Thalidomide neuropathy in patients treated for metastatic prostate cancer.
We prospectively evaluated thalidomide-induced neuropathy using electrodiagnostic studies. Sixty-seven men with metastatic androgen-independent prostate cancer in an open-label trial of oral thalidomide underwent neurologic examinations and nerve conduction studies (NCS) prior to and at 3-month intervals during treatment. NCS included recording of sensory nerve action potentials (SNAPs) from median, radial, ulnar, and sural nerves. SNAP amplitudes for each nerve were expressed as the percentage of its baseline, and the mean of the four was termed the SNAP index. A 40% decline in the SNAP index was considered clinically significant. Thalidomide was discontinued in 55 patients for lack of therapeutic response. Of 67 patients initially enrolled, 24 remained on thalidomide for 3 months, 8 remained at 6 months, and 3 remained at 9 months. Six patients developed neuropathy. Clinical symptoms and a decline in the SNAP index occurred concurrently. Older age and cumulative dose were possible contributing factors. Neuropathy may thus be a common complication of thalidomide in older patients. The SNAP index can be used to monitor peripheral neuropathy, but not for early detection.
Molloy
F M
FM
EMG Section, National Institute of Neurological Disorders and Stroke (NINDS), 10 Center Drive, MSC 1404, Bethesda, Maryland 20892-1404, USA.
Floeter
M K
MK
Syed
N A
NA
Sandbrink
F
F
Culcea
E
E
Steinberg
S M
SM
Dahut
W
W
Pluda
J
J
Kruger
E A
EA
Reed
E
E
Figg
W D
WD
D000200:Action Potentials / Q000187:drug effects; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001917:Brachial Plexus / Q000187:drug effects / Q000503:physiopathology; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004568:Electrodiagnosis; D004576:Electromyography; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009431:Neural Conduction / Q000187:drug effects; D009475:Neurons, Afferent / Q000187:drug effects; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000175:diagnosis*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000188:drug therapy*; D012307:Risk Factors; D013497:Sural Nerve / Q000187:drug effects / Q000503:physiopathology; D013792:Thalidomide / Q000009:adverse effects*
D013792:Thalidomide