Quantitative Sensory Testing at Baseline and During Cycle 1 Oxaliplatin Infusion Detects Subclinical Peripheral Neuropathy and Predicts Clinically Overt Chronic Neuropathy in Gastrointestinal Malignancies.
OBJECTIVE
Oxaliplatin neurotoxicity has a spectrum of manifestations from an often reversible acute neurotoxicity to a more irreversible "stocking and glove" chronic neuropathy that is associated with high morbidity. Quantitative sensory testing (QST) is a noninvasive psychometric testing method that can potentially be used in the clinic setting to measure subclinical neurologic changes early on to identify patients that will experience chronic oxaliplatin-induced peripheral neuropathy at 1 year.


METHODS
Thirty patients with gastrointestinal malignancies who were receiving oxaliplatin were recruited. QST and patient-reported outcomes were assessed at baseline; during infusion cycles 1, 2, 4, and 6; and at 1 year. National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE), version 4.0, chronic neuropathy scores were assessed at the 1-year time point. The variables at each time point were evaluated for prediction of 1-year chronic neuropathy scores.


RESULTS
We found that patients with preexisting subclinical neuropathy were more likely to experience grades 2 and 3 chronic neuropathy than were those who did not have this condition (heat detection threshold, Spearman correlation coefficient (rs) = 0.39; P = .037; pellet retrieval time, rs = 0.47; P = .024). Patients in whom thermal and cutaneous sensory deficits developed with cycle 1 infusion were also more likely to experience grades 2 and 3 neuropathy at 1 year (cold detection threshold, rs = 0.50; P = .007; heat detection threshold, rs = 0.39; P = .042; cutaneous detection threshold, rs = 0.42; P = .043).


CONCLUSIONS
QST provides a noninvasive, commercially available, and feasible clinical test to select patients, even before oxaliplatin treatment, who are likely to experience moderate to severe chronic peripheral neuropathy.
Division of Hematology/Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: smreddy1@mdanderson.org.
Sangeetha M
SM
Reddy
Geisel School of Medicine, Section of Palliative Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH.
Maxwell T
MT
Vergo
Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL.
Judith A
JA
Paice
Department of Biobehavioral Sciences, Columbia University, New York, NY.
Nancy
N
Kwon
Department of Preventive Medicine, Northwestern University, Chicago, IL.
Irene B
IB
Helenowski
Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL.
Al B
AB
Benson
Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL.
Mary F
MF
Mulcahy
Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL.
Halla S
HS
Nimeiri
Center for Pain Studies, Rehabilitation Institute of Chicago and Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL.
Robert N
RN
Harden
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D058070:Asymptomatic Diseases; D002908:Chronic Disease; D003110:Colonic Neoplasms / Q000188:drug therapy; D015179:Colorectal Neoplasms / Q000188:drug therapy; D004067:Digestive System Neoplasms / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000139:chemically induced / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009048:Motor Skills; D009460:Neurologic Examination; D020258:Neurotoxicity Syndromes / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D009944:Organoplatinum Compounds / Q000009:adverse effects*; D000077150:Oxaliplatin; D010190:Pancreatic Neoplasms / Q000188:drug therapy; D063868:Patient Outcome Assessment; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced / Q000175:diagnosis* / Q000503:physiopathology; D011434:Proprioception; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000188:drug therapy; D012684:Sensory Thresholds; D020886:Somatosensory Disorders / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology; D014110:Touch; D014732:Vibration
D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin
Colorectal; NCI CTCAE; Neurooncology; Neuropathy; Neurotoxicity; Oxaliplatin; Quantitative sensory testing; Thermal