title: [Evaluation of efficacy and safety of adjuvant analgesics for peripheral neuropathy induced by cancer chemotherapy in digestive cancer patients-a pilot study].
abstract: After 1990's, the development of new generation anti-cancer agents produced encouraging improvement of prognosis in inoperable or relapsed stomach cancer and colorectal cancer. However, non-hematological toxicity, such as peripheral neuropathies, become a new dose-limiting toxicity. In several new generation drugs, measures for controlling peripheral neuropathy had not been established besides dose modification or schedule modification. We tried to control the peripheral neuropathy induced by anti-cancer agents with the assistance of an adjuvant analgesics ladder. A total of 18 digestive cancer patients who presented with peripheral neuropathy of grade 1 or more(NCI-CTCAE ver 3.0), in the chemotherapy including Taxol or Oxaliplatin, were enrolled. The first stage of the adjuvant analgesics ladder was set as the antidepressant(amoxapin), the second stage was anticonvulsive drugs(valproic acid or clonazepam) and the third stage was antiarrhythmic drug(mexiletine). In each stage, if the drug turned out to be ineffective after two / weeks follow-up, it shifted to the next stage. The response rate of each step was 61.1%(11/18)of the first stage, 50.0%(5/10)of the 2nd stage, 50.0%(2/4)of the 3rd stage, and the overall response rate was 77.8%. The discontinuance of cancer treatment by peripheral neuropathy was observed only in 1 patient 5.5%(1/18)in the Taxol administered group. The toxicity profile was skin eruption and drowsiness, but the skin eruption was observed only in 1 patient at the 3rd stage and the drowsiness in 2 patients at the 2nd stage. It appears that the method to control the peripheral neuropathy induced by anti-cancer agents with the assistance of adjuvant analgesics ladder was effective and safe, but a large-scale clinical trial was warranted.
authors.affiliation: Division of Pharmacology, Sumitomo-Besshi Hospital, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Yano
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Yamane
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Fukuoka
authors.forename: Takashi
authors.initials: T
authors.lastname: Ninomiya
authors.forename: Shigeki
authors.initials: S
authors.lastname: Umemura
authors.forename: Seiyuu
authors.initials: S
authors.lastname: Suzuki
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Saeki
authors.forename: Toshihito
authors.initials: T
authors.lastname: Hanaoka
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Katou
authors.forename: Kaori
authors.initials: K
authors.lastname: Itoh
authors.forename: Takane
authors.initials: T
authors.lastname: Fujita
authors.forename: Haruhito
authors.initials: H
authors.lastname: Kamei
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000473:pathology; D010865:Pilot Projects
chemical_list: D000700:Analgesics; D000970:Antineoplastic Agents