Neuropathy severity at the time of oxaliplatin treatment alteration in patients with colon cancer (Alliance A151912)

• Published in: Supportive care in cancer Vol. 29; no. 12; pp. 7855 - 7863
• Main Authors: Hertz, Daniel L., Dockter, Travis J., Satele, Daniel V., Loprinzi, Charles L., Le-Rademacher, Jennifer
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-12-2021; Springer; Springer Nature B.V
• Subjects: Analysis; Antimitotic agents; Antineoplastic agents; Antineoplastic Agents - adverse effects; Antineoplastic Combined Chemotherapy Protocols; Cancer; Cancer patients; Care and treatment; Chemotherapy; Clinical practice guidelines; Colon cancer; Colonic Neoplasms - drug therapy; Colorectal cancer; Drug administration; Drug dosages; Evidence-based medicine; Humans; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Nursing; Nursing Research; Oncology; Original Article; Oxaliplatin - adverse effects; Pain Medicine; Patients; Peripheral Nervous System Diseases - chemically induced; Peripheral Nervous System Diseases - epidemiology; Peripheral neuropathy; Randomized Controlled Trials as Topic; Rehabilitation Medicine; Retrospective Studies; Biomarkers; Adverse event monitoring; Colon cancer; Patient-reported outcomes; Treatment alteration; Chemotherapy-induced peripheral neuropathy
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-021-06371-x

Background
Clinical guidelines recommend altering chemotherapy treatment by decreasing, delaying, or discontinuing dosing in patients who are experiencing chemotherapy-induced peripheral neuropathy. There are few data available on the clinical use of treatment alteration including the severity of CIPN at the time of treatment alteration.
Methods
This was a retrospective analysis of patients receiving oxaliplatin on the NCCTG N08CB trial. Neuropathy severity was assessed at each cycle by clinicians and patients. Patients were classified as (1) completed treatment without alteration, (2) dose reduction or delay due to neuropathy, (3) discontinuation due to neuropathy, (4) discontinuation for other toxicity, or (5) discontinuation for another reason (5). Comparisons focused primarily on patients with alteration due to neuropathy (groups 2 and/or 3) compared with patients who completed treatment without alteration (group 1).
Results
In 350 participants, 135 (39%) completed treatment without alteration, 70 (20%) had a dose reduction or delay due to neuropathy, and 35 (10%) discontinued early due to neuropathy. Clinician-assessed neuropathy severity was greater in patients at the time of dose reduction or delay compared with severity at the end of treatment in patients without alteration (
p
 < 0.0001). Patient-reported neuropathy severity at cycle 4 was worse in patients who eventually had a reduction or delay as compared with patients who completed treatment without alteration (
p
 = 0.017).
Conclusions
Treatment alterations due to neuropathy are common in patients receiving oxaliplatin for colon cancer and are associated with clinician-assessed neuropathy severity. Rapid increases in patient-reported neuropathy severity indicate a potential need for monitoring and intervention.
Trial Registration
Clinicaltrials.gov Identifier: NCT01099449 (NCCTG N08CB)