Vincristine-Induced Neuropathy in Patients Diagnosed with Solid and Hematological Malignancies: The Role of Dose Rounding

Abstract

Background: Vincristine is a vital constituent of chemotherapeutic regimens. Vincristine-induced neuropathy is a challenging adverse effect that impacts quality of life and treatment course. The dose rounding of chemotherapies is a strategy that is commonly used in clinical practice. Nevertheless, the frequency of developed neuropathy in vincristine first-time users and the potential association with dose rounding remains elusive. Methods: A retrospective analysis was conducted on patients administered vincristine for the first time between 2016 and 2022 using the King Saud University Medical City (KSUMC) database. Patients were stratified into pediatric and adult groups. Neuropathy frequency, its association with demographic and clinical parameters, and the Impact of dose rounding were assessed using SPSS software version 28. Results: Approximately 34.6% of patients were diagnosed with neuropathy after vincristine administration. Autonomic neuropathy was common among affected adults and pediatric patients (55.1% and 56.1%, respectively), while cranial neuropathy was more frequent in pediatric patients. Higher BSA (p = 0.038) and Scr (p = 0.044) in the pediatric group, the presence of respiratory comorbidities (p = 0.044), and the use of azole antifungals (p < 0.001) in the adult group were significantly associated with neuropathy episodes. The rounding-up of vincristine doses was significantly associated with increased neuropathy occurrence (p < 0.001), while dose rounding-down was significantly associated with a decrease in neuropathy in both groups of patients (p < 0.001). Conclusions: Our findings demonstrate that autonomic neuropathy is the most common vincristine-related neuropathy, regardless of the patient’s age. Dose rounding is a significant determinant of vincristine-induced neuropathy in both groups. Further studies are needed to evaluate the variables that exacerbate or prevent neuropathy associated with the first-time use of vincristine.

Characterising vincristine-induced peripheral neuropathy in adults: symptom development and long-term persistent outcomes

“…Other neurotoxic agents including taxanes, platinums, bortezomib and thalidomide are typically associated with only minor motor neuropathic symptoms [ 35 ]. Autonomic symptoms were more common in this current cohort compared to prior studies (30–39% versus 19%, [ 25 ]), and this is likely due to the varying methods of assessing autonomic neuropathy. While the present study utilised the autonomic items of the EORTC-QLQ-CIPN20, prior studies have highlighted limitations to this autonomic subscale [ 15 ].…”

“…Compared to prior investigations of VIPN undertaken more than 20 years ago [ 11 , 23 , 24 ], this study evaluated VIPN using current dosing regimens. Recent studies have utilised retrospective chart review or NCI-CTCAE grading to define neuropathy prevalence and characteristics [ 25 – 27 ]. However, this clinical study utilised a comprehensive and multifaceted assessment approach, incorporating patient reported, neurological and functional perspectives.…”