title: Capecitabine combined with oxaliplatin (CapOx) in clinical practice: how significant is peripheral neuropathy?
abstract: 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.
authors.affiliation: 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.
authors.forename: D J
authors.initials: DJ
authors.lastname: Storey
authors.affiliation: Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK.
authors.forename: M
authors.initials: M
authors.lastname: Sakala
authors.affiliation: Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK.
authors.forename: C M
authors.initials: CM
authors.lastname: McLean
authors.affiliation: Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK.
authors.forename: H A
authors.initials: HA
authors.lastname: Phillips
authors.affiliation: Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK.
authors.forename: L K
authors.initials: LK
authors.lastname: Dawson
authors.affiliation: Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK.
authors.forename: L R
authors.initials: LR
authors.lastname: Wall
authors.affiliation: Department of Palliative Care and Supportive Oncology, Institute of Genetics and Molecular Medicine, University of Edinburgh Cancer Research Centre.
authors.forename: M T
authors.initials: MT
authors.lastname: Fallon
authors.affiliation: Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK.
authors.forename: S
authors.initials: S
authors.lastname: Clive
mesh_terms: 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
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil