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Martland ME, Rashidi AS, Bennett MI, Fallon M, Jones C, Rolke R, Mulvey MR. The use of quantitative sensory testing in cancer pain assessment: A systematic review. Eur J Pain 2020; 24:669-684. [DOI: 10.1002/ejp.1520] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 11/19/2019] [Accepted: 12/05/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Maisie E. Martland
- St Gemma's Academic Unit of Palliative Care Leeds Institute of Health ScienceUniversity of Leeds Leeds UK
| | | | - Michael I. Bennett
- St Gemma's Academic Unit of Palliative Care Leeds Institute of Health ScienceUniversity of Leeds Leeds UK
| | - Marie Fallon
- Edinburgh Cancer Research Centre IGMMUniversity of Edinburgh Edinburgh UK
| | - Chris Jones
- St Gemma's Academic Unit of Palliative Care Leeds Institute of Health ScienceUniversity of Leeds Leeds UK
| | - Roman Rolke
- Department of Palliative Medicine Medical Faculty RWTH Aachen University Aachen Germany
| | - Matthew R. Mulvey
- St Gemma's Academic Unit of Palliative Care Leeds Institute of Health ScienceUniversity of Leeds Leeds UK
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Flatters SJL, Dougherty PM, Colvin LA. Clinical and preclinical perspectives on Chemotherapy-Induced Peripheral Neuropathy (CIPN): a narrative review. Br J Anaesth 2019; 119:737-749. [PMID: 29121279 DOI: 10.1093/bja/aex229] [Citation(s) in RCA: 224] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2017] [Indexed: 12/20/2022] Open
Abstract
This review provides an update on the current clinical and preclinical understanding of chemotherapy induced peripheral neuropathy (CIPN). The overview of the clinical syndrome includes a review of its assessment, diagnosis and treatment. CIPN is caused by several widely-used chemotherapeutics including paclitaxel, oxaliplatin, bortezomib. Severe CIPN may require dose reduction, or cessation, of chemotherapy, impacting on patient survival. While CIPN often resolves after chemotherapy, around 30% of patients will have persistent problems, impacting on function and quality of life. Early assessment and diagnosis is important, and we discuss tools developed for this purpose. There are no effective strategies to prevent CIPN, with limited evidence of effective drugs for treating established CIPN. Duloxetine has moderate evidence, with extrapolation from other neuropathic pain states generally being used to direct treatment options for CIPN. The preclinical perspective includes a discussion on the development of clinically-relevant rodent models of CIPN and some of the potentially modifiable mechanisms that have been identified using these models. We focus on the role of mitochondrial dysfunction, oxidative stress, immune cells and changes in ion channels from summary of the latest literature in these areas. Many causal mechanisms of CIPN occur simultaneously and/or can reinforce each other. Thus, combination therapies may well be required for most effective management. More effective treatment of CIPN will require closer links between oncology and pain management clinical teams to ensure CIPN patients are effectively monitored. Furthermore, continued close collaboration between clinical and preclinical research will facilitate the development of novel treatments for CIPN.
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Affiliation(s)
- S J L Flatters
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE1 1UL, UK
| | - P M Dougherty
- Division of Anaesthesia, Critical Care and Pain Medicine, Department of Pain Medicine Research, The University of Texas M.D. Anderson Cancer Centre, Houston, TX, USA
| | - L A Colvin
- Department of Anaesthesia, Critical Care & Pain Medicine, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh EH4 2XU, UK
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Roldan CJ, Johnson C, Lee SO, Peng A, Dougherty PM, Huh B. Subclinical Peripheral Neuropathy in Patients with Head and Neck Cancer: A Quantitative Sensory Testing (QST) Study. Pain Physician 2018; 21:E419-E427. [PMID: 30045608 PMCID: PMC6471511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a common and chronic complication associated with cancer treatment. Prior investigations have demonstrated the presence of subclinical peripheral neuropathy in patients with colorectal cancer even before the patients had received chemotherapy. OBJECTIVE To investigate subclinical peripheral neuropathy of the upper limbs in patients with squamous cell carcinoma (SCC) of the head and neck which developed before their exposure to neurotoxic anticancer agents. STUDY DESIGN Retrospective analysis. METHODS With the use of our quantitative sensory testing (QST) data bank, we retrospectively assessed the afferent fiber function of 25 patients with SCC of the head and neck before they had received chemotherapy (the patient group) and compared our findings with those from 23 healthy control patients. Skin temperature, sensorimotor function, sharpness detection, thermal detection, and touch detection (using both von Frey monofilaments and the Bumps detection test) were measured. RESULTS Touch thresholds were statistically higher in the patient group than in the healthy volunteer group at the palm (mean [± SD], 0.54 g [± 0.07 g] and 0.27 g [± 0.05 g], respectively [P < 0.01]) and at the forearm (0.74 g [± 0.12 g] and 0.41 g [± 0.08 g] [P < 0.05]). There was also a clear deficit in touch sensation as indicated by a Bumps detection threshold in patients of 6.5 µm ± 0.8 µm and in controls of 3.7 µm ± 0.5 µm. This yields an elevation in threshold to 165% in the patients relative to that of the control volunteers. The grooved pegboard test showed delayed completion times for patients compared with controls, with differences of 18.65 seconds in the dominant hand and of 23.36 seconds in the nondominant hand. The sharpness detection thresholds did not differ between patients and volunteers. LIMITATIONS Inadequacies in the original data acquisition and documentation of the QST and the medical records could not be addressed due to the retrospective nature of the study. In addition, based on available information, we did not find an objective parameter able to correlate the QST findings with pre-pain levels. CONCLUSION Patients with SCC were found to have deficits in sensory function before undergoing treatment, suggesting that cancer itself alters peripheral nerve function and may contribute to the development of CIPN. These results confirm the sensitivity of the Bumps detection test and highlight its potential role in early detection of peripheral neuropathy, especially in cancer patients for whom chemotherapies associated with CIPN have been prescribed. KEY WORDS Peripheral neuropathy, head and neck cancer, quantitative sensory testing.
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Affiliation(s)
- Carlos J. Roldan
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Emergency Medicine, The University of Texas Health Science Center, Houston, TX
| | | | - Sin-Ong Lee
- Department of Anesthesiology, Cathay General Hospital, Taipei, Taiwan
| | - Andrew Peng
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Patrick M. Dougherty
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Billy Huh
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Kandula T, Farrar MA, Krishnan AV, Murray J, Timmins HC, Goldstein D, Lin CSY, Kiernan MC, Park SB. Multimodal quantitative examination of nerve function in colorectal cancer patients prior to chemotherapy. Muscle Nerve 2017; 57:615-621. [PMID: 28881477 DOI: 10.1002/mus.25968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 09/01/2017] [Accepted: 09/04/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Given recent findings of subclinical sensory deficits in colorectal cancer patients before oxaliplatin treatment, in the current study we aimed to identify evidence of subclinical peripheral neuropathy on multimodal testing before chemotherapy commencement. METHODS Clinical, functional, and neurophysiological assessments were undertaken in 93 colorectal cancer patients before chemotherapy. RESULTS There was no neurophysiological evidence of neuropathy, with 92 of 93 sural sensory values within normative reference values for age and no significant abnormalities detected in nerve conduction or nerve excitability studies. Clinical neurological assessment revealed 75.9% of patients with no signs or symptoms, 10.3% with reduction in distal vibration or pinprick sensitivity, and 6.9% with reduction in ankle reflexes only. There was no difference in manual dexterity (using the 9-hole peg-board test) compared with normative data. DISCUSSION The present study has established a low likelihood of significant distal symmetrical polyneuropathy in colorectal cancer patients before initiation of chemotherapy. Muscle Nerve 57: 615-621, 2018.
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Affiliation(s)
- Tejaswi Kandula
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Michelle A Farrar
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Jenna Murray
- Prince of Wales Clinical School, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Hannah C Timmins
- Brain & Mind Centre, University of Sydney, 94-100 Mallett Street, Camperdown, New South Wales, 2050, Australia
| | - David Goldstein
- Prince of Wales Clinical School, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Cindy S-Y Lin
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew C Kiernan
- Brain & Mind Centre, University of Sydney, 94-100 Mallett Street, Camperdown, New South Wales, 2050, Australia
| | - Susanna B Park
- Brain & Mind Centre, University of Sydney, 94-100 Mallett Street, Camperdown, New South Wales, 2050, Australia.,Neuroscience Research Australia and Prince of Wales Clinical School, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Paice JA, Mulvey M, Bennett M, Dougherty PM, Farrar JT, Mantyh PW, Miaskowski C, Schmidt B, Smith TJ. AAPT Diagnostic Criteria for Chronic Cancer Pain Conditions. THE JOURNAL OF PAIN 2017; 18:233-246. [PMID: 27884691 PMCID: PMC5439220 DOI: 10.1016/j.jpain.2016.10.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 10/11/2016] [Accepted: 10/26/2016] [Indexed: 12/15/2022]
Abstract
Chronic cancer pain is a serious complication of malignancy or its treatment. Currently, no comprehensive, universally accepted cancer pain classification system exists. Clarity in classification of common cancer pain syndromes would improve clinical assessment and management. Moreover, an evidence-based taxonomy would enhance cancer pain research efforts by providing consistent diagnostic criteria, ensuring comparability across clinical trials. As part of a collaborative effort between the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) and the American Pain Society (APS), the ACTTION-APS Pain Taxonomy initiative worked to develop the characteristics of an optimal diagnostic system. After the establishment of these characteristics, a working group consisting of clinicians and clinical and basic scientists with expertise in cancer and cancer-related pain was convened to generate core diagnostic criteria for an illustrative sample of 3 chronic pain syndromes associated with cancer (ie, bone pain and pancreatic cancer pain as models of pain related to a tumor) or its treatment (ie, chemotherapy-induced peripheral neuropathy). A systematic review and synthesis was conducted to provide evidence for the dimensions that comprise this cancer pain taxonomy. Future efforts will subject these diagnostic categories and criteria to systematic empirical evaluation of their feasibility, reliability, and validity and extension to other cancer-related pain syndromes. PERSPECTIVE The ACTTION-APS chronic cancer pain taxonomy provides an evidence-based classification for 3 prevalent syndromes, namely malignant bone pain, pancreatic cancer pain, and chemotherapy-induced peripheral neuropathy. This taxonomy provides consistent diagnostic criteria, common features, comorbidities, consequences, and putative mechanisms for these potentially serious cancer pain conditions that can be extended and applied with other cancer-related pain syndromes.
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Affiliation(s)
- Judith A Paice
- Division of Hematology-Oncology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
| | - Matt Mulvey
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Michael Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Patrick M Dougherty
- The Division of Anesthesia and Critical Care Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - John T Farrar
- Department of Epidemiology, Neurology, and Anesthesia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Patrick W Mantyh
- Department of Pharmacology, University of Arizona, Tucson, Arizona
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, California
| | - Brian Schmidt
- Bluestone Center for Clinical Research, New York University College of Dentistry, New York, New York
| | - Thomas J Smith
- Department of Oncology, The Johns Hopkins Hospital, Baltimore, Maryland
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Krukowski K, Nijboer CH, Huo X, Kavelaars A, Heijnen CJ. Prevention of chemotherapy-induced peripheral neuropathy by the small-molecule inhibitor pifithrin-μ. Pain 2016; 156:2184-2192. [PMID: 26473292 DOI: 10.1097/j.pain.0000000000000290] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer treatment. It is the most frequent cause of dose reduction or treatment discontinuation in patients treated for cancer with commonly used drugs including taxanes and platinum-based compounds. No FDA-approved treatments for CIPN are available. In rodents, CIPN is represented by peripheral mechanical allodynia in association with retraction of intraepidermal nerve fibers. The mechanism of chemotherapy-induced neurotoxicity is unclear, but it has been established that mitochondrial dysfunction is an important component of the dysregulation in peripheral sensory neurons. We have shown earlier that inhibition of mitochondrial p53 accumulation with the small compound pifithrin-μ (PFT-μ) prevents cerebral neuronal death in a rodent model of hypoxic-ischemic brain damage. We now explore whether PFT-μ is capable of preventing neuronal mitochondrial damage and CIPN in mice. We demonstrate for the first time that PFT-μ prevents both paclitaxel- and cisplatin-induced mechanical allodynia. Electron microscopic analysis of peripheral sensory nerves revealed that PFT-μ secured mitochondrial integrity in paclitaxel-treated mice. In addition, PFT-μ administration protects against chemotherapy-induced loss of intraepidermal nerve fibers in the paw. To determine whether neuroprotective treatment with PFT-μ would interfere with the antitumor effects of chemotherapy, ovarian tumor cells were cultured in vitro with PFT-μ and paclitaxel. Pifithrin-μ does not inhibit tumor cell death but even enhances paclitaxel-induced tumor cell death. These data are the first to identify PFT-μ as a potential therapeutic strategy for prevention of CIPN to combat one of the most devastating side effects of chemotherapy.
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Affiliation(s)
- Karen Krukowski
- Laboratory of Neuroimmunology, Department Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA Laboratory of Neuroimmunology and Developmental Origins of Disease (NIDOD), University Medical Center Utrecht, Utrecht, the Netherlands
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Fernandes R, Siegel P, Komarova S, Hilton J, Addison C, Ibrahim MFK, Werier J, Dennis K, Singh G, Amir E, Jarvis V, Emmenegger U, Mazzarello S, Clemons M. Future directions for bone metastasis research - highlights from the 2015 bone and the Oncologist new updates conference (BONUS). J Bone Oncol 2016; 5:57-62. [PMID: 27335772 PMCID: PMC4908181 DOI: 10.1016/j.jbo.2016.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/10/2016] [Accepted: 02/10/2016] [Indexed: 12/21/2022] Open
Abstract
In an era of reduced peer-reviewed grant funding, performing academic bone oncology-related research has become increasingly challenging. Over the last 10 years we have held an annual meeting to bring together clinicians, clinician/scientists and basic biomedical researchers interested in the effects of cancer and its treatment on skeletal tissues. In the past these "Bone and the Oncologist New Updates Conference (BONUS)" meetings have served as critical catalyst for initiating productive research collaborations between attendees. The 2015 BONUS meeting format focused on potential key research themes that could form the basis of a coordinated national research strategy to tackle unmet clinical and research needs related to complications associated with cancer metastasis to bone. The three themes planned for discussion were: Is bone metastases-related pain the main issue facing patients? Are there new therapeutic targets for patients with bone metastases? How do we more firmly link basic science with clinical practice? We present a summary of lectures and commentaries from the attendees to serve as an example that other similarly motivated groups can model and share their experiences. It is our hope that these presentations will result in comments, feedback and suggestions from all those researchers interested in this important area.
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Affiliation(s)
- Ricardo Fernandes
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Peter Siegel
- Department of Medicine, Goodman Cancer Research Centre, McGill University, Montreal, Canada
| | - Svetlana Komarova
- Department of Medicine, Goodman Cancer Research Centre, McGill University, Montreal, Canada
- Faculty of Dentistry, McGill University, Montreal, Canada
| | - John Hilton
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Christina Addison
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Mohammed F K Ibrahim
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Joel Werier
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
- Department of Surgery, Division of Orthopaedic Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Kristopher Dennis
- Ottawa Hospital Division of Radiation Oncology and University of Ottawa, Ottawa, Ontario, Canada
| | | | - Eitan Amir
- Division of Medical Oncology, Department of Medicine, University Health Network and Princess Margaret Hospital and University of Toronto, Toronto, Canada
| | - Virginia Jarvis
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Urban Emmenegger
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Sasha Mazzarello
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Mark Clemons
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
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Pereira S, Fontes F, Sonin T, Dias T, Fragoso M, Castro-Lopes JM, Lunet N. Chemotherapy-induced peripheral neuropathy after neoadjuvant or adjuvant treatment of breast cancer: a prospective cohort study. Support Care Cancer 2015; 24:1571-81. [PMID: 26384827 DOI: 10.1007/s00520-015-2935-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 09/02/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE The purposes of this study were to estimate the incidence of chemotherapy-induced peripheral neuropathy (CIPN) and to identify its main determinants and impact in patient-reported outcomes. METHODS We performed a prospective cohort study including 296 patients with incident breast cancer submitted to chemotherapy, followed for 1 year. Patients with incident CIPN were reevaluated 6 months after this diagnosis. Relative risks (RR) with 95 % confidence intervals (95 % CI) were computed to quantify the relation between different clinical characteristics and the occurrence of CIPN, using Poisson regression. The variation of patient-reported outcomes between baseline and 1-year follow-up assessments was compared between patients with and without CIPN. RESULTS The cumulative incidence of CIPN in the first year after diagnosis was 28.7 % (95 % CI 23.8-34.1), and more than 80 % of the patients were still symptomatic after 6 months. Among the latter, there was a significant decrease in the median total neuropathy score, clinical version (7 versus 4) between the two periods. In multivariable analysis, the risk of CIPN was higher for treatment with docetaxel (cumulative doses ≤300 mg/m(2), RR = 6.96, 95 % CI 2.53-19.10; >300 mg/m(2), RR = 13.32; 95 % CI 4.11-43.14). Alcohol consumption and diabetes were not significantly associated with CIPN. There were no significant differences in the variation of patient-reported outcomes between the baseline and 1-year follow-up evaluations. CONCLUSIONS CIPN was frequent in this contemporary cohort of early-stage breast cancer patients and was strongly associated with docetaxel-based regimens. Symptoms persisted for at least 6 months in most patients, but severity was low and CIPN had no impact on patient-reported outcomes.
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Affiliation(s)
- Susana Pereira
- Portuguese Institute of Oncology of Porto, Rua Dr. António Bernardino de Almeida, 4200-075, Porto, Portugal.,EPIUnit-Institute of Public Health, University of Porto (ISPUP), Rua das Taipas, n 135, 4050-600, Porto, Portugal
| | - Filipa Fontes
- EPIUnit-Institute of Public Health, University of Porto (ISPUP), Rua das Taipas, n 135, 4050-600, Porto, Portugal.,Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Teresa Sonin
- Portuguese Institute of Oncology of Porto, Rua Dr. António Bernardino de Almeida, 4200-075, Porto, Portugal
| | - Teresa Dias
- Portuguese Institute of Oncology of Porto, Rua Dr. António Bernardino de Almeida, 4200-075, Porto, Portugal
| | - Maria Fragoso
- Portuguese Institute of Oncology of Porto, Rua Dr. António Bernardino de Almeida, 4200-075, Porto, Portugal
| | - José M Castro-Lopes
- Department of Experimental Biology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Institute for Molecular and Cell Biology (IBMC), University of Porto, Rua do Campo Alegre, n 823, 4150-180, Porto, Portugal
| | - Nuno Lunet
- EPIUnit-Institute of Public Health, University of Porto (ISPUP), Rua das Taipas, n 135, 4050-600, Porto, Portugal. .,Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
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Vichaya EG, Chiu GS, Krukowski K, Lacourt TE, Kavelaars A, Dantzer R, Heijnen CJ, Walker AK. Mechanisms of chemotherapy-induced behavioral toxicities. Front Neurosci 2015; 9:131. [PMID: 25954147 PMCID: PMC4404721 DOI: 10.3389/fnins.2015.00131] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/01/2015] [Indexed: 11/13/2022] Open
Abstract
While chemotherapeutic agents have yielded relative success in the treatment of cancer, patients are often plagued with unwanted and even debilitating side-effects from the treatment which can lead to dose reduction or even cessation of treatment. Common side effects (symptoms) of chemotherapy include (i) cognitive deficiencies such as problems with attention, memory and executive functioning; (ii) fatigue and motivational deficit; and (iii) neuropathy. These symptoms often develop during treatment but can remain even after cessation of chemotherapy, severely impacting long-term quality of life. Little is known about the underlying mechanisms responsible for the development of these behavioral toxicities, however, neuroinflammation is widely considered to be one of the major mechanisms responsible for chemotherapy-induced symptoms. Here, we critically assess what is known in regards to the role of neuroinflammation in chemotherapy-induced symptoms. We also argue that, based on the available evidence, neuroinflammation is unlikely the only mechanism involved in the pathogenesis of chemotherapy-induced behavioral toxicities. We evaluate two other putative candidate mechanisms. To this end we discuss the mediating role of damage-associated molecular patterns (DAMPs) activated in response to chemotherapy-induced cellular damage. We also review the literature with respect to possible alternative mechanisms such as a chemotherapy-induced change in the bioenergetic status of the tissue involving changes in mitochondrial function in relation to chemotherapy-induced behavioral toxicities. Understanding the mechanisms that underlie the emergence of fatigue, neuropathy, and cognitive difficulties is vital to better treatment and long-term survival of cancer patients.
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Affiliation(s)
- Elisabeth G Vichaya
- Laboratory of Neuroimmunology, Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center Houston, TX, USA
| | - Gabriel S Chiu
- Laboratory of Neuroimmunology, Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center Houston, TX, USA
| | - Karen Krukowski
- Laboratory of Neuroimmunology, Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center Houston, TX, USA
| | - Tamara E Lacourt
- Laboratory of Neuroimmunology, Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center Houston, TX, USA
| | - Annemieke Kavelaars
- Laboratory of Neuroimmunology, Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center Houston, TX, USA
| | - Robert Dantzer
- Laboratory of Neuroimmunology, Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center Houston, TX, USA
| | - Cobi J Heijnen
- Laboratory of Neuroimmunology, Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center Houston, TX, USA
| | - Adam K Walker
- Laboratory of Neuroimmunology, Division of Internal Medicine, Department of Symptom Research, The University of Texas MD Anderson Cancer Center Houston, TX, USA
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11
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de Carvalho Barbosa M, Kosturakis AK, Eng C, Wendelschafer-Crabb G, Kennedy WR, Simone DA, Wang XS, Cleeland CS, Dougherty PM. A quantitative sensory analysis of peripheral neuropathy in colorectal cancer and its exacerbation by oxaliplatin chemotherapy. Cancer Res 2014; 74:5955-62. [PMID: 25183707 PMCID: PMC4216766 DOI: 10.1158/0008-5472.can-14-2060] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Peripheral neuropathy caused by cytotoxic chemotherapy, especially platins and taxanes, is a widespread problem among cancer survivors that is likely to continue to expand in the future. However, little work to date has focused on understanding this challenge. The goal in this study was to determine the impact of colorectal cancer and cumulative chemotherapeutic dose on sensory function to gain mechanistic insight into the subtypes of primary afferent fibers damaged by chemotherapy. Patients with colorectal cancer underwent quantitative sensory testing before and then prior to each cycle of oxaliplatin. These data were compared with those from 47 age- and sex-matched healthy volunteers. Patients showed significant subclinical deficits in sensory function before any therapy compared with healthy volunteers, and they became more pronounced in patients who received chemotherapy. Sensory modalities that involved large Aβ myelinated fibers and unmyelinated C fibers were most affected by chemotherapy, whereas sensory modalities conveyed by thinly myelinated Aδ fibers were less sensitive to chemotherapy. Patients with baseline sensory deficits went on to develop more symptom complaints during chemotherapy than those who had no baseline deficit. Patients who were tested again 6 to 12 months after chemotherapy presented with the most numbness and pain and also the most pronounced sensory deficits. Our results illuminate a mechanistic connection between the pattern of effects on sensory function and the nerve fiber types that appear to be most vulnerable to chemotherapy-induced toxicity, with implications for how to focus future work to ameloirate risks of peripheral neuropathy.
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Affiliation(s)
- Mariana de Carvalho Barbosa
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG and CAPES/CNPq Coordination for the Improvement of Higher Education-Science without Borders, DF CNPJ, Brazil
| | - Alyssa K Kosturakis
- Department of Anesthesia and Pain Medicine Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cathy Eng
- Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - William R Kennedy
- Department of Neurology, the University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - Donald A Simone
- Department of Diagnostic and Biological Sciences, the University of Minnesota School of Dentistry, Minneapolis, Minnesota
| | - Xin S Wang
- Department of Symptom Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Charles S Cleeland
- Department of Symptom Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Patrick M Dougherty
- Department of Anesthesia and Pain Medicine Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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12
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Kosturakis AK, He Z, Li Y, Boyette-Davis JA, Shah N, Thomas SK, Zhang H, Vichaya EG, Wang XS, Wendelschafer-Crabb G, Kennedy WR, Simone DA, Cleeland CS, Dougherty PM. Subclinical peripheral neuropathy in patients with multiple myeloma before chemotherapy is correlated with decreased fingertip innervation density. J Clin Oncol 2014; 32:3156-62. [PMID: 25154818 DOI: 10.1200/jco.2013.54.5418] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The goal in this study was to determine the incidence of subclinical neuropathy in treatment-naive patients with multiple myeloma (MM) with no history of peripheral neuropathy using quantitative sensory tests (QSTs) and its correlation with innervation density of the extremities using noninvasive laser reflectance confocal microscopy. PATIENTS AND METHODS QST results were collected for 27 patients with a diagnosis of MM and compared with data collected from 30 age- and sex-matched healthy volunteers. Skin temperature, sensorimotor function (grooved pegboard test), and detection thresholds for temperature, sharpness, and low-threshold mechanical stimuli (von Frey monofilaments and bumps detection test) were measured. Meissner's corpuscle (MC) density in the fingertips was assessed using in vivo laser reflectance confocal microscopy. RESULTS Patients showed a high incidence (> 80%) of ≥ one subclinical QST deficit. These included increased von Frey, bumps, and warmth detection thresholds as compared with healthy volunteers. Patients also showed increases in cold pain, sensorimotor deficits (grooved pegboard test), and higher overall neuropathy scores. MC density was significantly lower in patients than controls and showed significant inverse correlation with bumps detection threshold. CONCLUSION Patients with MM commonly present with sensory and sensorimotor deficits before undergoing treatment, and these deficits seem to result from disease-related decreases in peripheral innervation density.
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Affiliation(s)
- Alyssa K Kosturakis
- Alyssa K. Kosturakis, Zijing He, Yan Li, Nina Shah, Sheeba K. Thomas, Haijun Zhang, Elisabeth G. Vichaya, Xin Shelley Wang, Charles S. Cleeland, and Patrick M. Dougherty, University of Texas MD Anderson Cancer Center, Houston, TX; Jessica A. Boyette-Davis, York College, York, PA; Gwen Wendelschafer-Crabb and William R. Kennedy, University of Minnesota School of Medicine; and Donald A. Simone, University of Minnesota School of Dentistry, Minneapolis, MN
| | - Zijing He
- Alyssa K. Kosturakis, Zijing He, Yan Li, Nina Shah, Sheeba K. Thomas, Haijun Zhang, Elisabeth G. Vichaya, Xin Shelley Wang, Charles S. Cleeland, and Patrick M. Dougherty, University of Texas MD Anderson Cancer Center, Houston, TX; Jessica A. Boyette-Davis, York College, York, PA; Gwen Wendelschafer-Crabb and William R. Kennedy, University of Minnesota School of Medicine; and Donald A. Simone, University of Minnesota School of Dentistry, Minneapolis, MN
| | - Yan Li
- Alyssa K. Kosturakis, Zijing He, Yan Li, Nina Shah, Sheeba K. Thomas, Haijun Zhang, Elisabeth G. Vichaya, Xin Shelley Wang, Charles S. Cleeland, and Patrick M. Dougherty, University of Texas MD Anderson Cancer Center, Houston, TX; Jessica A. Boyette-Davis, York College, York, PA; Gwen Wendelschafer-Crabb and William R. Kennedy, University of Minnesota School of Medicine; and Donald A. Simone, University of Minnesota School of Dentistry, Minneapolis, MN
| | - Jessica A Boyette-Davis
- Alyssa K. Kosturakis, Zijing He, Yan Li, Nina Shah, Sheeba K. Thomas, Haijun Zhang, Elisabeth G. Vichaya, Xin Shelley Wang, Charles S. Cleeland, and Patrick M. Dougherty, University of Texas MD Anderson Cancer Center, Houston, TX; Jessica A. Boyette-Davis, York College, York, PA; Gwen Wendelschafer-Crabb and William R. Kennedy, University of Minnesota School of Medicine; and Donald A. Simone, University of Minnesota School of Dentistry, Minneapolis, MN
| | - Nina Shah
- Alyssa K. Kosturakis, Zijing He, Yan Li, Nina Shah, Sheeba K. Thomas, Haijun Zhang, Elisabeth G. Vichaya, Xin Shelley Wang, Charles S. Cleeland, and Patrick M. Dougherty, University of Texas MD Anderson Cancer Center, Houston, TX; Jessica A. Boyette-Davis, York College, York, PA; Gwen Wendelschafer-Crabb and William R. Kennedy, University of Minnesota School of Medicine; and Donald A. Simone, University of Minnesota School of Dentistry, Minneapolis, MN
| | - Sheeba K Thomas
- Alyssa K. Kosturakis, Zijing He, Yan Li, Nina Shah, Sheeba K. Thomas, Haijun Zhang, Elisabeth G. Vichaya, Xin Shelley Wang, Charles S. Cleeland, and Patrick M. Dougherty, University of Texas MD Anderson Cancer Center, Houston, TX; Jessica A. Boyette-Davis, York College, York, PA; Gwen Wendelschafer-Crabb and William R. Kennedy, University of Minnesota School of Medicine; and Donald A. Simone, University of Minnesota School of Dentistry, Minneapolis, MN
| | - Haijun Zhang
- Alyssa K. Kosturakis, Zijing He, Yan Li, Nina Shah, Sheeba K. Thomas, Haijun Zhang, Elisabeth G. Vichaya, Xin Shelley Wang, Charles S. Cleeland, and Patrick M. Dougherty, University of Texas MD Anderson Cancer Center, Houston, TX; Jessica A. Boyette-Davis, York College, York, PA; Gwen Wendelschafer-Crabb and William R. Kennedy, University of Minnesota School of Medicine; and Donald A. Simone, University of Minnesota School of Dentistry, Minneapolis, MN
| | - Elisabeth G Vichaya
- Alyssa K. Kosturakis, Zijing He, Yan Li, Nina Shah, Sheeba K. Thomas, Haijun Zhang, Elisabeth G. Vichaya, Xin Shelley Wang, Charles S. Cleeland, and Patrick M. Dougherty, University of Texas MD Anderson Cancer Center, Houston, TX; Jessica A. Boyette-Davis, York College, York, PA; Gwen Wendelschafer-Crabb and William R. Kennedy, University of Minnesota School of Medicine; and Donald A. Simone, University of Minnesota School of Dentistry, Minneapolis, MN
| | - Xin Shelley Wang
- Alyssa K. Kosturakis, Zijing He, Yan Li, Nina Shah, Sheeba K. Thomas, Haijun Zhang, Elisabeth G. Vichaya, Xin Shelley Wang, Charles S. Cleeland, and Patrick M. Dougherty, University of Texas MD Anderson Cancer Center, Houston, TX; Jessica A. Boyette-Davis, York College, York, PA; Gwen Wendelschafer-Crabb and William R. Kennedy, University of Minnesota School of Medicine; and Donald A. Simone, University of Minnesota School of Dentistry, Minneapolis, MN
| | - Gwen Wendelschafer-Crabb
- Alyssa K. Kosturakis, Zijing He, Yan Li, Nina Shah, Sheeba K. Thomas, Haijun Zhang, Elisabeth G. Vichaya, Xin Shelley Wang, Charles S. Cleeland, and Patrick M. Dougherty, University of Texas MD Anderson Cancer Center, Houston, TX; Jessica A. Boyette-Davis, York College, York, PA; Gwen Wendelschafer-Crabb and William R. Kennedy, University of Minnesota School of Medicine; and Donald A. Simone, University of Minnesota School of Dentistry, Minneapolis, MN
| | - William R Kennedy
- Alyssa K. Kosturakis, Zijing He, Yan Li, Nina Shah, Sheeba K. Thomas, Haijun Zhang, Elisabeth G. Vichaya, Xin Shelley Wang, Charles S. Cleeland, and Patrick M. Dougherty, University of Texas MD Anderson Cancer Center, Houston, TX; Jessica A. Boyette-Davis, York College, York, PA; Gwen Wendelschafer-Crabb and William R. Kennedy, University of Minnesota School of Medicine; and Donald A. Simone, University of Minnesota School of Dentistry, Minneapolis, MN
| | - Donald A Simone
- Alyssa K. Kosturakis, Zijing He, Yan Li, Nina Shah, Sheeba K. Thomas, Haijun Zhang, Elisabeth G. Vichaya, Xin Shelley Wang, Charles S. Cleeland, and Patrick M. Dougherty, University of Texas MD Anderson Cancer Center, Houston, TX; Jessica A. Boyette-Davis, York College, York, PA; Gwen Wendelschafer-Crabb and William R. Kennedy, University of Minnesota School of Medicine; and Donald A. Simone, University of Minnesota School of Dentistry, Minneapolis, MN
| | - Charles S Cleeland
- Alyssa K. Kosturakis, Zijing He, Yan Li, Nina Shah, Sheeba K. Thomas, Haijun Zhang, Elisabeth G. Vichaya, Xin Shelley Wang, Charles S. Cleeland, and Patrick M. Dougherty, University of Texas MD Anderson Cancer Center, Houston, TX; Jessica A. Boyette-Davis, York College, York, PA; Gwen Wendelschafer-Crabb and William R. Kennedy, University of Minnesota School of Medicine; and Donald A. Simone, University of Minnesota School of Dentistry, Minneapolis, MN
| | - Patrick M Dougherty
- Alyssa K. Kosturakis, Zijing He, Yan Li, Nina Shah, Sheeba K. Thomas, Haijun Zhang, Elisabeth G. Vichaya, Xin Shelley Wang, Charles S. Cleeland, and Patrick M. Dougherty, University of Texas MD Anderson Cancer Center, Houston, TX; Jessica A. Boyette-Davis, York College, York, PA; Gwen Wendelschafer-Crabb and William R. Kennedy, University of Minnesota School of Medicine; and Donald A. Simone, University of Minnesota School of Dentistry, Minneapolis, MN.
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