Capecitabine combined with oxaliplatin (CapOx) in clinical practice: how significant is peripheral neuropathy?
BACKGROUND
There is speculation that peripheral neuropathy (PN) with capecitabine and oxaliplatin (CapOx; 130 mg/m(2), day 1, every 21 days) may be more common than with FOLFOX4 (5-fluorouracil and oxaliplatin 85 mg/m(2), day 1, every 14 days). We aimed to determine PN incidence and associations during CapOx, and 6 and 12 months after CapOx.


METHODS
Retrospective audit of 188 oxaliplatin-naive colorectal cancer patients (87 adjuvant, 101 palliative) who received at least one cycle of CapOx. Neurosensory Common Toxicity Criteria Adverse Events version 3 were applied.


RESULTS
Overall, 94% experienced acute PN. Worst severities for adjuvant and palliative patients, respectively, were grade 1, 44% and 54%; grade 2, 35% and 32%; grade 3, 16% and 3%; grade 4, 0% and 1% and grade unclear 1% and 1%. Two patients developed PN after CapOx completion despite no symptoms during treatment. Chronic PN at 6 months affected 57% and 18% of adjuvant and palliative patients, respectively. At 12 months, 35% and 16% were affected. Chronic PN at 12 months was associated with cumulative oxaliplatin dose but not age, gender, acute myotonia, pseudolaryngospasm or grade 2 or more PN during treatment.


CONCLUSIONS
Incidence of acute PN during CapOx appears similar to FOLFOX4 but chronic PN in adjuvant patients may be more common with CapOx.
Storey
D J
DJ
Department of Palliative Care and Supportive Oncology, Institute of Genetics and Molecular Medicine, University of Edinburgh Cancer Research Centre; Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK. Electronic address: dawn.storey@ed.ac.uk.
Sakala
M
M
Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK.
McLean
C M
CM
Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK.
Phillips
H A
HA
Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK.
Dawson
L K
LK
Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK.
Wall
L R
LR
Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK.
Fallon
M T
MT
Department of Palliative Care and Supportive Oncology, Institute of Genetics and Molecular Medicine, University of Edinburgh Cancer Research Centre.
Clive
S
S
Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK.
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D000069287:Capecitabine; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology
D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil