Peripheral Neurotoxicity Induced by Taxanes, Cisplatin, Oxaliplatin, Fluoropyrimidines and Vinorelbine. A clinical perspective

Abstract

Chemotherapy-induced peripheral neuropathy (CIPN) is the type of toxicity that affects treatment decisions often. Oncology specialists usually grade it using Common Terminology Criteria for Adverse Effects version (CTCAE), with some limitations. Dyck scale is a more objective method that is usually used for diabetic neuropathy grading.The present study included retrospectively registered patients (n=80) treated with platinum salts, taxanes, fluoropyrimidines or vinorelbine that subsequently developed CIPN. In some, the decision to lower the chemotherapy dose or withhold the treatment altogether was taken. CIPN was graded using both CTCAE 4.0 and Dyck scale for each patient. The aim of the study was to determine how the grades of each scale influenced the decision on the oncological treatment and whether objective, measurable changes are directly proportional to the impact CIPN has on the patients life. The present study reports high sensibility for both CTCAE and Dyck scale in deciding to modify the dose or interrupt chemotherapy. CTCAE should have more importance for the clinician in the early stages of CIPN. If CIPN presents as advanced, a less subjective alternative like the Dyck scale is a more suitable alternative. Dyck scale should be the most important argument in the decision regarding oncological treatment if the patients� scores more than 2a on this grading system.The decision to lower the dosage or stop oncological treatment due to CIPN is a complex one and both grading systems are useful. However, when dealing with a more severe case of CIPN, the more objective Dyck scale should be the more important argument.