Chemotherapy-induced peripheral neuropathy in patients with gastroesophageal cancer

Abstract

In gastroesophageal cancer (GEC), systemic therapy is one of the main treatment modalities for both curative and palliative treatment.1–3 Chemotherapy regimens almost always include platinum compounds and/or taxanes, which are known to cause acute and chronic peripheral neuropathy.4,5 The incidence and severity of chemotherapy-induced peripheral neuropathy (CIPN) mostly depends on the cytotoxic agents used, their dose intensity, and cumulative dose.6 The incidence of CIPN differs among chemotherapy types, varying between 10% to 20% for taxanes, 10% to 40% for carboplatin and cisplatin, and up to 80% for oxaliplatin, as reported in randomized trials.7

CIPN burden is most often expressed by sensory symptoms and problems (eg, tingling, numbness, and pain) but may also present as motor symptoms, such as cramping and distal weakness, or autonomic symptoms. These problems may persist or sometimes even worsen after end of treatment in up to 60% of patients.8 Previous research in other cancer types has shown a negative association between CIPN burden and health-related quality of life (HRQoL) in both cancer survivors and patients with advanced cancer.9 Therefore, close monitoring of CIPN is crucial to direct toward dose reductions and/or treatment discontinuation if deemed necessary by medical professionals or at patient request.

Data reported thus far have been derived from clinical trials and real-world studies, the latter mainly being performed in colorectal cancer.10,11 Population-based data investigating CIPN in GEC are limited.12–14 Because of the specific treatment regimens of GEC, real-world data on CIPN in this population specifically are needed to inform physicians and patients about CIPN and aid them in decision-making regarding therapy. A high prevalence of CIPN in this population can be expected, because the most often used treatment regimens in GEC contain either paclitaxel, docetaxel, carboplatin, and/or oxaliplatin.3,15 Additionally, due to the poor prognosis of GEC, it is essential to consider side effects of treatment and their impact on HRQoL. The aim of this study was to investigate the incidence of CIPN, its severity over time, and its association with HRQoL in a cohort of patients receiving taxane- and/or platinum-based chemoradiotherapy, chemotherapy with curative intent, or with palliative intent for GEC in a real-world setting.