Prospective analysis of chemotherapy-induced neuropathy in patients with gynecologic malignancies.

Abstract

e19737 Background: Chemotherapy induced peripheral neuropathy (PN) is a serious dose- limiting toxicity affecting chemotherapy administration. It is unclear how many patients are assessed for PN. The incidence and severity of PN depend on the chemotherapeutic agents, cumulative dose, schedule and patient characteristics. Taxanes and platinum analogs are associated with the highest incidence of PN. Few tools have been validated to assess the incidence and severity of PN. The NCI Common Toxicity criteria (NCI-CTCAE), Patient Neurotoxicity Questionnaire (PNQ), and Functional Assessment of Cancer Therapy Neurotoxicity Subscale (FACT-Ntx) are the most studied. The primary objective of our study was the prospective evaluation of the incidence of severe PN (NCI-CTCAE≥2) in patients with gynecologic malignancy receiving taxane/platinum regimen. The secondary endpoint was to determine the questionnaire that was the most sensitive in predicting PN; NCI-CTCAE and PNQ. Methods: Fifty-one patients with ovarian or endometrial cancer receiving carboplatin-paclitaxel based chemotherapy were enrolled and 451 assessments were completed. Assessments were performed at baseline, chemotherapy visists and monthly follow ups. Results: Seventeen patients had baseline PN and 29 (85.3%) patients developed PN during treatment. The table depicts the mean cumulative doses for both agents and both tools. Conclusions: The incidence of carboplatin-induced PN has been reported to range from 13% to 42% and the reported incidence of paclitaxel induced PN varied from 18% to 29% (every 3 weeks dosing, mean cumulative dose to onset of grade ≥ 2 PN-715 mg/m2). We report the incidence of severe PN in 85.3% of patients receiving combination of carboplatin/paclitaxel. These preliminary results show trend for PNQ tool to detect both sensory and motor PN at lower mean cumulative doses when compared to NCI-CTCAE. Our higher incidence of PN than previously reported for carboplatin/paclitaxel demonstrated a need for standarization of detection and treatment of PN. Tool No. of Patients (%) Paclitaxel (mg) Carboplatin (mg) NCI-CTCAE sensory 20 (58.8) 1,138 1,907 NCI-CTCAE motor 16 (47.1) 1,142 1,810 PNQ sensory 18 (52.9) 818 1,383 PNQ motor 18 (52.9) 1,003 1,588