LB89
Peripheral Neuropathy (PN) during and 12 months after Capecitabine and Oxaliplatin chemotherapy (CAPOX) for colorectal cancer
Dawn Storey1, Maria Sakala2, Sally Clive2
1University of Edinburgh Cancer Research Centre, UK; 2Edinburgh Cancer Centre, UK
Background
There is little data regarding PN during and after CAPOX and speculation
that it may be more common than with FOLFOX4 (5-Fluorouracil and Oxaliplatin
85mg/m2, d1, q14). We aimed to determine the incidence and associations of
acute PN during CAPOX and chronic PN 6 and 12 months afterwards.
Method
A retrospective audit of 188 Oxaliplatin nave colorectal cancer patients
(87 adjuvant, 101 palliative) who received at least one cycle of CAPOX
(Oxaliplatin 130mg/m2 over 2 hours, d1, q21 and Capecitabine 1000mg/m2 orally
twice daily day 1 evening to day 15 morning for 8 (adjuvant) or 6 cycles
(palliative)) between 1/6/06 and 31/5/07. Neurosensory Common Toxicity Criteria
version 3 were applied. Data were described and associations explored using Mann
Whitney and Chi-squared tests.
Results
Median age: 61 years (range 25 to 79). Overall 94%(n=158) experienced acute
PN. Worst severities for adjuvant and palliative patients respectively were:
grade 1, 44%(n=34) and 54%(n=50); grade 2, 35%(n=27) and 32%(n=29); grade 3,
16%(n=12) and 3%(n=3); grade 4, 0% and 1%(n=1), grade unclear 1%(n=1) and
1%(n=1). Other neurotoxicities included pseudolaryngospasm (26%, n=49), acute
lower limb muscular dysfunction (jelly legs, 5%, n=10) and visual disturbance
(1%, n=2). Two patients developed new PN after CAPOX completion despite no
symptoms during treatment. Chronic PN at 6 and 12 months affected 57%(n=31) and
35%(n=22) of adjuvant patients respectively. Correspondingly 18%(n=11) and
16%(n=6) of palliative patients were affected. Chronic PN at 12 months was
associated with a higher median cumulative Oxaliplatin dose, 834mg/m2 (447
to1040) versus 702mg/m2 (130 to 1040), p=0.001, but not age, gender, jelly
legs, layngospasm or ≥ grade 2 PN during treatment.
Conclusion
The incidence of acute PN during CAPOX appears similar to FOLFOX4 (Andre et
al, NEJM 2004;350;2343-2351) but chronic PN in adjuvant patients may be more
common with CAPOX. Prospective studies are required.
