Oxaliplatin‐ and docetaxel‐induced polyneuropathy: clinical and neurophysiological characteristics

Abstract

The aim of this study was to evaluate the presence and characterization of chemotherapyinduced neuropathy (CIPN) and neuropathic pain 5 years after adjuvant chemotherapy with docetaxel or oxaliplatin. Patients from an ongoing prospective study, who had received adjuvant chemotherapy with docetaxel or oxaliplatin in 2011 to 2012 were invited to participate. The patients underwent a thorough examination with interview, neurological examination, questionnaires, assessment tools, nerve conduction studies (NCS), quantitative sensory testing, MScan motor unit number estimation (MUNE), and corneal confocal microscopy (CCM). Patients were divided into no, possible, probable, and confirmed CIPN. Out of the 132 eligible patients, 63 agreed to participate: 28 had received docetaxel and 35 had received oxaliplatin. Forty-one percent had confirmed CIPN, 34% possible or probable CIPN, and 22% did not have CIPN. The CIPN was characterized mainly by sensory nerve fiber loss, with a more pronounced large fiber than small fiber loss but also some motor fiber loss identified on NCS and MUNE. In general, patients had mild neuropathy with relatively low scores on assessment tools and no association with mood and quality of life. CCM was not useful as a diagnostic tool. Of the patients with probable or confirmed CIPN, 30% experienced pain, which was most often mild, but still interfered moderately with daily life in 20% to 25% and was associated with lower quality of life. In conclusion CIPN was confirmed in 41% 5 years after chemotherapy. The neuropathy was generally mild, but in patients with neuropathic pain it was associated with lower quality of life.

A Cross-Sectional Study of Sub-Basal Corneal Nerve Reduction Following Neurotoxic Chemotherapy

“… 52 However, the evidence for small fiber involvement with paclitaxel treatment is more convincing, as shown by reduction in both intraepidermal and corneal nerve fiber densities. 53 , 54 Motor nerves are usually only minimally involved in CIPN as found by Bennedsgaard and colleagues, 14 which is also reflected in the current study. Large sensory nerve fiber function in nerve conduction studies have been shown to be reduced with CIPN.…”

“…Large sensory nerve fiber function in nerve conduction studies have been shown to be reduced with CIPN. 14 However, a cutoff value for sensory nerve conduction amplitudes for diagnosing CIPN is currently absent, with clinicians and researchers instead proposing a multimodal approach incorporating symptomatology as well as large and small nerve fiber assessments. 8 , 14 Future investigation of the ability of sensory nerve conduction studies and in vivo corneal confocal microscopy in differentiating patients with and without peripheral neuropathy during development and progression of the condition in longitudinal studies is warranted.…”

“… 9 – 12 Most research involving corneal assessment in CIPN were longitudinal studies during treatment without long-term follow-up to assess any persistent loss of peripheral and corneal nerves. 9 , 13 As investigations into corneal nerve morphology in patients with cancer treated with neurotoxic chemotherapy with high prevalence of persistent peripheral neuropathy well after treatment cessation is limited, 14 the current study aimed to observe corneal nerve morphology in patients with cancer who have received and completed treatment with paclitaxel or oxaliplatin.…”

Chemotherapy-Induced Peripheral Neuropathy: Mechanisms and Clinical Assessment

“…If sensory symptoms are limited to hands, median entrapment neuropathy should be also rule out. Long-term follow up of patients after oxaliplatin showed persistent low amplitudes at sensory nerves 3 year after treatment [38].…”

A cross-sectional study of ocular surface discomfort and corneal nerve dysfunction after paclitaxel treatment for cancer

“…The cornea is the most densely innervated region of the body, about 300–600 times that of the skin 15 , contributing to its sensitivity to a range of stimuli. While research has shown an association between ocular surface dysfunction and sub-basal corneal nerve damage in neuropathic conditions, particularly diabetic peripheral neuropathy 16 – 18 , evidence is minimal for chemotherapy-induced peripheral neuropathy 19 , 20 . In-vivo corneal confocal microscopy has been proposed as a useful clinical and research instrument for detecting small nerve fiber changes of the corneal sub-basal nerve plexus in ocular diseases particularly dry eye disease 21 , as well as in the context of diabetic peripheral neuropathy 22 , 23 with emerging evidence with neurotoxic chemotherapy from both human and animal studies 19 , 24 .…”