Phase III trial comparing chemotherapy plus once-daily or twice-daily radiotherapy in Stage III non-small-cell lung cancer 1 1This study was conducted as a collaborative trial of the North Central Cancer Treatment Group and Mayo Clinic. Additional participating institutions included Cedar Rapids Oncology Project CCOP, Cedar Rapids, IA; Meritcare Hospital CCOP, Fargo, ND; Sioux Community Cancer Consortium, Sioux Falls, SD; Geisinger Clinical Oncology Program, Danville, PA (Suresh Nair, M.D.); Rapid City Regional Oncology Group, Rapid City, SD (Larry P. Ebbert, M.D.), Saskatchewan Cancer Centre, Saskatoon, Saskatchewan, Canada; Allan Blair Cancer Centre, Regina, Saskatchewan, Canada (Maria Tria Tirona, M.D.); Scottsdale CCOP, Scottsdale, AZ (Tom R. Fitch, M.D.); Carle Cancer Center CCOP, Urbana, IL (Kendrith M. Rowland, M.D.); Medcenter One Health Systems, Bismarck, ND (Ferdinand Addo, M.D.); Altru Health Systems, Grand Forks, ND (Daniel J. Walsh, M.D.); Siouxland Hematology-Oncology Associates, Sioux City, IA (John C. Michalak, M.D.); and CentreCare Clinic, St. Cloud, MN (Harold E. Windschitl, M.D.).

Purpose Given that the clinical course of oxaliplatin-induced neuropathy is not well defined, the current study was performed to better understand clinical parameters associated with its presentation. Methods Acute and chronic neuropathy was evaluated in patients receiving adjuvant FOLFOX (fluorouracil, leucovorin, and oxaliplatin) on study N08CB (North Central Cancer Treatment Group, Alliance). Acute neuropathy was assessed by having patients complete daily questionnaires for 6 days with each cycle of FOLFOX. Before each dose of FOLFOX and as long as 18 months after chemotherapy cessation, chronic neurotoxicity was assessed with use of the 20-item, European Organisation for Research and Treatment of Cancer quality-of-life questionnaire for patients with chemotherapy-induced peripheral neuropathy. Results Three hundred eight (89%) of the 346 patients had at least one symptom of acute neuropathy with the first cycle of FOLFOX; these symptoms included sensitivity to touching cold items (71%), sensitivity to swallowing cold items (71%), throat discomfort (63%), or muscle cramps (42%). Acute symptoms peaked at day 3 and improved, although they did not always resolve completely between treatments. These symptoms were about twice as severe in cycles 2 through 12 as they were in cycle 1. For chronic neurotoxicity, tingling was the most severe symptom, followed by numbness and then pain. During chemotherapy, symptoms in the hands were more prominent than they were in the feet; by 18 months, symptoms were more severe in the feet than they were in the hands. Patients with more severe acute neuropathy during the first cycle of therapy experienced more chronic sensory neurotoxicity (P < .0001). Conclusion Acute oxaliplatin-induced neuropathy symptoms do not always completely resolve between treatment cycles and are only half as severe on the first cycle as compared with subsequent cycles. There is a correlation between the severities of acute and chronic neuropathies.

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