Chemotherapy-induced peripheral neurotoxicity (CIPN) exacerbates cumulatively and dose-dependently. Assessment of CIPN usually depends on subjective grading scales, such as the Common Terminology Criteria for Adverse Events (CTCAE). We previously validated a newly developed point-of-care nerve conduction device (POCD) for the quantitative assessment of CIPN (Cancer Sci 2016). The aim of the present study was to prospectively assess CIPN using this POCD.
Patients scheduled to receive 8 cycles of adjuvant CapeOX therapy (capecitabine and oxaliplatin) for colorectal cancer were enrolled. Sural nerve amplitude potentials (SNAP, μV), a quantitative measure of the axonal degeneration, and sural nerve conduction velocity (SNCV, m/s), that of the degree of demyelination, were recorded using a portable and automated POCD (DPN-Check®, Neurometrix Inc., Waltham, MA, USA) at baseline, each cycle of chemotherapy, and within 1 month after the end of chemotherapy. The severity of CIPN was evaluated according to the CTCAE. The total sum of SNAP/SNCV was calculated for each patient, and compared according to each CTCAE grade.Table: 1760P
A total of 39 patients (M/F: 22/17; median age 61 years, range 36-76; worst CTCAE G1/G2/G3: 25/10/4) were enrolled. Mean SNAP/SNCV at baseline, each cycle of chemotherapy, and within 1 month after the end of chemotherapy are shown in the table. SNAP decreased significantly during each cycle of chemotherapy (repeated ANOVA, P < 0.001), whereas SNCV remained relatively unchanged. The mean total sum of SNAP was 112.6±36.8 G1, 69.8±19.2 G2, and 44.8±12.8 G3. The mean total sum of SNCV was 451.1±34.9 G1, 454.2±24.7 G2, and 429.8±30.1 G3. The total SNAP differed significantly among each CTCAE grade (ANOVA, P < 0.001), whereas the total SNCV did not.
This POCD demonstrates SNAP-dominant neuropathy in patients who receive oxaliplatin, indicating axonal degeneration as a mechanism of CIPN.
Clinical trial identification
Legal entity responsible for the study
Nagoya University Hospital.
Novartis Pharma K.K.
Y. Ando: Honoraria: Yakult Honsha Co., Ltd, Chugai Pharmaceutical Co., Ltd, Mochida Pharmaceutical Co., Ltd.; Research funding: Yakult Honsha Co., Ltd, Chugai Pharmaceutical Co., Ltd, Mochida Pharmaceutical Co., Ltd, Nippon Kayaku Co. Ltd. All other authors have declared no conflicts of interest.