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Abstract
Introduction. Oxaliplatin-induced peripheral neuropathy (OIPN) is one of the most common and challenging adverse effects of oxaliplatin-based chemotherapy. It is difficult to manage and may lead to chronic symptoms. Despite its high incidence, optimal strategies for its prevention and management remain undefined.
Aim. To develop and implement a method for the early detection of OIPN in clinical oncology practice, facilitating timely referral of the patient to a neurologist for monitoring.
Materials and Methods. A prospective study was conducted involving 57 chemotherapy-naïve patients with stage IV metastatic colorectal cancer scheduled to receive the mFOLFOX6 regimen (± targeted therapy). Neuropathy was serially assessed using the Neuropathy Disability Score (NDS) and a graduated 128-Hz Rydel-Seiffer tuning fork. The EORTC QLQ-CIPN20 questionnaire served as a confirmatory patient-reported outcome measure. The follow-up period was 22 months. The primary endpoint was the detection of statistically significant changes indicating early neuropathy.
Results. Statistically significant signs of neuropathy were detected as early as after the first chemotherapy cycle, including changes in the sensory subscale of the EORTC QLQ-CIPN20 (p < 0.001), increased NDS scores, and a decreased vibration perception threshold. The vibration threshold decreased by 2 arbitrary units between cycles 1 and 2. OIPN of any grade developed in 93% of patients, with a chronic form in 84.9%. These early objective signs preceded clinically significant patient-reported symptoms by a median of two cycles. The median cycle for oxaliplatin dose reduction was the 5th.
Conclusion. Assessment of vibration perception using a graduated tuning fork enables the early detection of OIPN during treatment and can be feasibly incorporated into routine clinical practice by oncologists.
References
Fradkin M., Batash R., Elmaleh S., et al. Management of peripheral neuropathy induced by chemotherapy. Curr Med Chem. 2019; 26(25): 4698-4708.-DOI: https://doi.org/10.2174/0929867326666190107163756.
Seretny M., Currie G.L., Sena E.S., et al. Incidence, prevalence, and predictors of chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis. Pain. 2014; 155(12): 2461-2470.-DOI: https://doi.org/10.1016/j.pain.2014.09.020.
Yang Y., Zhao B., Gao X., et al. argeting strategies for oxaliplatin-induced peripheral neuropathy: clinical syndrome, molecular basis, and drug development. J Exp Clin Cancer Res. 2021; 40(1); 331.-DOI: https://doi.org/10.1186/s13046-021-02141-z.
Burgess J., Ferdousi M., Gosal D., et al. Chemotherapy-induced peripheral neuropathy: Epidemiology, pathomechanisms and treatment. Oncol Ther. 2021; 9(2): 385-450.-DOI: https://doi.org/10.1007/s40487-021-00168-y.
Teng C., Venkatesha V., Blinman P.L., Vardy J.L. Patterns of patient-reported chemotherapy-induced peripheral neuropathy in colorectal cancer survivors. J Natl Compr Canc Netw. 2022; 20(12): 1308-1315.-URL: https://pubmed.ncbi.nlm.nih.gov/36509075
Wang R.Y., Lin X.L., Xiang S.T., et al. Risk factors for oxaliplatin-induced peripheral neuropathy: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2022; 26(11): 4028-4043.-DOI: https://doi.org/10.26355/eurrev_202206_28973.
Gebremedhn E.G., Shortland P.J., Mahns D.A. The incidence of acute oxaliplatin-induced neuropathy and its impact on treatment in the first cycle: a systematic review. BMC Cancer. 2018; 18(1): 410.-DOI: https://doi.org/10.1186/s12885-018-4185-0.
Argyriou A.A., Bruna J., Marmiroli P., Cavaletti G. Chemotherapy-induced peripheral neurotoxicity (CIPN): an update. Crit Rev Oncol Hematol. 2012; 82(1): 51-77.-DOI: https://doi.org/10.1016/j.critrevonc.2011.04.012.
Staff N.P., Cavaletti G., Islam B., et al. Platinum-induced peripheral neurotoxicity: from pathogenesis to treatment. J Peripher Nerv Syst. 2019; 24(Suppl 2): S26-S39.-DOI: https://doi.org/10.1111/jns.12335.
Pachman D.R., Qin R., Seisler D.K., et al. Clinical course of oxaliplatin-induced neuropathy: results from the randomized Phase III trial N08CB (Alliance). J Clin Oncol. 2015; 33(30): 3416-3422.-DOI: https://doi.org/10.1200/JCO.2014.58.8533.
Tan A.C., McCrary J.M., Park S.B., et al. Chemotherapy-induced peripheral neuropathy: patient-reported outcomes compared with NCI-CTCAE grade. Support Care Cancer. 2019; 27(12): 4771-4777.-DOI: https://doi.org/10.1007/s00520-019-04781-6.
Oncology Section, Academy of Oncologic Physical Therapy, APTA. Chemotherapy-induced peripheral neuropathy: fact sheet for professionals. Alexandria (VA): Academy of Oncologic Physical Therapy, APTA. 2019.-URL: https://cdn.ymaws.com/oncologypt.org/resource/resmgr/fact_sheet/cipn_fact_sheet_for_professi.pdf.
National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Bethesda (MD): U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; 2017.-URL: https://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_8.5x11.pdf.
Krøigård T., Svendsen T.K., Wirenfeldt M., et al. Oxaliplatin neuropathy: Predictive values of skin biopsy, QST and nerve conduction. J Neuromuscul Dis. 2021; 8(4): 679-688.-DOI: https://doi.org/10.3233/JND-210630.
Латипова Д.Х., Андреев В.В., Маслова Д.А., et al. Неврологические осложнения противоопухолевой лекарственной терапии. Практические рекомендации RUSSCO, часть 2. Злокачественные опухоли. 2023; 13(3s2): 300-309.-URL: https://www.zlokno.ru/jour/article/view/2071. [Latipova D.Kh., Andreev V.V., Maslova D.A., et al. Neurological Complications of Anticancer Drug Therapy. RUSSCO Clinical Guidelines, Part 2. Zlokachestvennye Opukholi = Malignant Tumors. 2023; 13(3s2): 300-309.-URL: https://www.zlokno.ru/jour/article/view/2071 (In Rus)].
European Organisation for Research and Treatment of Cancer (EORTC). Quality of life questionnaire: Chemotherapy-induced peripheral neuropathy 20 (QLQ-CIPN20). Brussels: EORTC. 2003; 2.-URL: https://www.eortc.org/app/uploads/sites/2/2018/08/Specimen-CIPN20-English.pdf.
Alberta Health Services. Chemotherapy induced peripheral neuropathy effective date: December, 2019. Clinical practice guideline SUPP-010 – version 1. Edmonton: Alberta Health Services. 2019; 13.-URL: https://www.albertahealthservices.ca/assets/info/hp/cancer/if-hp-cancer-guide-supp010-peripheral-neuropathy.pdf.
Sharma S., Vas P.R., Rayman G. Assessment of diabetic neuropathy using a point-of-care nerve conduction device (DPNCheck™) and the modified neuropathy disability score. Diabetes Res Clin Pract. 2014; 104(1): e41-e43.-DOI: https://doi.org/10.1016/j.diabres.2014.01.026.
Pop-Busui R., Boulton A.J.M., Feldman E.L., et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care. 2017; 40(1): 136-154.-DOI: https://doi.org/10.2337/dc16-2042.
Starobova H., Vetter I. Pathophysiology of chemotherapy-induced peripheral neuropathy. Front Mol Neurosci. 2017; 10: 174.-DOI: https://doi.org/10.3389/fnmol.2017.00174.
Beijers A.J.M., Mols F., Vreugdenhil G. A systematic review on chronic oxaliplatin-induced peripheral neuropathy and the relation with oxaliplatin administration. Support Care Cancer. 2014; 22(7): 1999-2007.-DOI: https://doi.org/10.1007/s00520-014-2242-z.-URL: https://cris.maastrichtuniversity.nl/ws/portalfiles/portal/5607091/c5522.pdf.
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