Motor dominant neuropathy induced by adjuvant therapy with adriamycin and cyclophosphamide followed by dose-dense paclitaxel in a breast cancer patient.
A 38-year-old woman underwent mastectomy and axillary lymph node dissection for invasive ductal carcinoma with multiple lymph node involvement. The patient received adriamycin 60 mg/m(2) and cyclophosphamide 600 mg/m(2) followed by weekly paclitaxel 80 mg/m(2) (without interruption) as adjuvant treatment. After receiving ten courses of paclitaxel, the patient developed motor neuropathy, with difficulty in ascending stairs and rising from a chair. A nerve conduction study demonstrated impairment of bilateral peroneal nerve function, although the sural sensory nerves were intact. After 2 weeks of withholding paclitaxel treatment, the motor neuropathy was alleviated and the scheduled doses were completed. A pharmacokinetic study of paclitaxel showed the possibility of elimination delay at the last infusion. We suggest that a dose-dense schedule of paclitaxel may be a significant risk factor for this kind of motor neuropathy.
Hikino
Hajime
H
Department of Surgery, Matsue Red Cross Hospital, 200 Horo, Matsue, Shimane 690-8506, Japan. hahikino@mail.goo.ne.jp
Kawashima
Mika
M
Yamada
Takako
T
Ozaki
Nobuhiro
N
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D016472:Motor Neuron Disease / Q000139:chemically induced; D017239:Paclitaxel / Q000008:administration & dosage*; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced*
D004317:Doxorubicin; D003520:Cyclophosphamide; D017239:Paclitaxel