Oxaliplatin-Induced Peripheral Neuropathy and Identification of Unique Severity Groups in Colorectal Cancer

• Published in: Journal of pain and symptom management Vol. 54; no. 5; pp. 701 - 706.e1
• Main Authors: Griffith, Kathleen A., Zhu, Shijun, Johantgen, Meg, Kessler, Michael D., Renn, Cynthia, Beutler, Andreas S., Kanwar, Rahul, Ambulos, Nicholas, Cavaletti, Guido, Bruna, Jordi, Briani, Chiara, Argyriou, Andreas A., Kalofonos, Haralabos P., Yerges-Armstrong, Laura M., Dorsey, Susan G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2017; Elsevier Limited
• Subjects: Antineoplastic Agents - therapeutic use; Antineoplastic Agents - toxicity; Chemotherapy; Chemotherapy-induced peripheral neuropathy; chronic pain; Colorectal cancer; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - physiopathology; Dosage; Female; Humans; Identification; Latent class analysis; Male; measurement; Middle Aged; Neurologic Examination; Neurotoxicity Syndromes - classification; Neurotoxicity Syndromes - diagnosis; Neurotoxicity Syndromes - physiopathology; Organoplatinum Compounds - therapeutic use; Organoplatinum Compounds - toxicity; Oxaliplatin; pain; Patients; Peripheral Nervous System Diseases - chemically induced; Peripheral Nervous System Diseases - classification; Peripheral Nervous System Diseases - diagnosis; Peripheral Nervous System Diseases - physiopathology; Peripheral neuropathy; Prospective Studies; Reflexes; Sensory stimulation; Severity; Severity of Illness Index; Symptom management; Variability; Vibration; oxaliplatin; pain; chronic pain; latent class analysis; Chemotherapy-induced peripheral neuropathy; measurement
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2017.07.033

Oxaliplatin-induced peripheral neuropathy (OIPN) is a dose-limiting toxicity of oxaliplatin and affects most colorectal cancer patients. OIPN is commonly evaluated by patient symptom report, using scales to reflect impairment. They do not discriminate between unique grouping of symptoms and signs, which impedes prompt identification of OIPN.
The objective of this study was to identify clusters of symptoms and signs that differentiated underlying clinical severity and segregated patients within our population into OIPN subgroups.
Chemotherapy-naive colorectal cancer patients (N = 148) receiving oxaliplatin were administered the Total Neuropathy Score clinical (TNSc©), which includes symptom report (sensory, motor, autonomic) and sensory examination (pin sense, vibration, reflexes). The TNSc was administered before chemotherapy initiation (T0) and after cumulative doses of oxaliplatin 510–520 mg/m2 (T1) and 1020–1040 mg/m2 of oxaliplatin (T2). Using mean T2 TNSc scores, latent class analysis grouped patients into OIPN severity cohorts.
Latent class analysis categorized patients into four distinct OIPN groups: low symptoms and low signs (n = 54); low symptoms and intermediate signs (n = 44); low symptoms and high signs (n = 21); and high symptoms and high signs (n = 29). No differences were noted among OIPN groups on age, sex, chemotherapy regimen, or cumulative oxaliplatin dose.
We identified OIPN patient groups with distinct symptoms/signs, demonstrating variability of OIPN presentation regardless of cumulative oxaliplatin dose. Over half of the sample had positive findings on OIPN examination despite little or no symptoms. Sensory examination of all patients receiving oxaliplatin is indicated for timely identification of OIPN, which will allow earlier symptom management.