The Total Neuropathy Score as an assessment tool for grading the course of chemotherapy‐induced peripheral neurotoxicity: comparison with the National Cancer Institute‐Common Toxicity Scale

Cavaletti, Guido; Frigeni, Barbara; Lanzani, Francesca; Piatti, M.; Rota, S.; Briani, Chiara; Zara, Gabriella; Plasmati, R.; Pastorelli, Francesca; Caraceni, Augusto; Pace, Andrea; Manicone, Mariagrazia; Lissoni, Andrea Alberto; Colombo, Nicoletta; Bianchi, Giulia; Zanna, Claudio

doi:10.1111/j.1529-8027.2007.00141.x

Cited by 221 publications

(187 citation statements)

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“… Oxaliplatin-Related Neuropathy: The presence of neuropathy was assessed by the reduced version of the total neuropathy score (rTNS) [34] at baseline and at the last visit by blinded neurophysiologists with no other role in the study. The severity of oxaliplatin-induced neuropathy was assessed by the NCI-CTCv3 [34], [35], [36]. Concomitant Analgesic Medication Use: The number of psychotropic analgesics used during the trial was quantified in each visit by the BPI.…”

Section: Trial Informationmentioning

confidence: 99%

Pregabalin for the Prevention of Oxaliplatin-Induced Painful Neuropathy: A Randomized, Double-Blind Trial

et al. 2017

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Lessons Learned. Pregabalin is a medication that can decrease neuronal hyperexcitability, relieve neuropathic pain, and reach stable plasma levels after a titration period of only a few days.Its use during oxaliplatin infusions was not able to decrease the incidence of chronic, oxalipaltin‐related neuropathic pain, compared with placebo.Background.Patients with colorectal cancer (CRC) receiving oxaliplatin (OXA) develop acute and chronic painful oxaliplatin‐induced peripheral neuropathy (OXAIPN). Acute and chronic OXA‐related neuropathies have different pathophysiological bases, but both lead to a common phenomenon: central sensitization (CS) of nociceptive neuronal networks, leading to increased sensitivity (hyperlgesia, allodynia) in the somatosensory system, the common ground of chronic neuropathic pain. Because CS is related to increased risk of painful OXAIPN, we hypothesized that preemptive use of the anti‐hyperalgesic drug pregabaline (known to decrease CS) during OXA infusions would decrease the incidence of chronic OXAIPN.Methods.Pain‐free, chemotherapy‐naïve CRC patients receiving at least one cycle of modified‐FLOX [5‐FU(500 mg/m2)+leucovorin(20 mg/m2)/week for] 6 weeks+oxaliplatin(85 mg/m2) at weeks 1‐3‐5 every 8 weeks] were randomized (1:1) into the study. Patients received either pregabalin or placebo for 3 days before and 3 days after each OXA infusion and were followed for up to 6 months. Clinical assessments were performed at baseline, at the end of chemotherapy, and after the follow‐up period. The main outcome was average pain at the last visit assessed by the visual analogic scale (0–10) item of the Brief Pain Inventory (BPI). Secondary endpoints were presence of neuropathic pain according to the Douleur Neuropathique‐4 (DN‐4), pain dimensions (short‐ form McGill Pain Questionnaire [MPQ]), Neuropathic Pain Symptom Inventory (NPSI), and changes in nerve conduction studies (NCS) and side effect profile.Results.One hundred ninety‐nine patients (57.0 ± 10.7 years old, 98 female, 101 male) were randomized. Data from 56 patients were not included in the analyses (as they did not receive at least one full cycle of modified FLOX). Data from 78 patients in the pregabalin group and 65 patients in the placebo group were retained for analyses. At the last visit, pain intensity in the pregabalin group was 1.03 (95% confidence interval [CI] = 0.79–1.26), and 0.85 (95% CI = 0.64–1.06) in the placebo group, which did not reach significance. Scores from the BPI, MPQ, DN‐4, NPSI, and NCS and side‐effect profiles and incidence of death did not differ between groups. Quality of life (QoL) score did not differ between groups (placebo = 76.9 ± 23.1, pregabalin group 79.4 ± 20.6). Mood scores were not significantly different between groups (placebo 9.7 [8.1–11.2]; pregabalin 6.8 [5.6–8.0]).Conclusion.The preemptive use of pregabalin during OXA infusions was safe, but did not decrease the incidence of chronic pain related to OXAIPN.

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Section: Trial Informationmentioning

confidence: 99%

Pregabalin for the Prevention of Oxaliplatin-Induced Painful Neuropathy: A Randomized, Double-Blind Trial

et al. 2017

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“…Clinical data were classified according to the Total Neuropathy Scale (TNS) [18,19] using the clinical version (TNSc) [20] and the reduced version (TNSr), incorporating neurophysiological measures [21] with severity rankings of 0 (none) to 4 (very severe), as previously validated in patients with chemotherapy-induced neuropathy [21,22]. Patients' descriptions of symptoms were staged using the Neuropathy Symptom Score (NSS) into negative (subset IIA) and positive (subset IIB) sensory symptoms summed to give a composite score out of 5 [23].…”

Section: Clinical Assessment: Grading Of Neurotoxicitymentioning

confidence: 99%

Long-Term Neuropathy After Oxaliplatin Treatment: Challenging the Dictum of Reversibility

et al. 2011

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After completing this course, the reader will be able to:1. Define the symptoms of sensory neurotoxicity in oxaliplatin-treated patients and identify the long-term natural history of nerve dysfunction as a long-lasting complication of treatment that does not necessarily resolve within 6 months.2. Use sensory excitability techniques to predict long-standing changes in sensory nerve function produced by oxaliplatin.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTObjectives. Oxaliplatin-induced neuropathy is a significant and dose-limiting toxicity that adversely affects quality of life. However, the long-term neurological sequelae have not been adequately described. The present study aimed to describe the natural history of oxaliplatin-induced neuropathy, using subjective and objective assessments. The Oncologist CME Program is located online at http://cme.theoncologist.com/. To take the CME activity related to this article, you must be a registered user. Methods. From a population of 108 oxaliplatin-treated Symptom Management and Supportive CareThe Oncologist 2011;16:708 -716 www.TheOncologist.com Results. At follow-up, 79.2% of patients reported residual neuropathic symptoms, with distal loss of pinprick sensibility in 58.3% of patients and loss of vibration sensibility in 83.3% of patients. Symptom severity scores were significantly correlated with cumulative dose. There was no recovery of sensory action potential amplitudes in upper and lower limbs, consistent with persistent axonal sensory neuropathy. Sensory excitability parameters had not returned to baseline levels, suggesting persisting abnormalities in nerve function. The extent of excitability abnormalities during treatment was significantly correlated with clinical outcomes at follow-up.Conclusions. These findings establish the persistence of subjective and objective deficits in oxaliplatin-treated patients post-oxaliplatin, suggesting that sensory neuropathy is a long-term outcome, thereby challenging the literature on the reversibility of oxaliplatin-induced neuropathy. The Oncologist 2011;16:708 -716

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“…Chemotherapy-induced peripheral neuropathy (CIPN) is the most common neurological syndrome secondary to anticancer therapy. Sensory neu-ropathy is the most frequent type of CIPN, primarily affecting patients treated with taxanes (docetaxel and paclitaxel), platinum derivatives (oxaliplatin, cisplatin and carboplatin), vinca alkaloids (vincristine, vinblastine and vinorelbine), thalidomide and bortezomib 2,3 . The incidence of CIPN is widely different among studies, with rates from 10% to 100%, especially for therapies involving taxanes and platinum derivatives.…”

Section: Introductionmentioning

confidence: 99%

Chemotherapy-induced peripheral neuropathy: review for clinical practice

Simão¹,

Murad²,

Martins³

et al. 2015

Revista Dor

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The Total Neuropathy Score as an assessment tool for grading the course of chemotherapy‐induced peripheral neurotoxicity: comparison with the National Cancer Institute‐Common Toxicity Scale

Cited by 221 publications

References 15 publications

Pregabalin for the Prevention of Oxaliplatin-Induced Painful Neuropathy: A Randomized, Double-Blind Trial

Pregabalin for the Prevention of Oxaliplatin-Induced Painful Neuropathy: A Randomized, Double-Blind Trial

Long-Term Neuropathy After Oxaliplatin Treatment: Challenging the Dictum of Reversibility

Chemotherapy-induced peripheral neuropathy: review for clinical practice

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