mol Biol Transl Sci. 2015;131:471-508.
Kerckhove N, Collin A, Condé S, Chaleteix C, Pezet D, Balayssac D. Long-Term Effects, Pathophysiological Mechanisms, and Risk Factors of Chemotherapy-Induced Peripheral Neuropathies: A Comprehensive Literature Review. Front Pharmacol. 2017;8:86.
Fallon MT. Neuropathic pain in cancer. Br J Anaesth. 2013;111(1):105-11.
Staff NP, Grisold A, Grisold W, Windebank AJ. Chemotherapy-induced peripheral neuropathy: A current review. Ann Neurol. 2017;81(6):772-81.
Tanabe Y, Hashimoto K, Shimizu C, Hirakawa A, Harano K, Yunokawa M, et al. Paclitaxel-induced peripheral neuropathy in patients receiving adjuvant chemotherapy for breast cancer. Int J Clin Oncol. 2013;18(1):132-8.
Akerley W, Herndon JE, Egorin MJ, Lyss AP, Kindler HL, Savarese DM, et al. Weekly, high-dose paclitaxel in advanced lung carcinoma: a phase II study with pharmacokinetics by the Cancer and Leukemia Group B. Cancer. 2003;97(10):2480-6.
Chung T, Prasad K, Lloyd TE. Peripheral neuropathy: clinical and electrophysiological considerations. Neuroimaging Clin N Am. 2014;24(1):49-65.
Selvy M, Kerckhove N, Pereira B, Barreau F, Nguyen D, Busserolles J, et al. Prevalence of Chemotherapy-Induced Peripheral Neuropathy in Multiple Myeloma Patients and its Impact on Quality of Life: A Single Center Cross-Sectional Study. Front Pharmacol. 2021;12:637593.
Abbas W, Rao RR, Agarwal A, Saha R, Bajpai P, Qureshi S, et al. Incidence of neuropathy with weekly paclitaxel and role of oral glutamine supplementation for prevention of paclitaxel induced peripheral neuropathy randomized controlled trial. Indian J Med Paediatr Oncol. 2018;39:339-48.
Scripture CD, Figg WD, Sparreboom A. Peripheral neuropathy induced by paclitaxel: recent insights and future perspectives. Curr Neuropharmacol. 2006;4(2):165-72.
Timmins HC, Li T, Trinh T, Kiernan MC, Harrison M, Boyle F, et al. Weekly Paclitaxel-Induced Neurotoxicity in Breast Cancer: Outcomes and Dose Response. Oncologist. 2021;26(5):366-74.
Molassiotis A, Cheng HL, Lopez V, Au JSK, Chan A, Bandla A et al. Are we misestimating chemotherapy-induced peripheral neuropathy? Analysis of assessment methodologies from a prospective, multinational, longitudinal cohort study of patients receiving neurotoxic chemotherapy. BMC Cancer. 2019;19(1):132.
