Oxaliplatin-induced peripheral neuropathy risk factors and management in Tunisian population.

Aref Zribi,Sonia Ben Nasr,Syrine Hamdi,Abderrazek Haddaoui,Jihen Ayari,Mehdi Balti,Sana Fendri

doi:10.11604/pamj.2020.35.83.18357

Abstract

The most important limits of oxaliplatin treatment is its peripheral neurotoxicity. The aim of our study was to evaluate the oxaliplatin-induced peripheral neuropathy, its impact on treatment and its management. One hundred chemo-naive patients treated with oxaliplatin-based regimen in the medical oncology department of the military hospital of Tunis between 2012 and 2017 were recruited retrospectively. Evaluation of neuropathy was done according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE V4). Fifty-six patients were aged more than 60 years. The sex-ratio was 1.56. Twenty-seven patients were overweight, 17 were obese and 56 had a BMI inferior to 25 kg/m2. Two patients were consuming alcohol. Twenty-three patients had diabetes. Sixty-four patients developed chronic peripheral neuropathy because of oxaliplatin (grade 1-2 in 58 cases and grade 3 in 6 cases). Sex, BMI, diabetes and alcohol consumption were not associated with the development of peripheral neuropathy. No association was found between grades of neuropathy and sex, alcohol consumption and diabetes. The median cumulative dose of oxaliplatin that induced neuropathy was 432.4 mg/m2. The most prescribed treatment was gabapentin (81%) and carbamazepine (16.8%). The treatment was not sufficient to stop neuropathy in 82.6% of cases. Dose reduction was done in 64.2% of cases, treatment delay in 10.7% of cases and treatment interruption in 10.7% of cases. We didn't find any association between known risk factors and peripheral neuropathy. The cumulative dose is interesting to define or to predict the timing of neurotoxicity.

Highlights

Oxaliplatin is a third generation platinum-based agent largely used in oncology
Data collection: we collected parameters that might be associated with neuropathy according to literature: diabetes, alcohol consumption, body mass index (BMI) and neuropathy treatment
No correlation was found between grades of neuropathy and sex, alcohol consumption and diabetes (Table 2)

Summary

Introduction

Oxaliplatin is a third generation platinum-based agent largely used in oncology. It's effective in the treatment of localized and metastatic gastrointestinal cancers and has improved survival with a 5 year disease free survival of 78% [1,2,3,4]. One of the most important limits of oxaliplatin treatment is its peripheral neurotoxicity. Acute and chronic neuropathy differ in their timing, duration and symptomatology. Acute oxaliplatin neurotoxicity is induced by cold and is characterized by distal sensory symptoms such as paresthesia and dysesthesia occurring in days following oxaliplatin infusion [5]. It occurs rapidly in most patients treated and is typically transient [6,7]. There is no effective strategy for preventing oxaliplatin-induced peripheral neuropathy (OIPN) and pharmacologic management is limited [11]. The aim of our study was to evaluate the OIPN, its impact on treatment and to discuss its management

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Methods

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Discussion

Conclusion