Clinical and Electrophysiological Assessment of Peripheral Neurotoxicity in Cancer Patients Treated with Paclitaxel Chemotherapy

Background: Taxane-induced peripheral neuropathy (TIPN) is a dose-limiting side effect and can lead to severe disability. Objective: To study the clinical and electrophysiological findings of paclitaxel (taxane) induced peripheral neurotoxicity in cancer patients. Methods: The study included 34 patients scheduled to be treated with paclitaxel and paclitaxel-cisplatin based regimens according to cancer type. Patients were divided into 2 groups: The first included patients treated by paclitaxel as single agent and the second included patients treated with paclitaxel and cisplatin. Patients were clinically and electrophysiologically monitored during and 3 months after discontinuing the chemotherapy; via the Modified Peripheral Neuropathy (PNP) score. Results: Evidence of Polyneuropathy (PN) was disclosed in 25 patients of the 34 patients (73.5%) treated with paclitaxel –based chemotherapy. The mean score of PNP was significantly higher in patients of group II than in patients of group I. Moreover, it was significantly increased from the 3 rd to 6 th cycles of chemotherapy. Significant deterioration in the amplitude of sensory action potentials (a-SAPs) of both ulnar and sural nerves was seen from the 3 rd to 6 th cycles of treatment. Further progression of neuropathy after discontinuation of chemotherapy, as particularly demonstrated by the sensory conduction abnormalities, was evident in group II. Conclusion: Our results indicated that patients treated with either paclitaxel alone or in combination with cisplatin based regimens would manifest an axonal predominately sensory PN. Combination of taxane and cisplatin increase the severity of PN than taxane alone. Persistence of PN for at least 3 months after the discontinuation of paclitaxel-cisplatin based chemotherapy also should be expected. [Egypt J Neurol Psychiat Neurosurg. 2010; 47(3): 433-440]