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Huo H, Zhou S, Xue Y, Mu X, Du N, Cao Z. Implementation of personalized multidisciplinary neuropathy management program for chemotherapy-induced peripheral neuropathy symptoms in breast cancer patients. Int J Neurosci 2024:1-8. [PMID: 38652002 DOI: 10.1080/00207454.2024.2347556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 04/20/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To construct a personalized multidisciplinary neurotoxicity management program for chemotherapy-induced peripheral neuropathy (CIPN) symptoms in breast cancer patients and evaluate its application effects. METHODS A retrospective analysis was conducted on clinical data of 133 breast cancer chemotherapy patients admitted to our hospital from January 2022 to January 2024. Based on the nursing protocols received, patients were divided into a control group (n = 66) and an intervention group (n = 67). The control group received conventional nursing interventions, while the intervention group received personalized nursing interventions in addition to the control group interventions. The nursing programs were carried out during chemotherapy. A comparison was made between the two groups before chemotherapy and 3 months after chemotherapy in terms of the degree of neuropathy, cancer-related fatigue, negative emotional status, and symptom management knowledge, attitudes, and practices (KAP). RESULTS The intervention group showed significantly lower neuropathy severity (FACT/GOG-Ntx), cancer-related fatigue (CFS), and negative emotions (PHQ-9, GAD-7) scores after chemotherapy compared to the control group (p < 0.05). Additionally, the intervention group exhibited higher scores for symptom management knowledge, beliefs, and behaviors (p < 0.05). CONCLUSION Personalized multidisciplinary neurotoxicity management program significantly improved neuropathy severity, reduced cancer-related fatigue and negative emotions, and enhanced symptom management knowledge, attitudes, and practices among breast cancer patients undergoing chemotherapy.
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Affiliation(s)
- Hongbo Huo
- Department of Breast Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Shaoguang Zhou
- Department of Breast Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yanyan Xue
- Department of Breast Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xinxin Mu
- Department of Breast Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Na Du
- Department of Breast Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Zhongru Cao
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
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2
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Chen X, Gan Y, Au NPB, Ma CHE. Current understanding of the molecular mechanisms of chemotherapy-induced peripheral neuropathy. Front Mol Neurosci 2024; 17:1345811. [PMID: 38660386 PMCID: PMC11039947 DOI: 10.3389/fnmol.2024.1345811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is the most common off-target adverse effects caused by various chemotherapeutic agents, such as cisplatin, oxaliplatin, paclitaxel, vincristine and bortezomib. CIPN is characterized by a substantial loss of primary afferent sensory axonal fibers leading to sensory disturbances in patients. An estimated of 19-85% of patients developed CIPN during the course of chemotherapy. The lack of preventive measures and limited treatment options often require a dose reduction or even early termination of life-saving chemotherapy, impacting treatment efficacy and patient survival. In this Review, we summarized the current understanding on the pathogenesis of CIPN. One prominent change induced by chemotherapeutic agents involves the disruption of neuronal cytoskeletal architecture and axonal transport dynamics largely influenced by the interference of microtubule stability in peripheral neurons. Due to an ineffective blood-nerve barrier in our peripheral nervous system, exposure to some chemotherapeutic agents causes mitochondrial swelling in peripheral nerves, which lead to the opening of mitochondrial permeability transition pore and cytochrome c release resulting in degeneration of primary afferent sensory fibers. The exacerbated nociceptive signaling and pain transmission in CIPN patients is often linked the increased neuronal excitability largely due to the elevated expression of various ion channels in the dorsal root ganglion neurons. Another important contributing factor of CIPN is the neuroinflammation caused by an increased infiltration of immune cells and production of inflammatory cytokines. In the central nervous system, chemotherapeutic agents also induce neuronal hyperexcitability in the spinal dorsal horn and anterior cingulate cortex leading to the development of central sensitization that causes CIPN. Emerging evidence suggests that the change in the composition and diversity of gut microbiota (dysbiosis) could have direct impact on the development and progression of CIPN. Collectively, all these aspects contribute to the pathogenesis of CIPN. Recent advances in RNA-sequencing offer solid platform for in silico drug screening which enable the identification of novel therapeutic agents or repurpose existing drugs to alleviate CIPN, holding immense promises for enhancing the quality of life for cancer patients who undergo chemotherapy and improve their overall treatment outcomes.
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Affiliation(s)
- Xinyu Chen
- Department of Neuroscience, Hong Kong Special Administrative Region (HKSAR), City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Yumeng Gan
- Department of Neuroscience, Hong Kong Special Administrative Region (HKSAR), City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Ngan Pan Bennett Au
- Department of Neuroscience, Hong Kong Special Administrative Region (HKSAR), City University of Hong Kong, Kowloon, Hong Kong SAR, China
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
- Institute of Life Sciences and Healthcare, University of Portsmouth, Portsmouth, United Kingdom
| | - Chi Him Eddie Ma
- Department of Neuroscience, Hong Kong Special Administrative Region (HKSAR), City University of Hong Kong, Kowloon, Hong Kong SAR, China
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Huang Y, Tan T, Liu L, Yan Z, Deng Y, Li G, Li M, Xiong J. Corrigendum: Exercise for reducing chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis of randomized controlled trials. Front Neurol 2024; 15:1378461. [PMID: 38515446 PMCID: PMC10956360 DOI: 10.3389/fneur.2024.1378461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/16/2024] [Indexed: 03/23/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fneur.2023.1252259.].
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Affiliation(s)
- Yingjie Huang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tian Tan
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lu Liu
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zijian Yan
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuexia Deng
- Southern Theater General Hospital, Guangzhou, China
| | - Guangyao Li
- Department of Traditional Chinese Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Min Li
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jia Xiong
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi Province, China
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Chiorazzi A, Canta A, Carozzi VA, Meregalli C, Pozzi E, Ballarini E, Rodriguez-Menendez V, Marmiroli P, Cavaletti G, Alberti P. Morphofunctional characterisation of axonal damage in different rat models of chemotherapy-induced peripheral neurotoxicity: The role of nerve excitability testing. J Peripher Nerv Syst 2024; 29:47-57. [PMID: 38009865 DOI: 10.1111/jns.12607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/30/2023] [Accepted: 11/23/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND AIMS Chemotherapy-induced peripheral neurotoxicity (CIPN) is a common and long-lasting adverse event of several anticancer compounds, for which treatment has not yet been developed. To fill this gap, preclinical studies are warranted, exploiting highly translational outcome measure(s) to transfer data from bench to bedside. Nerve excitability testing (NET) enables to test in vivo axonal properties and can be used to monitor early changes leading to axonal damage. METHODS We tested NET use in two different CIPN rat models: oxaliplatin (OHP) and paclitaxel (PTX). Animals (female) were chronically treated with either PTX or OHP and compared to respective control animals. NET was performed as soon as the first injection was administered. At the end of the treatment, CIPN onset was verified via a multimodal and robust approach: nerve conduction studies, nerve morphometry, behavioural tests and intraepidermal nerve fibre density. RESULTS NET showed the typical pattern of axonal hyperexcitability in the 72 h following the first OHP administration, whereas it showed precocious signs of axonal damage in PTX animals. At the end of the month of treatment, OHP animals showed a pattern compatible with a mild axonal sensory polyneuropathy. Instead, PTX cohort was characterised by a rather severe sensory axonal polyneuropathy with minor signs of motor involvement. INTERPRETATION NET after the first administration demonstrated the ongoing OHP-related channelopathy, whereas in PTX cohort it showed precocious signs of axonal damage. Therefore, NET could be suggested as an early surrogate marker in clinical trials, to detect precocious changes leading to axonal damage.
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Affiliation(s)
- Alessia Chiorazzi
- Experimental Neurology Unit, School of Medicine and Surgery, Monza, Italy
- NeuroMI (Milan Center for Neuroscience), Milan, Italy
| | - Annalisa Canta
- Experimental Neurology Unit, School of Medicine and Surgery, Monza, Italy
- NeuroMI (Milan Center for Neuroscience), Milan, Italy
| | - Valentina Alda Carozzi
- Experimental Neurology Unit, School of Medicine and Surgery, Monza, Italy
- NeuroMI (Milan Center for Neuroscience), Milan, Italy
| | - Cristina Meregalli
- Experimental Neurology Unit, School of Medicine and Surgery, Monza, Italy
- NeuroMI (Milan Center for Neuroscience), Milan, Italy
| | - Eleonora Pozzi
- Experimental Neurology Unit, School of Medicine and Surgery, Monza, Italy
- NeuroMI (Milan Center for Neuroscience), Milan, Italy
| | - Elisa Ballarini
- Experimental Neurology Unit, School of Medicine and Surgery, Monza, Italy
- NeuroMI (Milan Center for Neuroscience), Milan, Italy
| | - Virginia Rodriguez-Menendez
- Experimental Neurology Unit, School of Medicine and Surgery, Monza, Italy
- NeuroMI (Milan Center for Neuroscience), Milan, Italy
| | - Paola Marmiroli
- Experimental Neurology Unit, School of Medicine and Surgery, Monza, Italy
- NeuroMI (Milan Center for Neuroscience), Milan, Italy
| | - Guido Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, Monza, Italy
- NeuroMI (Milan Center for Neuroscience), Milan, Italy
- Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Paola Alberti
- Experimental Neurology Unit, School of Medicine and Surgery, Monza, Italy
- NeuroMI (Milan Center for Neuroscience), Milan, Italy
- Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Moreno-Alonso D, Llorens-Torromé S, Corcoy de Febrer B, Amandi García M, Serrano-Bermúdez G, Trelis-Navarro J, Mayoral-Rojals V, Serrano-Afonso A. Adhesive capsaicin 8% patch for improved control of pain caused by chemotherapy-induced peripheral neuropathy in patients with multiple myeloma: A single-centre, seven-case series. J Oncol Pharm Pract 2024:10781552241230887. [PMID: 38415287 DOI: 10.1177/10781552241230887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Capsaicin is a highly selective agonist of the transient receptor potential vanilloid 1. The adhesive capsaicin patch provides a high capsaicin concentration (8%) directly in the painful area - its efficacy in benign peripheral neuropathic pain (diabetic neuropathy or postherpetic neuralgia) has recently been described in the literature. However, there is scant evidence of its efficacy in chemotherapy-induced peripheral neuropathy (CIPN). This is a concern for patients with multiple myeloma, who suffer from peripheral neuropathic pain induced by first-line treatments (bortezomib or thalidomide). AIM To describe improved control of CIPN in patients with multiple myeloma using adhesive capsaicin 8% patch. METHODS We opted for a retrospective observational case series. Between October 2017 and October 2020, we collected clinical data from adult multiple myeloma patients affected by CIPN who were administered the capsaicin 8% patch in our palliative care outpatient clinic. We compiled Numerical Pain Rating Scale (NPRS) scores, patients' medication needs and performance status before and after patch application. RESULTS Two women and five men with an average age of 62.85 years received bortezomib. Two patients (28.57% of the sample) also received thalidomide. The average NPRS score before patch application was 6.42/10. Five of the seven patients (71.42%) received a mean daily oral morphine dose of 52.85 mg/day, five (71.42%) received gabapentinoids and one (14.28%) received antidepressants. The average NPRS score decreased to 4/10 seven days after patch application, while the mean daily oral morphine dose remained stable. Performance status improved slightly in two patients (28.57%) and remained stable in the rest. One patient (14.28%) required an extra analgesic dose during patch application. CONCLUSIONS Capsaicin 8% patch application appears to reduce pain intensity in patients with multiple myeloma suffering from CIPN.
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Affiliation(s)
- Deborah Moreno-Alonso
- R+D responsible, Palliative Care Service, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- School of Medicine and Health Science, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Sílvia Llorens-Torromé
- Palliative Care Service, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Blanca Corcoy de Febrer
- Palliative Care Service, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Gala Serrano-Bermúdez
- Palliative Care Service, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Trelis-Navarro
- Palliative Care Service, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Victor Mayoral-Rojals
- Department of Anesthesia, Reanimation and Pain Clinic, Hospital Universitari de Bellvitge, Universitat de Barcelona- Health campus, IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ancor Serrano-Afonso
- Department of Anesthesia, Reanimation and Pain Clinic, Hospital Universitari de Bellvitge, Universitat de Barcelona- Health campus, IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
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Bernard A, Mroué M, Bourthoumieu S, Boyce M, Richard L, Sturtz F, Demiot C, Danigo A. Netazepide, an Antagonist of Cholecystokinin Type 2 Receptor, Prevents Vincristine-Induced Sensory Neuropathy in Mice. Pharmaceuticals (Basel) 2024; 17:144. [PMID: 38399359 PMCID: PMC10892341 DOI: 10.3390/ph17020144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
Among the vinca-alkaloid class, vincristine is a potent chemotherapeutic agent with significant neurotoxic effects and is employed to address a wide spectrum of cancer types. Recently, the therapeutic potential of the cholecystokinin type 2 receptor (CCK2R) as a target for vincristine-induced peripheral neuropathy (VIPN) was demonstrated. In this study, the impact of preventive CCK2R blockade using netazepide (Trio Medicines Ltd., London, UK) was investigated in a mouse model of vincristine-induced peripheral neuropathy. Netazepide is a highly selective CCK2R antagonist under development for the treatment of patients with gastric neuroendocrine tumors caused by hypergastrinemia secondary to chronic autoimmune atrophic gastritis. Vincristine-induced peripheral neuropathy was induced by intraperitoneal injections of vincristine at 100 µg/kg/d for 7 days (D0 to D7). Netazepide (2 mg/kg/d or 5 mg/kg/d, per os) was administered one day before vincristine treatment until D7. Vincristine induced a high tactile allodynia from D1 to D7. VIPN was characterized by dorsal root ganglion neuron (DRG) and intraepidermal nerve fiber (IENF) loss, and enlargement and loss of myelinated axons in the sciatic nerve. Netazepide completely prevented the painful symptoms and nerve injuries induced by vincristine. In conclusion, the fact that netazepide protected against vincristine-induced peripheral neuropathy in a mouse model strongly supports the assessment of its therapeutic potential in patients receiving such chemotherapy.
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Affiliation(s)
- Amandine Bernard
- NeurIT Neuropathies et Innovations Thérapeutiques UR 20218, Faculties of Medicine and Pharmacy, University of Limoges, 87025 Limoges, France; (A.B.); (M.M.); (S.B.); (L.R.); (F.S.); (C.D.)
| | - Mohamad Mroué
- NeurIT Neuropathies et Innovations Thérapeutiques UR 20218, Faculties of Medicine and Pharmacy, University of Limoges, 87025 Limoges, France; (A.B.); (M.M.); (S.B.); (L.R.); (F.S.); (C.D.)
| | - Sylvie Bourthoumieu
- NeurIT Neuropathies et Innovations Thérapeutiques UR 20218, Faculties of Medicine and Pharmacy, University of Limoges, 87025 Limoges, France; (A.B.); (M.M.); (S.B.); (L.R.); (F.S.); (C.D.)
- Department of Cytogenetic, Medical Genetic and Reproduction Biology, University Hospital of Limoges, 87042 Limoges, France
| | - Malcolm Boyce
- Hammersmith Medicines Research Limited and Trio Medicines Limited, 44 Cumberland Avenue, London NW10 7EW, UK;
| | - Laurence Richard
- NeurIT Neuropathies et Innovations Thérapeutiques UR 20218, Faculties of Medicine and Pharmacy, University of Limoges, 87025 Limoges, France; (A.B.); (M.M.); (S.B.); (L.R.); (F.S.); (C.D.)
- Department of Neurology, Reference Center for Rare Peripheral Neuropathies, University Hospital of Limoges, 87042 Limoges, France
| | - Franck Sturtz
- NeurIT Neuropathies et Innovations Thérapeutiques UR 20218, Faculties of Medicine and Pharmacy, University of Limoges, 87025 Limoges, France; (A.B.); (M.M.); (S.B.); (L.R.); (F.S.); (C.D.)
- Department of Biochemistry and Molecular Genetics, University Hospital of Limoges, 87042 Limoges, France
| | - Claire Demiot
- NeurIT Neuropathies et Innovations Thérapeutiques UR 20218, Faculties of Medicine and Pharmacy, University of Limoges, 87025 Limoges, France; (A.B.); (M.M.); (S.B.); (L.R.); (F.S.); (C.D.)
- Transversal and Territorial Therapeutic Education Unit (UTTEP87), University Hospital of Limoges, 87042 Limoges, France
| | - Aurore Danigo
- NeurIT Neuropathies et Innovations Thérapeutiques UR 20218, Faculties of Medicine and Pharmacy, University of Limoges, 87025 Limoges, France; (A.B.); (M.M.); (S.B.); (L.R.); (F.S.); (C.D.)
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Huang Y, Tan T, Liu L, Yan Z, Deng Y, Li G, Li M, Xiong J. Exercise for reducing chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis of randomized controlled trials. Front Neurol 2024; 14:1252259. [PMID: 38283674 PMCID: PMC10813204 DOI: 10.3389/fneur.2023.1252259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/21/2023] [Indexed: 01/30/2024] Open
Abstract
Background More than half of cancer patients develop severe chemotherapy-induced peripheral neuropathy (CIPN), resulting in low quality of life, negative effects on function, and challenges in treatment compliance. Most recent studies have shown that exercise therapy has a positive impact on reducing CIPN symptoms and can also improve quality of life, balance, and activity levels. The aim of this meta-analysis was to evaluate the effect of exercise therapy on the efficacy of CIPN. Methods Computerized search of Embase, Web of Science, CNKI, Wan Fang Data, VIP, CBM for RCTs on exercise therapy for CIPN from database creation to November 2022, without language restriction. The Cochrane Handbook 5.3 risk of bias assessment tool was used to evaluate the quality of the included studies. Then Revman 5.3 software was used to evaluate the quality of the included studies. The heterogeneity of the research results is tested by I2, continuous variables were presented as weighted mean difference or standard mean difference, and confidence intervals were set at 95%. Stata15.0 was utilized to conduct a meta-analysis. Results A total of 15 RCTs with 1,124 patients were included. Meta-analysis showed that the test group was superior to the control group in terms of total symptom score (SMD: -0.62; 95% Cl: -0.99, -0.24), numbness, tingling, quality of life score (total score, physical, function), pain, balance, and neurotoxicity function assessment (FACT/GOG-NTX) questionnaire (p < 0.05). Limitations The duration and frequency of treatment are different every week, which may have some impact on the results. Conclusion Exercise therapy can be effective in treating CIPN by improving symptom score (total symptom score, numbness, tingling), quality of life score (total score, physical function), pain, balance, and FACT/GOG-NTX questionnaires. It still needs to be refined and validated by more high-quality, multicenter, large-sample RCTs in the future. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022373131, identifier: CRD42022373131.
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Affiliation(s)
- Yingjie Huang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tian Tan
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lu Liu
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zijian Yan
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuexia Deng
- Southern Theater General Hospital, Guangzhou, China
| | - Guangyao Li
- Department of Traditional Chinese Medicine, Guangdong Provincial Key Laboratory ofMajor Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Min Li
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jia Xiong
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi Province, China
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Balayssac D, Durif J, Lambert C, Dalbos C, Chapuy E, Etienne M, Demiot C, Busserolles J, Martin V, Sapin V. Exploring Serum Biomarkers for Neuropathic Pain in Rat Models of Chemotherapy-Induced Peripheral Neuropathy: A Comparative Pilot Study with Oxaliplatin, Paclitaxel, Bortezomib, and Vincristine. Toxics 2023; 11:1004. [PMID: 38133405 PMCID: PMC10747971 DOI: 10.3390/toxics11121004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
Blood biomarkers, including neurofilament light chain (NfL), have garnered attention as potential indicators for chemotherapy-induced peripheral neuropathy (CIPN), a dose-limiting adverse effect of neurotoxic anticancer drugs. However, no blood biomarker has been established for routine application or translational research. This pilot study aimed to evaluate a limited panel of blood biomarkers in rat models of CIPN and their correlations with neuropathic pain. CIPN models were induced through repeated injections of oxaliplatin, paclitaxel, bortezomib, and vincristine. Electronic von Frey testing was used to assess tactile allodynia. Post anticancer injections, serum concentrations of 31 proteins were measured. Allodynia thresholds decreased in anticancer-treated animals compared to controls. No consistent modifications were observed in the biomarkers across CIPN models. The most noteworthy biomarkers with increased concentrations in at least two CIPN models were NfL (paclitaxel, vincristine), MCP-1, and RANTES (oxaliplatin, vincristine). Vincristine-treated animals exhibited strong correlations between LIX, MCP-1, NfL, and VEGF concentrations and tactile allodynia thresholds. No single biomarker can be recommended as a unique indicator of CIPN-related pain. Because of the study limitations (single dose of each anticancer drug, young animals, and single time measurement of biomarkers), further investigations are necessary to define the kinetics, specificities, and sensitivities of MCP-1, RANTES, and NfL.
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Affiliation(s)
- David Balayssac
- Direction de la Recherche Clinique et de l’Innovation, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
- INSERM U1107 NEURO-DOL, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (C.D.); (E.C.); (J.B.)
| | - Julie Durif
- Laboratoire de Biochimie et de Génétique Moléculaire, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France;
| | - Céline Lambert
- Unité de Biostatistiques, Direction de la Recherche Clinique et de l’Innovation, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France;
| | - Cristelle Dalbos
- INSERM U1107 NEURO-DOL, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (C.D.); (E.C.); (J.B.)
| | - Eric Chapuy
- INSERM U1107 NEURO-DOL, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (C.D.); (E.C.); (J.B.)
| | - Monique Etienne
- Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (M.E.)
| | - Claire Demiot
- UR 20218—Neuropathies et Innovations Thérapeutiques (NeurIT), Faculties of Medicine and Pharmacy, University of Limoges, F-87025 Limoges, France;
| | - Jérôme Busserolles
- INSERM U1107 NEURO-DOL, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (C.D.); (E.C.); (J.B.)
| | - Vincent Martin
- Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (M.E.)
- Institut Universitaire de France (IUF), F-75000 Paris, France
| | - Vincent Sapin
- Laboratoire de Biochimie et de Génétique Moléculaire, CNRS, INSERM, iGReD, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France;
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McDonald JL, Bauer M. Is Electroacupuncture Contraindicated for Preventing and Treating Chemotherapy-Induced Peripheral Neuropathy? Med Acupunct 2023; 35:290-295. [PMID: 38162553 PMCID: PMC10753944 DOI: 10.1089/acu.2023.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Background Chemotherapy-induced peripheral neuropathy (CIPN) is a common side-effect of several drugs used to combat cancer. Thus, researchers have sought better treatments for and prevention of CIPN, such as electroacupuncture (EA). Some trials show EA worsens or prolongs CIPN pain and recommend against further studies on this. This narrative review explores EA for preventing or treating CIPN, comparing positive and negative outcomes. Methods PubMed, ScienceDirect, and Google Scholar were searched for electroacupuncture, CIPN, and peripheral neuropathy. A snowballing method was used to find systematic reviews and studies in systematic reviews. Results Seven English-language trials were found on using EA for preventing or treating CIPN. In 3 prevention studies, 1 had significant benefits, 1 had modest benefits, and 1 had worse pain in an EA group at follow-up, compared to sham controls. In 4 treatment studies, 2 had significant benefits, 1 had no difference from 3 controls, and 1 had sham control was superior to verum EA. Conclusions Most of the studies were limited by small sample sizes, and some studies used EA protocols and treatment doses (frequency and total number of sessions) that were potentially suboptimal. The quantity and quality of the studies are insufficient to draw firm conclusions on effectiveness and safety. More studies must test optimal EA protocols and treatment dosages. It is inappropriate to say that EA is not recommended for CIPN prevention or treatment, because there is no robust evidence to justify this. Generally, research has found benefits and no harms.
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Affiliation(s)
- John L McDonald
- Department of Chinese Medicine, Endeavour College of Natural Health, Southport, Queensland, Australia
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10
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Lemanska A, Harkin A, Iveson T, Kelly C, Saunders M, Faithfull S. The association of clinical and patient factors with chemotherapy-induced peripheral neuropathy (CIPN) in colorectal cancer: secondary analysis of the SCOT trial. ESMO Open 2023; 8:102063. [PMID: 37988949 PMCID: PMC10774973 DOI: 10.1016/j.esmoop.2023.102063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of oxaliplatin. CIPN can impair long-term quality of life and limit the dose of chemotherapy. We investigated the association of CIPN over time with age, sex, body mass index, baseline neuropathy, and chemotherapy regimen in people treated with adjuvant oxaliplatin-containing chemotherapy for colorectal cancer. PATIENTS AND METHODS We carried out secondary analysis of data from the SCOT randomised controlled trial. SCOT compared 3 months to 6 months of oxaliplatin-containing adjuvant chemotherapy in 6088 people with colorectal cancer recruited between March 2008 and November 2013. Two different chemotherapy regimens were used: capecitabine with oxaliplatin (CAPOX) or fluorouracil with oxaliplatin (FOLFOX). CIPN was recorded with the Functional Assessment of Cancer Therapy/Gynaecologic Oncology Group-Neurotoxicity 4 tool in 2871 participants from baseline (randomisation) for up to 8 years. Longitudinal trends in CIPN [averages with 95% confidence intervals (CIs)] were plotted stratified by the investigated factors. Analysis of covariance (ANCOVA) was used to analyse the association of factors with CIPN adjusting for the SCOT randomisation arm and oxaliplatin dose. P < 0.01 was adopted as cut-off for statistical significance to account for multiple testing. RESULTS Patients receiving CAPOX had lower CIPN scores than those receiving FOLFOX. Chemotherapy regimen was associated with CIPN from 6 months (P < 0.001) to 2 years (P = 0.001). The adjusted ANCOVA coefficient for CAPOX at 6 months was -1.6 (95% CIs -2.2 to -0.9) and at 2 years it was -1.6 (95% CIs -2.5 to -0.7). People with baseline neuropathy scores ≥1 experienced higher CIPN than people with baseline neuropathy scores of 0 (P < 0.01 for all timepoints apart from 18 months). Age, sex, and body mass index did not link with CIPN. CONCLUSIONS A neuropathy assessment before treatment with oxaliplatin can help identify people with an increased risk of CIPN. More research is needed to understand the CIPN-inducing effect of different chemotherapy regimens.
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Affiliation(s)
- A Lemanska
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
| | - A Harkin
- Cancer Research UK Glasgow Clinical Trials Unit, Glasgow, UK
| | - T Iveson
- Department of Medical Oncology, University of Southampton, Southampton, UK
| | - C Kelly
- Cancer Research UK Glasgow Clinical Trials Unit, Glasgow, UK
| | | | - S Faithfull
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK; School of Medicine, Trinity College, Dublin, Ireland
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11
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Sturgeon KM, Kok DE, Kleckner IR, Guertin KA, McNeil J, Parry TL, Ehlers DK, Hamilton A, Schmitz K, Campbell KL, Winters‐Stone K. Updated systematic review of the effects of exercise on understudied health outcomes in cancer survivors. Cancer Med 2023; 12:22278-22292. [PMID: 38018376 PMCID: PMC10757127 DOI: 10.1002/cam4.6753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023] Open
Abstract
INTRODUCTION The American College of Sports Medicine provided guidelines for exercise prescriptions in cancer survivors for specific cancer- and treatment-related health outcomes. However, there was insufficient evidence to generate exercise prescriptions for 10 health outcomes of cancer treatment. We sought to update the state of evidence. METHODS We conducted a systematic review of these 10 understudied health outcomes (bone health, sleep, cardiovascular function, chemotherapy-induced peripheral neuropathy (CIPN), cognitive function, falls and balance, nausea, pain, sexual function, and treatment tolerance) and provided an update of evidence. RESULTS While the evidence base for each outcome has increased, there remains insufficient evidence to generate exercise prescriptions. Common limitations observed across outcomes included: variability in type and quality of outcome measurement tools, variability in definitions of the health outcomes, a lack of phase III trials, and a majority of trials investigating breast or prostate cancer survivors only. CONCLUSION We identified progress in the field of exercise oncology for several understudied cancer- and treatment-related health outcomes. However, we were not able to generate exercise prescriptions due to continued insufficient evidence base. More work is needed to prescribe exercise as medicine for these understudied health outcomes, and our review highlights several strategies to aid in research acceleration within these areas of exercise oncology.
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Affiliation(s)
- Kathleen M. Sturgeon
- Department of Public Health SciencesCollege of Medicine, Penn State UniversityHersheyPennsylvaniaUSA
| | - Dieuwertje E. Kok
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Ian R. Kleckner
- Department of Pain & Translational Symptom Science, School of NursingUniversity of Maryland BaltimoreBaltimoreMarylandUSA
| | - Kristin A. Guertin
- Department of Public Health SciencesUniversity of Connecticut HealthStorrsConnecticutUSA
| | - Jessica McNeil
- Department of Kinesiology, School of Health and Human SciencesUniversity of North Carolina at GreensboroGreensboroNorth CarolinaUSA
| | - Traci L. Parry
- Department of Kinesiology, School of Health and Human SciencesUniversity of North Carolina at GreensboroGreensboroNorth CarolinaUSA
| | - Diane K. Ehlers
- Division of Epidemiology, Department of Quantitative Health SciencesMayo Clinic ArizonaPhoenixArizonaUSA
| | - Andrew Hamilton
- Oregon Health & Science University, LibraryPortlandOregonUSA
| | - Kathryn Schmitz
- Division of Hematology/Oncology, University of Pittsburgh School of MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Kristin L. Campbell
- Department of Physical TherapyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Kerri Winters‐Stone
- Division of Oncological Sciences, School of MedicineOregon Health & Science UniversityPortlandOregonUSA
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12
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Martínez-Martel I, Pol O. A Novel Therapy for Cisplatin-Induced Allodynia and Dysfunctional and Emotional Impairments in Male and Female Mice. Antioxidants (Basel) 2023; 12:2063. [PMID: 38136183 PMCID: PMC10741113 DOI: 10.3390/antiox12122063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
Patients undergoing chemotherapy with cisplatin (CIS) develop neuropathy in addition to other symptoms such as, anxiety, depression, muscle wasting and body weight loss. This symptomatology greatly weakens patients and may even lead to adjournment of chemotherapy. The protecting actions of molecular hydrogen in many neurological illnesses have been described, but its effect on the functional and emotional deficiencies caused by CIS has not been assessed. In C57BL/6J male and female mice injected with CIS, we examined the impact of the prophylactic treatment with hydrogen-rich water (HRW) on: (i) the tactile and cold allodynia, (ii) the deficits of grip strength and weight loss, (iii) the anxiodepressive-like behaviors and (iv) the inflammatory and oxidative reactions incited by CIS in the dorsal root ganglia (DRG) and prefrontal cortex (PFC). The results demonstrate that the mechanical allodynia and the anxiodepressive-like comportment provoked by CIS were similarly manifested in both sexes, whereas the cold allodynia, grip strength deficits and body weight loss produced by this chemotherapeutic agent were greater in female mice. Nonetheless, the prophylactic treatment with HRW prevented the allodynia and the functional and emotional impairments resulting from CIS in both sexes. This treatment also inhibited the inflammatory and oxidative responses activated by CIS in the DRG and PFC in both sexes, which might explain the therapeutic actions of HRW in male and female mice. In conclusion, this study revealed the plausible use of HRW as a new therapy for the allodynia and physical and mental impairments linked with CIS and its possible mechanism of action.
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Affiliation(s)
- Ignacio Martínez-Martel
- Grup de Neurofarmacologia Molecular, Institut de Recerca Sant Pau, Sant Quintí 77-79, 08041 Barcelona, Spain
- Grup de Neurofarmacologia Molecular, Institut de Neurociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Olga Pol
- Grup de Neurofarmacologia Molecular, Institut de Recerca Sant Pau, Sant Quintí 77-79, 08041 Barcelona, Spain
- Grup de Neurofarmacologia Molecular, Institut de Neurociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
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13
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Ünel ÇÇ, Eroğlu E, Özatik O, Erol K. Chlorogenic acid co-administration alleviates cisplatin-induced peripheral neuropathy in rats. Fundam Clin Pharmacol 2023. [PMID: 37996998 DOI: 10.1111/fcp.12970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 10/06/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is still an unresolved problem in cisplatin (CIS) use. OBJECTIVES This study investigates possible anti-neuropathic effect of chlorogenic acid (CGA) against CIS-induced CIPN in rats while also investigating the contribution of nitric oxide (NO) to this phenomenon. METHODS Initially, CGA (250-1000 μM) was tested by MTT assay on primary DRG neurons. Subsequently, CIPN was induced in Sprague-Dawley rats by 3 mg/kg intraperitoneal injections of CIS once/week for 5 weeks. CGA (100 mg/kg) was co-administered with CIS, both alone and in combination with l-arginine (LARG) or l-nitro-arginine-methyl-ester (LNAME), to elucidate the contribution of nitrergic system to anti-neuropathic effects. Mechanical allodynia, thermal hyperalgesia, and cold plate tests were performed to test CIPN. Rotarod, footprint analysis, and activitymeter were used to evaluate motor coordination and performance. Tumor necrosis factor alpha (TNF-α) was measured as a marker of inflammation. Histological evaluations of DRG and sciatic nerves (SNs) were performed utilizing toluidine blue staining. Two-way analysis of variance and Kruskal-Wallis following Tukey's test were used as statistical analysis. RESULTS Higher concentration of CGA (1000 μM) exhibited protective effect against in vitro neurotoxicity. Neither LARG nor LNAME exerted significant change in this effect. Co-administration of CGA alleviated histological abnormalities and neuropathic effects induced by CIS. Ameliorative effect of CGA was not changed in mechanical allodynia but attenuated in cold allodynia, and motor activity/coordination tests by LARG and LNAME. Neuropathic effects of CIS remained unchanged with LARG and LNAME in behavioral experiments. CONCLUSION The study identified CGA as candidate agent in mitigating CIPN. NO seems to play a modulatory role in this effect.
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Affiliation(s)
- Çiğdem Çengelli Ünel
- Faculty of Medicine, Department of Medical Pharmacology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ezgi Eroğlu
- Department of Clinical Research, Turkish Medicines and Medical Devices Agency, Ankara, Turkey
| | - Orhan Özatik
- Faculty of Medicine, Department of Histology and Embryology, Kutahya Health Sciences University, Kutahya, Turkey
| | - Kevser Erol
- Faculty of Medicine, Department of Pharmacology, Bahçeşehir University, Istanbul, Turkey
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14
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Rodwin RL, DelRocco NJ, Hibbitts E, Devidas M, Whitley MK, Mohrmann CE, Schore RJ, Raetz E, Winick NJ, Hunger SP, Loh ML, Hockenberry MJ, Ma X, Angiolillo AL, Ness KK, Kairalla JA, Kadan-Lottick NS. Assessment of proxy-reported responses as predictors of motor and sensory peripheral neuropathy in children with B-lymphoblastic leukemia. Pediatr Blood Cancer 2023; 70:e30634. [PMID: 37592363 PMCID: PMC10552080 DOI: 10.1002/pbc.30634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/20/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN), a common condition in children with acute lymphoblastic leukemia, can be challenging to diagnose. Using data from Children's Oncology Group AALL0932 physical function study, we sought to determine if parent/guardian proxy-reported responses from the Pediatric Outcomes Data Collection Instrument could identify children with motor or sensory CIPN diagnosed by physical/occupational therapists (PT/OT). Four variables moderately discriminated between children with and without motor CIPN (c-index 0.76, 95% confidence interval [CI]: 0.64-0.84), but sensory and optimism-corrected models had weak discrimination (c-index sensory models 0.65, 95% CI: 0.54-0.74). New proxy-report measures are needed to identify children with PT/OT diagnosed CIPN.
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Affiliation(s)
- Rozalyn L Rodwin
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| | - Natalie J DelRocco
- Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, Florida, USA
| | - Emily Hibbitts
- Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, Florida, USA
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Moira K Whitley
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Caroline E Mohrmann
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA
- Goldfarb School of Nursing, St. Louis, Missouri, USA
| | - Reuven J Schore
- Center of Cancer and Blood Disorders, Children's National Health System, Washington, District of Columbia, USA
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Elizabeth Raetz
- Department of Pediatrics, NYU Langone Health, New York, New York, USA
| | - Naomi J Winick
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stephen P Hunger
- Department of Pediatrics and the Center for Childhood Cancer Research, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mignon L Loh
- Division of Pediatric Hematology, Oncology, Bone Marrow Transplant and Cellular Therapy, Seattle Children's Hospital and the Ben Towne Center for Childhood Cancer Research, University of Washington, Seattle, Washington, USA
| | - Marilyn J Hockenberry
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Xiaomei Ma
- Yale Cancer Center, New Haven, Connecticut, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, Connecticut, USA
| | - Anne L Angiolillo
- Center of Cancer and Blood Disorders, Children's National Health System, Washington, District of Columbia, USA
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Servier Pharmaceuticals, Boston, Massachusetts, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - John A Kairalla
- Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, Florida, USA
| | - Nina S Kadan-Lottick
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
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15
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Chen CS, Zirpoli G, Barlow WE, Budd GT, McKiver B, Pusztai L, Hortobagyi GN, Albain KS, Damaj MI, Godwin AK, Thompson A, Henry NL, Ambrosone CB, Stringer KA, Hertz DL. Vitamin D Insufficiency as a Risk Factor for Paclitaxel-Induced Peripheral Neuropathy in SWOG S0221. J Natl Compr Canc Netw 2023; 21:1172-1180.e3. [PMID: 37935109 PMCID: PMC10976748 DOI: 10.6004/jnccn.2023.7062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/24/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Prior work suggests that patients with vitamin D insufficiency may have a higher risk of chemotherapy-induced peripheral neuropathy (CIPN) from paclitaxel. The objective of this study was to validate vitamin D insufficiency as a CIPN risk factor. METHODS We used data and samples from the prospective phase III SWOG S0221 (ClinicalTrials.gov identifier: NCT00070564) trial that compared paclitaxel-containing chemotherapy regimens for early-stage breast cancer. We quantified pretreatment 25-hydroxy-vitamin D in banked serum samples using a liquid chromatography-tandem mass spectrometry targeted assay. We tested the association between vitamin D insufficiency (≤20 ng/mL) and grade ≥3 sensory CIPN via multiple logistic regression and then adjusted for self-reported race, age, body mass index, and paclitaxel schedule (randomization to weekly or every-2-week dosing). We also tested the direct effect of vitamin D deficiency on mechanical hypersensitivity in mice randomized to a regular or vitamin D-deficient diet. RESULTS Of the 1,191 female patients in the analysis, 397 (33.3%) had pretreatment vitamin D insufficiency, and 195 (16.4%) developed grade ≥3 CIPN. Patients with vitamin D insufficiency had a higher incidence of grade ≥3 CIPN than those who had sufficient vitamin D (20.7% vs 14.2%; odds ratio [OR], 1.57; 95% CI, 1.14-2.15; P=.005). The association retained significance after adjusting for age and paclitaxel schedule (adjusted OR, 1.65; 95% CI, 1.18-2.30; P=.003) but not race (adjusted OR, 1.39; 95% CI, 0.98-1.97; P=.066). In the mouse experiments, the vitamin D-deficient diet caused mechanical hypersensitivity and sensitized mice to paclitaxel (both P<.05). CONCLUSIONS Pretreatment vitamin D insufficiency is the first validated potentially modifiable predictive biomarker of CIPN from paclitaxel. Prospective trials are needed to determine whether vitamin D supplementation prevents CIPN and improves treatment outcomes in patients with breast and other cancer types.
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Affiliation(s)
- Ciao-Sin Chen
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Gary Zirpoli
- Slone Epidemiology Center, Boston University, Boston, MA, USA
| | | | - G. Thomas Budd
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Bryan McKiver
- Department of Pharmacology and Toxicology and Translational Research Initiative for Pain and Neuropathy, Virginia Commonwealth University, USA
| | | | - Gabriel N. Hortobagyi
- Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - M. Imad Damaj
- Department of Pharmacology and Toxicology and Translational Research Initiative for Pain and Neuropathy, Virginia Commonwealth University, USA
| | - Andrew K. Godwin
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
- Kansas Institute for Precision Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - N. Lynn Henry
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Christine B. Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kathleen A. Stringer
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
- NMR Metabolomics Laboratory, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Daniel L. Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Wang AB, Housley SN, Ludvig D, Franz CK, Flores AM, Cope TC, Perreault EJ. Cancer survivors post-chemotherapy exhibit unimpaired short-latency stretch reflexes in the proximal upper extremity. J Neurophysiol 2023; 130:895-909. [PMID: 37671425 PMCID: PMC10649846 DOI: 10.1152/jn.00299.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/07/2023] Open
Abstract
Oxaliplatin (OX) chemotherapy can lead to long-term sensorimotor impairments in cancer survivors. The impairments are often thought to be caused by OX-induced progressive degeneration of sensory afferents known as length-dependent dying-back sensory neuropathy. However, recent preclinical work has identified functional defects in the encoding of muscle proprioceptors and in motoneuron firing. These functional defects in the proprioceptive sensorimotor circuitry could readily impair muscle stretch reflexes, a fundamental building block of motor coordination. Given that muscle proprioceptors are distributed throughout skeletal muscle, defects in stretch reflexes could be widespread, including in the proximal region where dying-back sensory neuropathy is less prominent. All previous investigations on chemotherapy-related reflex changes focused on distal joints, leading to results that could be influenced by dying-back sensory neuropathy rather than more specific changes to sensorimotor circuitry. Our study extends this earlier work by quantifying stretch reflexes in the shoulder muscles in 16 cancer survivors and 16 healthy controls. Conduction studies of the sensory nerves in hand were completed to detect distal sensory neuropathy. We found no significant differences in the short-latency stretch reflexes (amplitude and latency) of the shoulder muscles between cancer survivors and healthy controls, contrasting with the expected differences based on the preclinical work. Our results may be linked to differences between the human and preclinical testing paradigms including, among many possibilities, differences in the tested limb or species. Determining the source of these differences will be important for developing a complete picture of how OX chemotherapy contributes to long-term sensorimotor impairments.NEW & NOTEWORTHY Our results showed that cancer survivors after oxaliplatin (OX) treatment exhibited stretch reflexes that were comparable with age-matched healthy individuals in the proximal upper limb. The lack of OX effect might be linked to differences between the clinical and preclinical testing paradigms. These findings refine our expectations derived from the preclinical study and guide future assessments of OX effects that may have been insensitive to our measurement techniques.
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Affiliation(s)
- Allison B Wang
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, United States
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- Shirley Ryan AbilityLab, Chicago, Illinois, United States
| | - Stephen N Housley
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, United States
| | - Daniel Ludvig
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, United States
- Shirley Ryan AbilityLab, Chicago, Illinois, United States
| | - Colin K Franz
- Shirley Ryan AbilityLab, Chicago, Illinois, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Ann Marie Flores
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, United States
| | - Timothy C Cope
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, United States
- W.H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Georgia Institute of Technology, Atlanta, Georgia, United States
- Integrated Cancer Research Center, Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia, United States
| | - Eric J Perreault
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, United States
- Shirley Ryan AbilityLab, Chicago, Illinois, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
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Seth NH, Qureshi I. Effectiveness of physiotherapy interventions on improving quality of life, total neuropathy score, strength and reducing pain in cancer survivors suffering from chemotherapy-induced peripheral neuropathy - a systematic review. Acta Oncol 2023; 62:1143-1151. [PMID: 37522184 DOI: 10.1080/0284186x.2023.2238890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Cancer treatment frequently results in chemotherapy-induced peripheral neuropathy (CIPN), which is a side effect that is now neither properly preventable nor treatable. Physical therapy has been studied in this patient population and is frequently utilised for neurological rehabilitation after damage. PURPOSE This study set out to thoroughly review randomised controlled trials (RCTs) examining the efficacy of physical therapy for patients with chemotherapy-induced peripheral neuropathy. DATA SOURCES From their beginning in January 2017 to January 2023, EMBASE, PubMed, Medline, PEDro, and the Cochrane Library were searched for pertinent RCTs. Additionally, manual search techniques were applied. STUDY SELECTION On the basis of the inclusion criteria, two reviewers independently determined the study's eligibility. DATA EXTRACTION Reviewers evaluated the quality of the studies and took note of their methodologies, designs, interventions, outcomes, and conclusions. DATA SYNTHESIS Ten RCTs met all inclusion criteria. LIMITATIONS Overall results are constrained by the variety of interventions and the small sample sizes of the included studies, which also indicate the need for more studies. CONCLUSIONS Physical therapy has additional benefits for enhancing the quality of life of patients with peripheral neuropathy brought on by chemotherapy.
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Affiliation(s)
- Nikita H Seth
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, India
| | - Irshad Qureshi
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, India
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18
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Cavaletti G, Pizzamiglio C, Man A, Engber TM, Comi C, Wilbraham D. Studies to Assess the Utility of Serum Neurofilament Light Chain as a Biomarker in Chemotherapy-Induced Peripheral Neuropathy. Cancers (Basel) 2023; 15:4216. [PMID: 37686492 PMCID: PMC10486738 DOI: 10.3390/cancers15174216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most common and disabling dose-limiting toxicities of chemotherapy. We report here the results of two separate non-interventional studies (49 patients), which evaluated blood neurofilament light chain (NfL) as a biomarker of CIPN in breast cancer patients treated with paclitaxel. All patients underwent a standard treatment protocol that was established independently of the present studies. NfL was measured in serum using an ultrasensitive single-molecule array and compared with the self-administered European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-CIPN twenty-item scale (CIPN20) and Total Neuropathy Score clinical version (TNSc), a clinician-reported measure of neuropathy progression. The TNSc increased with cumulative dose compared with baseline, and the NfL concentrations were also strongly associated with the cumulative dose of chemotherapy. The analysis showed a correlation between TNSc and NfL. Both TNSc and NfL showed weak to moderate associations with CIPN20 subscores, with a better association for the CIPN20 sensory compared with motor and autonomic subscores. Data from the two studies provide evidence that serum NfL has the potential to be used as a biomarker to monitor and mitigate CIPN. However, studies with additional patients planned in the ongoing clinical trial will determine the universal application of NfL as a biomarker in CIPN.
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Affiliation(s)
- Guido Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Chiara Pizzamiglio
- Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Albert Man
- Eli Lilly and Company, Indianapolis, IN 46285, USA (T.M.E.)
| | | | - Cristoforo Comi
- Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
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19
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Staff NP, Hrstka SC, Dasari S, Capobianco E, Rieger S. Skin Extracellular Matrix Breakdown Following Paclitaxel Therapy in Patients with Chemotherapy-Induced Peripheral Neuropathy. Cancers (Basel) 2023; 15:4191. [PMID: 37627219 PMCID: PMC10453667 DOI: 10.3390/cancers15164191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
The chemotherapeutic agent paclitaxel causes peripheral neuropathy, a dose-limiting side effect, in up to 68% of cancer patients. In this study, we investigated the impact of paclitaxel therapy on the skin of breast cancer patients with chemotherapy-induced peripheral neuropathy (CIPN), building upon previous findings in zebrafish and rodents. Comprehensive assessments, including neurological examinations and quality of life questionnaires, were conducted, followed by intraepidermal nerve fiber (IENF) density evaluations using skin punch biopsies. Additionally, RNA sequencing, immunostaining for Matrix-Metalloproteinase 13 (MMP-13), and transmission electron microscopy provided insights into molecular and ultrastructural changes in this skin. The results showed no significant difference in IENF density between the control and CIPN patients despite the presence of patient-reported CIPN symptoms. Nevertheless, the RNA sequencing and immunostaining on the skin revealed significantly upregulated MMP-13, which is known to play a key role in CIPN caused by paclitaxel therapy. Additionally, various genes involved in the regulation of the extracellular matrix, microtubules, cell cycle, and nervous system were significantly and differentially expressed. An ultrastructural examination of the skin showed changes in collagen and basement membrane structures. These findings highlight the presence of CIPN in the absence of IENF density changes and support the role of skin remodeling as a major contributor to CIPN.
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Affiliation(s)
- Nathan P. Staff
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA; (N.P.S.)
| | - Sybil C. Hrstka
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA; (N.P.S.)
| | - Surendra Dasari
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA; (N.P.S.)
| | | | - Sandra Rieger
- Department of Biology, University of Miami, Coral Gables, FL 33146, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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20
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Cao F, Wang X, Ye Q, Yan F, Lu W, Xie J, Bi B, Wang X. Identifying circRNA-miRNA-mRNA Regulatory Networks in Chemotherapy-Induced Peripheral Neuropathy. Curr Issues Mol Biol 2023; 45:6804-6822. [PMID: 37623249 PMCID: PMC10453290 DOI: 10.3390/cimb45080430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent and severe side effect of first-line chemotherapeutic agents. The association between circular RNAs (circRNAs) and CIPN remains unclear. In this study, CIPN models were constructed with Taxol, while 134 differentially expressed circRNAs, 353 differentially expressed long non-coding RNAs, and 86 differentially expressed messenger RNAs (mRNAs) were identified utilizing RNA sequencing. CircRNA-targeted microRNAs (miRNAs) were predicted using miRanda, and miRNA-targeted mRNAs were predicted using TargetScan and miRDB. The intersection of sequencing and mRNA prediction results was selected to establish the circRNA-miRNA-mRNA networks, which include 15 circRNAs, 18 miRNAs, and 11 mRNAs. Functional enrichment pathway analyses and immune infiltration analyses revealed that differentially expressed mRNAs were enriched in the immune system, especially in T cells, monocytes, and macrophages. Cdh1, Satb2, Fas, P2ry2, and Zfhx2 were further identified as hub genes and validated by RT-qPCR, correlating with macrophages, plasmacytoid dendritic cells, and central memory CD4 T cells in CIPN. Additionally, we predicted the associated diseases, 36 potential transcription factors (TFs), and 30 putative drugs for hub genes using the DisGeNET, TRRUST, and DGIdb databases, respectively. Our results indicated the crucial role of circRNAs, and the immune microenvironment played in CIPN, providing novel insights for further research.
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Affiliation(s)
- Fei Cao
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (F.C.); (X.W.); (Q.Y.); (F.Y.); (W.L.); (J.X.)
| | - Xintong Wang
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (F.C.); (X.W.); (Q.Y.); (F.Y.); (W.L.); (J.X.)
| | - Qingqing Ye
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (F.C.); (X.W.); (Q.Y.); (F.Y.); (W.L.); (J.X.)
| | - Fang Yan
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (F.C.); (X.W.); (Q.Y.); (F.Y.); (W.L.); (J.X.)
| | - Weicheng Lu
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (F.C.); (X.W.); (Q.Y.); (F.Y.); (W.L.); (J.X.)
| | - Jingdun Xie
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (F.C.); (X.W.); (Q.Y.); (F.Y.); (W.L.); (J.X.)
| | - Bingtian Bi
- Department of Clinical Trial Center, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xudong Wang
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (F.C.); (X.W.); (Q.Y.); (F.Y.); (W.L.); (J.X.)
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21
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Yun HD, Goel Y, Gupta K. Crosstalk of Mast Cells and Natural Killer Cells with Neurons in Chemotherapy-Induced Peripheral Neuropathy. Int J Mol Sci 2023; 24:12543. [PMID: 37628724 PMCID: PMC10454469 DOI: 10.3390/ijms241612543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a major comorbidity of cancer. Multiple clinical interventions have been studied to effectively treat CIPN, but the results have been disappointing, with no or little efficacy. Hence, understanding the pathophysiology of CIPN is critical to improving the quality of life and clinical outcomes of cancer patients. Although various mechanisms of CIPN have been described in neuropathic anti-cancer agents, the neuroinflammatory process involving cytotoxic/proinflammatory immune cells remains underexamined. While mast cells (MCs) and natural killer (NK) cells are the key innate immune compartments implicated in the pathogenesis of peripheral neuropathy, their role in CIPN has remained under-appreciated. Moreover, the biology of proinflammatory cytokines associated with MCs and NK cells in CIPN is particularly under-evaluated. In this review, we will focus on the interactions between MCs, NK cells, and neuronal structure and their communications via proinflammatory cytokines, including TNFα, IL-1β, and IL-6, in peripheral neuropathy in association with tumor immunology. This review will help lay the foundation to investigate MCs, NK cells, and cytokines to advance future therapeutic strategies for CIPN.
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Affiliation(s)
- Hyun Don Yun
- Hematology, Oncology, Veterans Affairs Long Beach Healthcare System, Long Beach, CA 90822, USA
- Division of Hematology, Oncology, Department of Medicine, School of Medicine, University of California, Irvine, CA 92617, USA; (Y.G.); (K.G.)
| | - Yugal Goel
- Division of Hematology, Oncology, Department of Medicine, School of Medicine, University of California, Irvine, CA 92617, USA; (Y.G.); (K.G.)
| | - Kalpna Gupta
- Division of Hematology, Oncology, Department of Medicine, School of Medicine, University of California, Irvine, CA 92617, USA; (Y.G.); (K.G.)
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22
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Teng C, Chiarovano E, Tighe D, Bui KT, Venkatesha, Blinman PL, MacDougall HG, Vardy JL. Exploring assessment of balance using virtual reality in patients at risk of chemotherapy-induced peripheral neuropathy. Intern Med J 2023; 53:1356-1365. [PMID: 35762188 PMCID: PMC10946840 DOI: 10.1111/imj.15861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting toxicity for people treated for cancer. Impaired balance and falls are functional consequences of CIPN. Virtual reality (VR) technology may be able to assess balance and identify patients at risk of falls. AIMS To assess the impact of potentially neurotoxic chemotherapy on balance using VR, and explore associations between VR balance assessment, falls and CIPN. METHODS This prospective, repeated measures longitudinal study was conducted at two Australian cancer centres. Eligible participants were commencing adjuvant chemotherapy containing a taxane for breast cancer, or oxaliplatin for colorectal cancer (CRC), per institutional guidelines. Balance assessments using VR were conducted at baseline, end of chemotherapy and 3 and 6 months after completion of chemotherapy. Participants also completed a comprehensive CIPN assessment comprising clinical and patient-reported outcomes, and recorded falls or near falls. RESULTS Out of 34 participants consented, 24 (71%) had breast cancer and 10 (29%) had CRC. Compared to baseline, balance threshold was reduced in 10/28 (36%) evaluable participants assessed at the end of chemotherapy, and persistent in 7/22 (32%) at 6 months. CIPN was identified in 86% at end of chemotherapy and persisted to 6 months after chemotherapy completion in 73%. Falls or near falls were reported by 12/34 (35%) participants, and were associated with impaired VR balance threshold (P = 0.002). CONCLUSIONS While VR balance assessment was no better at identifying CIPN than existing measures, it is a potential surrogate method to assess patients at risk of falls from CIPN.
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Affiliation(s)
- Christina Teng
- Concord Cancer CentreConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
- Department of Medical OncologyCentral Coast Cancer CentreSydneyNew South WalesAustralia
| | - Elodie Chiarovano
- School of PsychologyUniversity of SydneySydneyNew South WalesAustralia
| | - David Tighe
- Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Kim Tam Bui
- Concord Cancer CentreConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Venkatesha
- Clinical Research CentreSydney Local Health DistrictSydneyNew South WalesAustralia
| | - Prunella L. Blinman
- Concord Cancer CentreConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | | | - Janette L. Vardy
- Concord Cancer CentreConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
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23
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Dong-Wook K, Jae-Gyun C, Hee JS, Jaehyuk K, Miae L, Taehee K, Suk-Yun K, Yeonhee R, Hwa SY, Jin SL, Jin BP, Sang DL, Hyun-Woo K. Analgesic efficacy of median nerve stimulation in mice with chemotherapy-induced peripheral neuropathymodulation of brain-derived neurotrophic factor expression. J TRADIT CHIN MED 2023; 43:686-694. [PMID: 37454253 PMCID: PMC10320447 DOI: 10.19852/j.cnki.jtcm.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/03/2022] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Chemotherapeutic agents such as docetaxel (DTX) can trigger chemotherapy-induced peripheral neuropathy (CIPN), which is characterized by unbearable pain. This study was designed to investigate the analgesic effect and related neuronal mechanism of low-frequency median nerve stimulation (LFMNS) on DTX-induced tactile hypersensitivity in mice. METHODS To produce CIPN, DTX was administered intraperitoneally 4 times, once every 2 d, to male ICR mice. LFMNS was performed on the wrist area, and the pain response was measured using von Frey filaments on both hind paws. Western blot and immunofluorescence staining were performed using dorsal root ganglion and spinal cord samples to measure the expression of brain-derived neurotrophic factor (BDNF). RESULTS Repeated LFMNS significantly attenuated the DTX-induced abnormal sensory response and suppressed the enhanced expression of BDNF in the DRG neurons and spinal dorsal area. CONCLUSIONS LFMNS might be an effective non-pharmaceutical option for treating patients suffering from CIPN regulating the expression of peripheral and central BDNF.
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Affiliation(s)
- Kang Dong-Wook
- 1 Department of Physiology and Medical Science, College of Medicine and Brain Research Institute, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Choi Jae-Gyun
- 1 Department of Physiology and Medical Science, College of Medicine and Brain Research Institute, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Ju Song Hee
- 1 Department of Physiology and Medical Science, College of Medicine and Brain Research Institute, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Kim Jaehyuk
- 1 Department of Physiology and Medical Science, College of Medicine and Brain Research Institute, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Lee Miae
- 1 Department of Physiology and Medical Science, College of Medicine and Brain Research Institute, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Kim Taehee
- 1 Department of Physiology and Medical Science, College of Medicine and Brain Research Institute, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Kang Suk-Yun
- 2 KM Fundamental Research Division Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
| | - Ryu Yeonhee
- 2 KM Fundamental Research Division Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
| | - Seung Yoo Hwa
- 3 East-West Cancer Center, Dunsan Korean Medicine Hospital of Daejeon University, Daejeon 35234, Republic of Korea
| | - Sun Lee Jin
- 4 Department of Surgery, Chungnam National University Hospital, Daejeon 35015, Republic of Korea
| | - Bong Park Jin
- 5 Laboratory of Veterinary Pharmacology, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Do Lee Sang
- 1 Department of Physiology and Medical Science, College of Medicine and Brain Research Institute, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Kim Hyun-Woo
- 1 Department of Physiology and Medical Science, College of Medicine and Brain Research Institute, Chungnam National University, Daejeon 35015, Republic of Korea
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24
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van de Graaf DL, Smeets T, van der Lee ML, Trompetter HR, Baars-Seebregts A, Børøsund E, Solberg Nes L, Schreurs KMG, Mols F. Patient-centered development of Embrace Pain: an online acceptance and commitment therapy intervention for cancer survivors with chronic painful chemotherapy-induced peripheral neuropathy. Acta Oncol 2023; 62:676-688. [PMID: 36939672 DOI: 10.1080/0284186x.2023.2187260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/28/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Around 30% of cancer survivors suffer from chemotherapy-induced peripheral neuropathy (CIPN) ≥6 months after completion of chemotherapy, which comes with limitations in daily functioning and worsened quality of life(QoL). Treatment options are scarce. Our aim was to develop an online self-help intervention based on Acceptance and Commitment Therapy (ACT) to reduce pain interference in cancer survivors experiencing painful chronic CIPN. MATERIAL AND METHODS This article applied a patient-centered design process using the Center for eHealth Research (CeHRes) roadmap. User needs were examined using online semi-structured interviews with patients and experts (N = 23). Interviews were transcribed verbatim and analyzed using thematic analysis. Personas were created based on interviews. Intervention content was based on identified user needs and ACT. Content and design were finalized using low-fidelity prototype testing (N = 5), and high-fidelity prototype testing (N = 7). RESULTS Patients appreciated and agreed with the elements of ACT, had varying guidance needs, and wanted to have autonomy (e.g., moment and duration of use). Additionally, it was important to be aware that patients have had a life-threatening disease which directly relates to the symptoms they experience. Patients reported to prefer a user-friendly and accessible intervention. Similar points also emerged in the expert interviews. The final intervention, named Embrace Pain, includes six sessions. Session content is based on psychoeducation and all ACT processes. Further interpretation of the intervention (such as quotes, guidance, and multimedia choices) is based on the interviews. CONCLUSION This development demonstrated how a patient-centered design process from a theoretical framework can be applied. Theory-driven content was used as the basis of the intervention. Findings show an online ACT intervention designed for cancer survivors with painful chronic CIPN.
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Affiliation(s)
- Daniëlle L van de Graaf
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychological Disorders and Somatic Diseases, Tilburg University, Tilburg, the Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Tom Smeets
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychological Disorders and Somatic Diseases, Tilburg University, Tilburg, the Netherlands
| | - Marije L van der Lee
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychological Disorders and Somatic Diseases, Tilburg University, Tilburg, the Netherlands
- Centre for Psycho-Oncology, Scientific Research Department, Helen Dowling Institute, Bilthoven, the Netherlands
| | - Hester R Trompetter
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychological Disorders and Somatic Diseases, Tilburg University, Tilburg, the Netherlands
| | - Aafke Baars-Seebregts
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychological Disorders and Somatic Diseases, Tilburg University, Tilburg, the Netherlands
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Karlein M G Schreurs
- Department of Psychology, Health & Technology, Centre for eHealth & Well-Being Research, University of Twente, Enschede, the Netherlands
| | - Floortje Mols
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychological Disorders and Somatic Diseases, Tilburg University, Tilburg, the Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
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25
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Uta D, Takeuchi K, Fukano K, Kawamura H, Ito A. Effect of a Single Dose of Oxaliplatin on the Induction of Peripheral Neuropathy in a Rat Model: An in vivo Electrophysiological Study. Biol Pharm Bull 2023:b23-00263. [PMID: 37331804 DOI: 10.1248/bpb.b23-00263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
The anticancer drug oxaliplatin is associated with peripheral neuropathy as a side effect accompanied by mechanical and cold allodynia. Although the superficial layer of the spinal cord dorsal horn is known to receive information primarily from peripheral pain nerves, to our knowledge, no in vivo electrophysiological analyses have been conducted to determine whether oxaliplatin administration increases the excitability of superficial layer neurons. Therefore, in vivo extracellular recordings were performed to measure action potentials in the deep and superficial layers of the spinal cord dorsal horn in rats treated with a single dose (6 mg/kg) of oxaliplatin. Action potentials were produced by mechanical stimulation with von Frey filaments to the hindlimb receptive fields. The results revealed that the firing frequency of action potentials increased relative to the intensity of mechanical stimulation, and that both deep and superficial layer neurons in the spinal cord dorsal horn increased significantly in oxaliplatin-treated compared with vehicle-treated rats, especially in the superficial layer. Several superficial layer neurons showed spontaneous firing that was not seen in vehicle-treated rats. In addition, a clear increase was seen in the firing frequency of neurons in the superficial layer of oxaliplatin-treated rats in response to a cold stimulus (here, the addition of acetone to the hindlimb receptive field). This study suggests that the superficial spinal cord dorsal horn strongly reflects the pain pathophysiology in peripheral neuropathy induced by oxaliplatin administration, and that the superficial layer neurons are useful for in vivo electrophysiological analysis using this pathological model.
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Affiliation(s)
- Daisuke Uta
- Department of Applied Pharmacology, Faculty of Pharmaceutical Sciences, University of Toyama
| | - Keita Takeuchi
- Laboratory for Pharmacology, Pharmaceutical Research Center, Asahi Kasei Pharma Corp
| | - Keigo Fukano
- Laboratory for Pharmacology, Pharmaceutical Research Center, Asahi Kasei Pharma Corp
| | - Hinata Kawamura
- Laboratory for Pharmacology, Pharmaceutical Research Center, Asahi Kasei Pharma Corp
| | - Akitoshi Ito
- Laboratory for Pharmacology, Pharmaceutical Research Center, Asahi Kasei Pharma Corp
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26
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Bennet BM, Pardo ID, Assaf BT, Buza E, Cramer S, Crawford LK, Engelhardt JA, Grubor B, Morrison JP, Osborne TS, Sharma AK, Bolon B. Scientific and Regulatory Policy Committee Points to Consider: Sampling, Processing, Evaluation, Interpretation, and Reporting of Test Article-Related Ganglion Pathology for Nonclinical Toxicity Studies. Toxicol Pathol 2023; 51:176-204. [PMID: 37489508 DOI: 10.1177/01926233231179707] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Certain biopharmaceutical products consistently affect dorsal root ganglia, trigeminal ganglia, and/or autonomic ganglia. Product classes targeting ganglia include antineoplastic chemotherapeutics, adeno-associated virus-based gene therapies, antisense oligonucleotides, and anti-nerve growth factor agents. This article outlines "points to consider" for sample collection, processing, evaluation, interpretation, and reporting of ganglion findings; these points are consistent with published best practices for peripheral nervous system evaluation in nonclinical toxicity studies. Ganglion findings often occur as a combination of neuronal injury (e.g., degeneration, necrosis, and/or loss) and/or glial effects (e.g., increased satellite glial cell cellularity) with leukocyte accumulation (e.g., mononuclear cell infiltration or inflammation). Nerve fiber degeneration and/or glial reactions may be seen in nerves, dorsal spinal nerve roots, spinal cord, and occasionally brainstem. Interpretation of test article (TA)-associated effects may be confounded by incidental background changes or experimental procedure-related changes and limited historical control data. Reports should describe findings at these sites, any TA relationship, and the criteria used for assigning severity grades. Contextualizing adversity of ganglia findings can require a weight-of-evidence approach because morphologic changes of variable severity occur in ganglia but often are not accompanied by observable overt in-life functional alterations detectable by conventional behavioral and neurological testing techniques.
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Affiliation(s)
| | | | | | - Elizabeth Buza
- University of Pennsylvania, Gene Therapy Program, Philadelphia, Pennsylvania, USA
| | | | - LaTasha K Crawford
- University of Wisconsin-Madison, School of Veterinary Medicine, Madison, Wisconsin, USA
| | | | | | - James P Morrison
- Charles River Laboratories, Inc., Shrewsbury, Massachusetts, USA
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27
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Huerta MÁ, de la Nava J, Artacho-Cordón A, Nieto FR. Efficacy and Security of Tetrodotoxin in the Treatment of Cancer-Related Pain: Systematic Review and Meta-Analysis. Mar Drugs 2023; 21:md21050316. [PMID: 37233510 DOI: 10.3390/md21050316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 05/27/2023] Open
Abstract
The pharmacological treatment of cancer-related pain is unsatisfactory. Tetrodotoxin (TTX) has shown analgesia in preclinical models and clinical trials, but its clinical efficacy and safety have not been quantified. For this reason, our aim was to perform a systematic review and meta-analysis of the clinical evidence that was available. A systematic literature search was conducted in four electronic databases (Medline, Web of Science, Scopus, and ClinicalTrials.gov) up to 1 March 2023 in order to identify published clinical studies evaluating the efficacy and security of TTX in patients with cancer-related pain, including chemotherapy-induced neuropathic pain. Five articles were selected, three of which were randomized controlled trials (RCTs). The number of responders to the primary outcome (≥30% improvement in the mean pain intensity) and those suffering adverse events in the intervention and placebo groups were used to calculate effect sizes using the log odds ratio. The meta-analysis showed that TTX significantly increased the number of responders (mean = 0.68; 95% CI: 0.19-1.16, p = 0.0065) and the number of patients suffering non-severe adverse events (mean = 1.13; 95% CI: 0.31-1.95, p = 0.0068). However, TTX did not increase the risk of suffering serious adverse events (mean = 0.75; 95% CI: -0.43-1.93, p = 0.2154). In conclusion, TTX showed robust analgesic efficacy but also increased the risk of suffering non-severe adverse events. These results should be confirmed in further clinical trials with higher numbers of patients.
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Affiliation(s)
- Miguel Á Huerta
- Department of Pharmacology, University of Granada, 18016 Granada, Spain
- Institute of Neuroscience, Biomedical Research Center, University of Granada, 18016 Granada, Spain
- Biosanitary Research Institute ibs. Granada, 18012 Granada, Spain
| | - Javier de la Nava
- Department of Pharmacology, University of Granada, 18016 Granada, Spain
- Institute of Neuroscience, Biomedical Research Center, University of Granada, 18016 Granada, Spain
| | - Antonia Artacho-Cordón
- Department of Pharmacology, University of Granada, 18016 Granada, Spain
- Institute of Neuroscience, Biomedical Research Center, University of Granada, 18016 Granada, Spain
- Biosanitary Research Institute ibs. Granada, 18012 Granada, Spain
| | - Francisco R Nieto
- Department of Pharmacology, University of Granada, 18016 Granada, Spain
- Institute of Neuroscience, Biomedical Research Center, University of Granada, 18016 Granada, Spain
- Biosanitary Research Institute ibs. Granada, 18012 Granada, Spain
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Itoh K, Shimoyama M, Schiller PW, Toyama S. Protective effect of a mitochondria-targeting peptide against paclitaxel-induced peripheral neuropathy. Chem Biol Drug Des 2023; 101:1012-1018. [PMID: 36513390 PMCID: PMC10064869 DOI: 10.1111/cbdd.14192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a major side effect of several anticancer agents including paclitaxel, a chemotherapeutic drug widely used in cancer treatment. CIPN deteriorates patients' quality of life and compromises cancer treatment. Dysfunction or injury of mitochondria has been suggested to be involved in the induction of this neuropathy. SS-20 is a tetrapeptide that targets mitochondria and restores mitochondrial bioenergetics. This study was aimed to examine the protective effect of SS-20 against paclitaxel-induced peripheral neuropathy using a murine model. Repeated administration of paclitaxel to mice induced peripheral neuropathy as demonstrated by the presence of mechanical allodynia and the loss of intraepidermal nerve fibers in the hind paw. Concomitant administration of SS-20 protected against the development of the neuropathy. Our results suggest that SS-20 may be a drug candidate for the prevention of CIPN.
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Affiliation(s)
- Kensaku Itoh
- Center for Neuroscience of Pain, The Jikei University School of Medicine, Minato-Ku, Tokyo
| | - Megumi Shimoyama
- Center for Neuroscience of Pain, The Jikei University School of Medicine, Minato-Ku, Tokyo
| | - Peter W. Schiller
- Laboratory of Chemical Biology and Peptide Research, Montreal Clinical Research Institute, Montreal, Quebec, Canada
- Department of Pharmacology and Physiology, University of Montreal, Montreal, Quebec, Canada
| | - Satoshi Toyama
- Center for Neuroscience of Pain, The Jikei University School of Medicine, Minato-Ku, Tokyo
- Department of Anesthesiology, Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences, Bunkyo-Ku, Tokyo
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Zhai M, Hu H, Zheng Y, Wu B, Sun W. PGC1α: an emerging therapeutic target for chemotherapy-induced peripheral neuropathy. Ther Adv Neurol Disord 2023; 16:17562864231163361. [PMID: 36993941 PMCID: PMC10041632 DOI: 10.1177/17562864231163361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 02/25/2023] [Indexed: 03/29/2023] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN)-mediated paresthesias are a common complication in cancer patients undergoing chemotherapy. There are currently no treatments available to prevent or reverse CIPN. Therefore, new therapeutic targets are urgently needed to develop more effective analgesics. However, the pathogenesis of CIPN remains unclear, and the prevention and treatment strategies of CIPN are still unresolved issues in medicine. More and more studies have demonstrated that mitochondrial dysfunction has become a major factor in promoting the development and maintenance of CIPN, and peroxisome proliferator-activated receptor gamma (PPARγ) coactivator 1α (PGC1α) plays a significant role in maintaining the mitochondrial function, protecting peripheral nerves, and alleviating CIPN. In this review, we highlight the core role of PGC1α in regulating oxidative stress and maintaining normal mitochondrial function and summarize recent advances in its therapeutic effects and mechanisms in CIPN and other forms of peripheral neuropathy. Emerging studies suggest that PGC1α activation may positively impact CIPN mitigation by modulating oxidative stress, mitochondrial dysfunction, and inflammation. Therefore, novel therapeutic strategies targeting PGC1α could be a potential therapeutic target in CIPN.
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Affiliation(s)
- Mingzhu Zhai
- Center for Medical Experiments (CME), University of Chinese Academy of Sciences-Shenzhen Hospital, Shenzhen, China
- Yantian Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Haibei Hu
- Center for Medical Experiments (CME), University of Chinese Academy of Sciences-Shenzhen Hospital, Shenzhen, China
| | - Yi Zheng
- Center for Medical Experiments (CME), University of Chinese Academy of Sciences-Shenzhen Hospital, Shenzhen, China
| | - Benqing Wu
- Center for Medical Experiments (CME), University of Chinese Academy of Sciences-Shenzhen Hospital, Shenzhen 518016, China
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Hsieh CF, Chan YN, Wu CJ, Yen LY, Chang YC, Wang YJ. Patient-reported motor chemotherapy-induced peripheral neuropathy impacts function in advanced colorectal cancer survivors receiving chemotherapy: A cross-sectional study. Jpn J Nurs Sci 2023:e12531. [PMID: 36960772 DOI: 10.1111/jjns.12531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/25/2023] [Accepted: 02/10/2023] [Indexed: 03/25/2023]
Abstract
AIMS Chemotherapy-induced peripheral neuropathy limits cancer survivors' compliance with chemotherapy and impaired function. This study aimed to examine separate impacts of clinician-assessed, patient-reported sensory and motor chemotherapy-induced peripheral neuropathy on physical/role function and functional interference in advanced colorectal cancer survivors receiving chemotherapy. METHODS A cross-sectional, correlational design utilizing convenience sampling enrolled 75 stage III or IV colorectal cancer adults undergoing chemotherapy. Participants filled out the Patient Neurotoxicity Questionnaire, Identification Pain Questionnaire, and Peripheral Neuropathy Scale. Then, a trained research nurse conducted a brief neurological assessment using the Total Neuropathy Scale - clinical version. RESULTS The prevalence of sensory and motor chemotherapy-induced peripheral neuropathy was from 34.7% to 54.7% and from 16.0% to 17.3%, respectively. Further, 20% of participants suffered from neuropathic pain. A low correlation between clinician-assessed and patient-reported chemotherapy-induced peripheral neuropathy was detected. The function was significantly impacted by patient-reported motor chemotherapy-induced peripheral neuropathy. CONCLUSIONS This study was superior in utilizing the brief and valid patient-reported and clinician-assessed tools to measure sensory and motor chemotherapy-induced peripheral neuropathy. Moreover, the identification of patient-reported motor symptoms has the largest influence on function in advanced colorectal cancer survivors. Nurses may use the brief and easily administered tools in clinical settings for effective screening and early detection of motor and sensory chemotherapy-induced peripheral neuropathy to prevent functional decline in advanced colorectal cancer survivors. However, this study was still limited because of the cross-sectional design, small sample size, sample heterogeneity, and recruiting participants from only one medical center.
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Affiliation(s)
- Chia-Fen Hsieh
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ya-Ning Chan
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chih-Jung Wu
- School of Nursing, China Medical University, Taichung City, Taiwan
| | - Li-Yu Yen
- LabCorp Taiwan Services Limited, Taipei City, Taiwan
| | - Yu-Chi Chang
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ya-Jung Wang
- Department of Nursing, Dayeh University, Changhua, Taiwan
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31
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Sun W, Hao Y, Li R, Ho IHT, Wu S, Li N, Ba X, Wang J, Xiong D, Jiang C, Xiao L, Liu X. Comparative Transcriptome of Dorsal Root Ganglia Reveals Distinct Etiologies of Paclitaxel- and Oxaliplatin-induced Peripheral Neuropathy in Rats. Neuroscience 2023; 516:1-14. [PMID: 36822350 DOI: 10.1016/j.neuroscience.2023.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/08/2023] [Accepted: 02/11/2023] [Indexed: 02/25/2023]
Abstract
Chemotherapy-induced peripheral neuropathy is one of the most common side effects of anticancer therapy. It is anticipated that chemotherapies with different mechanisms of action may affect somatosensory neurons differently. This study aimed to explore similar and differential etiologies of oxaliplatin- and paclitaxel-induced neuropathy by comparing the transcriptomes of dorsal root ganglia (DRGs). We retrieved our previously published transcriptome data of DRGs extracted from vehicle-, oxaliplatin- and paclitaxel-treated rats (GSE160543), to analyze in parallel the differentially expressed genes (DEGs) and Gene ontology (GO) terms enrichment. We found that both oxaliplatin and paclitaxel treatments consistently produced mechanical allodynia, thermal hyperalgesia, and cold hyperalgesia in rats. Compared to vehicle, 320 and 150 DEGs were identified after oxaliplatin and paclitaxel treatment, respectively. Only 17 DEGs were commonly dysregulated by the two reagents. Activating transcription factor 3 (Atf3), a marker of nerve injury, was elevated only after paclitaxel treatment. GO analysis suggested that paclitaxel treatment was associated with neuronal changes characterized by numerous terms that are related to synaptic transmission, while oxaliplatin was more likely to affect dividing cells (e.g., the glia) and neuroinflammation. Notably, 29 biological processes GO terms were commonly enriched in response to both drugs. However, 28 out of 29 terms were oppositely modulated. This study suggests that distinct mechanisms underly paclitaxel- and oxaliplatin-induced neuropathy. Paclitaxel might directly affect somatosensory neurons while oxaliplatin primarily targets dividing cells and immune cells.
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Mondaca S, Pinto MP, Briones J, Caire N, Peña J, Koch É, Muñiz S, Herrera ME, Sánchez C, Galindo H, Pizarro G, Acevedo F, Ibañez C, Balmaceda C, Norero E, Duran D, Garrido M, Nervi B. Impact of Adjuvant FOLFOX on Quality of Life and Peripheral Neuropathy Incidence in Patients With Gastric Cancer: A Prospective Cohort Study. Value Health Reg Issues 2023; 35:13-18. [PMID: 36805388 DOI: 10.1016/j.vhri.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 10/21/2022] [Accepted: 12/18/2022] [Indexed: 02/18/2023]
Abstract
OBJECTIVES Perioperative and adjuvant chemotherapy have demonstrated clinical benefits in localized gastric cancer. Nevertheless, the reports on their effects on patient's health-related quality of life (HRQoL) are scarce. Here, we prospectively assessed quality of life and the incidence of chemotherapy-induced peripheral neuropathy (CIPN) in a cohort of patients treated with adjuvant FOLFOX. METHODS Localized stomach or gastroesophageal junction adenocarcinoma patients who underwent curative resection were recruited at a single center. All patients received adjuvant FOLFOX6, and HRQoL and CIPN were assessed using the European organization for research and treatment of cancer quality life (EORTC) C30 and the EORTC CIPN20 questionnaires, respectively. Clinically significant deterioration of HRQoL was also assessed as a coprimary outcome in a longitudinal analysis. RESULTS We recruited a total of 63 patients. Median age was 62.5 years, and 75% had stomach tumors. Twenty-four weeks after the start of treatment, the probability of being free from HRQoL deterioration and CIPN was 29% (95% confidence interval [CI] 18%-42%) and 6% (95% CI 2%-17%), respectively. Five-year disease-free survival was 45% (95% CI 24%-64%) and 5-year overall survival was 63% (95% CI 48%-76%). CONCLUSIONS Adjuvant FOLFOX is associated with a high rate of long-term survival in localized gastric cancer; nevertheless, it has detrimental effects on patients' quality of life.
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Affiliation(s)
- Sebastián Mondaca
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Mauricio P Pinto
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Briones
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Hematology and Oncology Unit, Complejo Asistencial Dr. Sotero del Rio, Santiago, Chile
| | - Nicole Caire
- Hematology and Oncology Unit, Complejo Asistencial Dr. Sotero del Rio, Santiago, Chile
| | - José Peña
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Hematology and Oncology Unit, Complejo Asistencial Dr. Sotero del Rio, Santiago, Chile
| | - Érica Koch
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Hematology and Oncology Unit, Complejo Asistencial Dr. Sotero del Rio, Santiago, Chile
| | - Sabrina Muñiz
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Elisa Herrera
- Department of Hematology and Oncology, Clinica Alemana de Valdivia, Valdivia, Chile
| | - Cesar Sánchez
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Héctor Galindo
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gonzalo Pizarro
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Acevedo
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Ibañez
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Balmaceda
- Health Technology Assessment Unit, Clinical Research Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Enrique Norero
- Esophagogastric Surgery Unit, Complejo Asistencial Dr. Sotero del Rio, Santiago, Chile; Department of Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Doris Duran
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcelo Garrido
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bruno Nervi
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Erdem H, Sarıkcıoğlu L, Boyan N, Savaş K, Yaras N, Oguz O. Vitamin D3 Promotes Structural and Functional Recovery After Vincristine-Induced Peripheral Neuropathy in Rats: An Experimental Study. Cureus 2023; 15:e34979. [PMID: 36938210 PMCID: PMC10019938 DOI: 10.7759/cureus.34979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/16/2023] Open
Abstract
Background Vincristine-induced peripheral neuropathy (VIPN) is a distal axonopathy characterized by the loss of distal myelinated axons. This study aimed to assess the potential neuroregenerative roles of vitamin D3 using functional and electron microscopic analyses in a rat model of VIPN. Methodology A total of 40 female Wistar rats were randomly divided into four main groups: Group 1 (control, n = 10), Group 2 (vincristine, n = 10), Group 3 (vincristine + vitamin D3, n = 10), and Group 4 (vincristine + vehicle, n = 10). Vincristine was administered intraperitoneally at a dose of 0.15 mg/kg, for two weeks, to induce peripheral neuropathy. Following successful induction, vitamin D3 (500 IU/kg/day) and vehicle treatments were applied weekly over four weeks. Structural (electron microscopic analysis) and functional analysis (von Frey test, pinch test, and electrophysiological analysis) were performed to assess functional recovery after peripheral nerve impairment. Results Withdrawal responses to mechanical allodynia and pinch tests were significantly higher in the vitamin D3-treated group (P < 0.05). The electrophysiological analysis also supported these results. Electron microscopic evaluation revealed that the remyelinated nerve fibers in the vitamin D3-treated group (Group 3) had thick myelin sheaths and normal axonal morphology. Conclusions Our study demonstrated that vitamin D3 could promote functional and structural recovery in a rat model of VIPN. Further studies should be conducted to elucidate the underlying mechanisms by which vitamin D3 exerts its regenerative effects in VIPN, using alternative administration protocols.
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Affiliation(s)
- Hüseyin Erdem
- Department of Anatomy, Cukurova University Faculty of Medicine, Adana, TUR
| | - Levent Sarıkcıoğlu
- Department of Anatomy, Akdeniz University Faculty of Medicine, Antalya, TUR
| | - Neslihan Boyan
- Department of Anatomy, Cukurova University Faculty of Medicine, Adana, TUR
| | - Kamil Savaş
- Department of Biophysics, Kirklareli University Faculty of Medicine, Kirklareli, TUR
| | - Nazmi Yaras
- Department of Biophysics, Akdeniz University Faculty of Medicine, Antalya, TUR
| | - Ozkan Oguz
- Department of Anatomy, Cukurova University Faculty of Medicine, Adana, TUR
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Li X, Zhi L, Han KY, Li SQ, Ahmad K, Seluzicki C, Wang R, Bao T. Impact of Baseline Expectancy on Outcome Prediction of Real and Sham Acupuncture for Persistent Chemotherapy-Induced Peripheral Neuropathy Pain in Solid Tumor Survivors: A Secondary Analysis of a Randomized Clinical Trial. Integr Cancer Ther 2023; 22:15347354221149992. [PMID: 36691937 PMCID: PMC9893060 DOI: 10.1177/15347354221149992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) pain significantly worsens cancer survivors' quality of life. Expectancy may play an important role in acupuncture response. We sought to explore whether expectancy predicts pain outcome in real acupuncture (RA) and sham acupuncture (SA) in cancer survivors. METHODS We analyzed data from a randomized clinical trial that evaluated the effect of RA on CIPN symptoms compared to SA and wait list control (WLC) in 75 cancer survivors. This secondary analysis was limited to CIPN pain measured by the Numeric Rating Scale (NRS), graded from 0 to 10. Interventions were delivered over 8 weeks. SA was implemented using a combination of non-acupuncture points and a non-insertion procedure. Patient expectancy was measured by the Acupuncture Expectancy Scale (AES) 3 times during the study. We used a linear regression model to evaluate if the NRS score was associated with the baseline AES score at the end of treatment (week 8), adjusting for baseline NRS score. RESULTS AES was similar among 3 groups at baseline (RA: 11.8 ± 2.7; SA: 12.1 ± 3.8.; WLC: 14.6 ± 4.2; P = .062). Baseline AES was not found to be significantly associated with the week 8 NRS score among patients in all RA, SA, and WLC groups (all P > .05). However, we found a trend that higher baseline AES predicted lower NRS score at week 8 in the SA group: a one-point higher score on baseline expectancy was associated with a 0.3-point reduction in NRS pain score (P = .059) at week 8. CONCLUSIONS The association of baseline expectancy and acupuncture response was similar between RA and SA. However, SA seemed to rely more on expectancy than RA. Further studies with larger sample sizes are needed to confirm this finding.
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Affiliation(s)
- Xiaotong Li
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lilly Zhi
- Ward Melville High School, East Setauket, NY, USA
| | | | - Susan Q. Li
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Khalada Ahmad
- AdventHealth Cancer Institute Clinical Research, AdventHealth Great Lakes Region, Hinsdale, IL, USA
| | | | - Rui Wang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, NY, USA,Ting Bao, Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 321 East 61st Street, 4th Floor, New York, NY 10065, USA.
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Jeong JG, Ahn CH, Min YS, Kim SE, Kim JY, Jung TD. Electrophysiologic Patterns of Symptomatic Vincristine-Induced Peripheral Neuropathy in Children with Acute Lymphocytic Leukemia. J Clin Med 2023; 12:jcm12020686. [PMID: 36675615 PMCID: PMC9864890 DOI: 10.3390/jcm12020686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
Acute lymphocytic leukemia is one of the most common cancers in children. Multi-drug chemotherapy is used for treatment, and the representative drug is vincristine. Although various side effects may occur due to vincristine, the association with peripheral neuropathy is high compared to that of other drugs. This study focused on children under the age of 18 years of age with ALL who received chemotherapy containing vincristine. We retrospectively analyzed the results of a nerve conduction study and a cumulative dose of vincristine in 30 children diagnosed with peripheral neuropathy. The average cumulative dose until diagnosis of vincristine-induced peripheral neuropathy was 14.99 ± 1.21 mg/m2, and motor nerves were predominantly involved. Additionally, a marked decrease in average amplitude was also observed in motor nerves. In addition, when the relationship between the incidence of peripheral neuropathy and the cumulative dose was analyzed through the survival curve, about 50% of children developed peripheral neuropathy at a dose of 15.5 ± 1.77 mg/m2. Based on the electrophysiological characteristics of pediatric vincristine-induced peripheral neuropathy, as well as the relationship between the incidence rate and the cumulative dose, it is possible to observe more closely the vincristine-induced peripheral neuropathy occurrence in children with ALL at an appropriate time.
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Affiliation(s)
- Jae-Gyeong Jeong
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Chang-Hwan Ahn
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Yu-Sun Min
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Sung Eun Kim
- Department of Pediatrics, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Ji Yoon Kim
- Department of Pediatrics, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Correspondence: (J.Y.K.); (T.-D.J.)
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Correspondence: (J.Y.K.); (T.-D.J.)
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Suzuki K, Morishita S, Nakano J, Okayama T, Inoue J, Tanaka T, Fukushima T. Neurological Outcomes of Chemotherapy-Induced Peripheral Neuropathy in Patients With Cancer: A Systematic Review and Meta-Analysis. Integr Cancer Ther 2023; 22:15347354231185110. [PMID: 37822238 PMCID: PMC10571681 DOI: 10.1177/15347354231185110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/02/2023] [Accepted: 06/13/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND This systematic review and meta-analysis aimed to determine whether chemotherapy-induced peripheral neuropathy (CIPN) affects the risk of falls and physical function in patients with cancer. METHODS A literature search was conducted in the CINAHL, Scopus, and PubMed databases for articles published from January 1950 to April 2022. Seven review authors retrieved studies using predetermined eligibility criteria, extracted the data, and evaluated the quality. RESULTS Nine studies were included in the analysis. Patients with CIPN had a significantly higher risk of falls than those without CIPN (risk ratio = 1.38, 95% confidence interval [CI] =1.18-1.62). Patients with CIPN had lower grip strength (standardized mean difference [SMD] =-0.42, 95% CIs = -0.70 to -0.14, P = .003), longer chair stand time (SMD = 0.56, 95% CIs = -0.01 to 1.17, P = .05), worse timed up and go test time (SMD = 0.79, 95% CIs = 0.41 to 1.17, P < .0001), and lower mean Fullerton Advanced Balance scale score (SMD = -0.81, 95% CIs = -1.27 to -0.36, P = .005) than patients without CIPN. There were no significant differences in gait speed (P = .38) or Activities-specific Balance Confidence Scale score (P = .09) between patients with and without CIPN. CONCLUSIONS This systematic review and meta-analysis demonstrated that patients with CIPN are prone to falls and impaired balance function and muscle strength.
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Affiliation(s)
| | | | | | | | - Junichiro Inoue
- Kobe University Hospital International Clinical Cancer Research Center, Kobe, Japan
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Suzuki M, Zhou Z, Nagayasu K, Shirakawa H, Nakagawa T, Kaneko S. Inhibitors of the Mechanistic Target of Rapamycin Can Ameliorate Bortezomib-Induced Peripheral Neuropathy. Biol Pharm Bull 2023; 46:1049-1056. [PMID: 37532556 DOI: 10.1248/bpb.b22-00861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Bortezomib, an anticancer drug for multiple myeloma and mantle cell lymphoma, causes severe adverse events and leads to peripheral neuropathy. The associated neuropathy limits the use of bortezomib and could lead to discontinuation of the treatment; therefore, effective intervention is crucial. In the present study, we statistically searched for a drug that could alleviate bortezomib-induced peripheral neuropathy using adverse event self-reports. We observed that specific inhibitors of the mechanistic target of rapamycin (mTOR) lowered the incidence of bortezomib-induced peripheral neuropathy. These findings were experimentally validated in mice, which exhibited long-lasting mechanical hypersensitivity after repeated bortezomib treatment. This effect was inhibited for hours after a systemic injection with rapamycin or everolimus in a dose-dependent manner. Bortezomib-induced allodynia was accompanied by the activation of spinal astrocytes, and intrathecal injection of mTOR inhibitors or an inhibitor of ribosomal protein S6 kinase 1, a downstream target of mTOR, exhibited considerable analgesic effects in a dose-dependent manner. These results suggest that mTOR inhibitors, which are readily available to patients prescribed bortezomib, are one of the most effective therapeutics for bortezomib-induced peripheral neuropathy.
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Affiliation(s)
- Mari Suzuki
- Department of Molecular Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto University
| | - Zijian Zhou
- Department of Molecular Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto University
| | - Kazuki Nagayasu
- Department of Molecular Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto University
| | - Hisashi Shirakawa
- Department of Molecular Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto University
| | - Takayuki Nakagawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital
| | - Shuji Kaneko
- Department of Molecular Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto University
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Li X, Sun Q, Ding H, Hao S, Lan Y, Liu L, Wang R. A randomized controlled study of a combination of internal and external treatments for albumin paclitaxel-related peripheral neurotoxicity: A randomized controlled: A study protocol. Medicine (Baltimore) 2022; 101:e32252. [PMID: 36595835 PMCID: PMC9794297 DOI: 10.1097/md.0000000000032252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Albumin-bound paclitaxel (nab-PTX), a novel paclitaxel preparation, has been found to successfully blocks tumor progression in breast and lung cancer. However, at the same time of as clinical application, neurotoxicity caused by nab-PTX has become the main factor limiting the clinical application of nab-PTX, which seriously affects the quality of life of patients and increases their psychological or financial burden. In clinical applications, JHGWD combined with bloodletting therapy at the end of the extremities has a positive effect on neurotoxic symptoms such as numbness, pain, and weakness of the hands and feet caused by nab-PTX. In a single-arm experiment, it was also found that the immediate effective rate of exsanguination therapy was as high as 70%, and when combined with oral Chinese medicine treatment, it further improved the efficacy. Therefore, a randomized controlled trial (RCT) was designed to further evaluate the efficacy and safety of this treatment. METHODS This RCT will be conducted at the Shanxi Provincial Hospital of Traditional Chinese Medicine. A total of 120 patients with Nab-PTX chemotherapy-induced neurotoxicity will be recruited. Treatment groups will be categorized into herbs alone group, bloodletting treatment alone group, and herbs combined with bloodletting group. Blank control was used. The primary outcome will be the EORTC QLQ-CIPN20 scale of the included patients, and the secondary outcomes will include EMG, peripheral neurotoxicity symptom score, NCI-CTCAE5.0 peripheral neurotoxicity grade, and WHO anti-tumor drug peripheral neurotoxicity grade. Adverse reactions will be recorded throughout the process. All data in this RCT will be analyzed by SPSS 26.0 software. DISCUSSION The results of this RCT will contribute to treating PIPN, relieving the neurotoxic symptoms, and improving the quality of life of patients. Finally, the RCT results will be published in a relevant academic journal on completion of the trial. TRIAL REGISTRATION ChiCTR2200060217(May22,2022).
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Affiliation(s)
- Xiaoli Li
- Department of Oncology, Shanxi Province Hospital of Traditional Chinese Medicine, Taiyuan, China
| | - Qimeng Sun
- Department of Oncology, Shanxi Province Hospital of Traditional Chinese Medicine, Taiyuan, China
| | - Hao Ding
- Department of Oncology, Shanxi Province Hospital of Traditional Chinese Medicine, Taiyuan, China
| | - Shulan Hao
- Department of Oncology, Shanxi Province Hospital of Traditional Chinese Medicine, Taiyuan, China
| | - Yonglin Lan
- Department of Oncology, Shanxi Province Hospital of Traditional Chinese Medicine, Taiyuan, China
| | - Likun Liu
- Department of Oncology, Shanxi Province Hospital of Traditional Chinese Medicine, Taiyuan, China
- *Correspondence: Li-Kun Liu, Department of Oncology, Shanxi Province Hospital of Traditional Chinese Medicine, No. 46 Bingzhou East Street, Yingze District, Taiyuan, Shanxi 030012, China (e-mail:)
| | - Ruimin Wang
- Department of Oncology, Shanxi Province Hospital of Traditional Chinese Medicine, Taiyuan, China
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Bernard A, Danigo A, Mroué M, Rovini A, Richard L, Nizou A, Desmoulière A, Sturtz F, Demiot C, Bourthoumieu S. Blockade of Cholecystokinin Type 2 Receptors Prevents the Onset of Vincristine-Induced Neuropathy in Mice. Pharmaceutics 2022; 14. [PMID: 36559317 DOI: 10.3390/pharmaceutics14122823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Vincristine (VCR) is responsible for the onset of the VCR-induced peripheral neuropathy (VIPN), associated with neuropathic pain. Several reports have strongly linked the cholecystokinin type 2 receptor (CCK2R) to nociceptive modulation. Thus, our aim was to evaluate the effect of CCK2R blockade on the onset of VIPN, as well as its interaction on VCR anticancer efficacy. VCR was administrated in mice for 8 days (100 µg/kg/d, i.p.). Transcriptomic analysis of the dorsal root ganglia (DRG) was performed at day 7 in VCR and control mice. Proglumide (30 mg/kg/d), a CCK1R and CCK2R antagonist, and Ly225910 (1 mg/kg/d), a selective CCK2R antagonist, were administrated one day before and during VCR treatment. Tactile sensitivity was assessed during treatments. Immunofluorescence and morphological analyses were performed on the skin, DRG and sciatic nerve at day 7. The cytotoxicity of VCR in combination with proglumide/Ly225910 was evaluated in human cancer cell lines. Cck2r was highly upregulated in the DRG of VCR mice. Proglumide accelerated the recovery of normal sensitivity, while Ly225910 totally prevented the onset of allodynia and nerve injuries induced by VCR. Proglumide or Ly225910 in combination with VCR did not affect the cytotoxicity of VCR. Targeting CCK2R could therefore be an effective strategy to prevent the onset of VIPN.
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40
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Meregalli C, Monza L, Jongen JLM. A mechanistic understanding of the relationship between skin innervation and chemotherapy-induced neuropathic pain. Front Pain Res (Lausanne) 2022; 3:1066069. [PMID: 36582196 PMCID: PMC9792502 DOI: 10.3389/fpain.2022.1066069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022]
Abstract
Neuropathic pain is a frequent complication of chemotherapy-induced peripheral neurotoxicity (CIPN). Chemotherapy-induced peripheral neuropathies may serve as a model to study mechanisms of neuropathic pain, since several other common causes of peripheral neuropathy like painful diabetic neuropathy may be due to both neuropathic and non-neuropathic pain mechanisms like ischemia and inflammation. Experimental studies are ideally suited to study changes in morphology, phenotype and electrophysiologic characteristics of primary afferent neurons that are affected by chemotherapy and to correlate these changes to behaviors reflective of evoked pain, mainly hyperalgesia and allodynia. However, hyperalgesia and allodynia may only represent one aspect of human pain, i.e., the sensory-discriminative component, while patients with CIPN often describe their pain using words like annoying, tiring and dreadful, which are affective-emotional descriptors that cannot be tested in experimental animals. To understand why some patients with CIPN develop neuropathic pain and others not, and which are the components of neuropathic pain that they are experiencing, experimental and clinical pain research should be combined. Emerging evidence suggests that changes in subsets of primary afferent nerve fibers may contribute to specific aspects of neuropathic pain in both preclinical models and in patients with CIPN. In addition, the role of cutaneous neuroimmune interactions is considered. Since obtaining dorsal root ganglia and peripheral nerves in patients is problematic, analyses performed on skin biopsies from preclinical models as well as patients provide an opportunity to study changes in primary afferent nerve fibers and to associate these changes to human pain. In addition, other biomarkers of small fiber damage in CIPN, like corneal confocal microscope and quantitative sensory testing, may be considered.
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Affiliation(s)
- Cristina Meregalli
- School of Medicine and Surgery, Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, Monza, Italy,Correspondence: Cristina Meregalli
| | - Laura Monza
- School of Medicine and Surgery, Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Joost L. M. Jongen
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
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Alberti P, Salvalaggio A, Argyriou AA, Bruna J, Visentin A, Cavaletti G, Briani C. Neurological Complications of Conventional and Novel Anticancer Treatments. Cancers (Basel) 2022; 14:cancers14246088. [PMID: 36551575 PMCID: PMC9776739 DOI: 10.3390/cancers14246088] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Various neurological complications, affecting both the central and peripheral nervous system, can frequently be experienced by cancer survivors after exposure to conventional chemotherapy, but also to modern immunotherapy. In this review, we provide an overview of the most well-known adverse events related to chemotherapy, with a focus on chemotherapy induced peripheral neurotoxicity, but we also address some emerging novel clinical entities related to cancer treatment, including chemotherapy-related cognitive impairment and immune-mediated adverse events. Unfortunately, efficacious curative or preventive treatment for all these neurological complications is still lacking. We provide a description of the possible mechanisms involved to drive future drug discovery in this field, both for symptomatic treatment and neuroprotection.
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Affiliation(s)
- Paola Alberti
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- NeuroMI (Milan Center for Neuroscience), 20126 Milan, Italy
| | | | - Andreas A. Argyriou
- Neurology Department, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece
| | - Jordi Bruna
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO Hospitalet, Bellvitge Institute for Biomedical Research (IDIBELL), 08908 Barcelona, Spain
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35131 Padova, Italy
| | - Guido Cavaletti
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neurosciences, University of Padova, 35131 Padova, Italy
- Correspondence:
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Abe Y, Taira N, Kashiwabara K, Tsurutani J, Kitada M, Takahashi M, Kato H, Kikawa Y, Sakata E, Naito Y, Hasegawa Y, Saito T, Iwasa T, Takashima T, Aihara T, Mukai H, Hara F, Shien T, Doihara H, Toyooka S. Association of Genetic Polymorphism with Taxane-induced Peripheral Neuropathy: Sub-analysis of a Randomized Phase II Study to Determine the Optimal Dose of 3-week Cycle Nab-Paclitaxel in Metastatic Breast Cancer Patients. Acta Med Okayama 2022; 76:661-671. [PMID: 36549768 DOI: 10.18926/amo/64116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is an important clinical challenge that threatens patients' quality of life. This sub-study of the ABROAD trial investigated the influence of single nucleotide polymorphisms (SNPs) on CIPN, using genotype data from a randomized study to determine the optimal dose of a 3-week-cycle regimen of nab-paclitaxel (q3w nab-PTX) in patients with metastatic breast cancer (MBC). Patients with HER2-negative MBC were randomly assigned to three doses of q3w nab-PTX (SD: 260 mg/m2 vs. MD: 220 mg/m2 vs. LD: 180 mg/m2). Five SNPs (EPHA4-rs17348202, EPHA5-rs7349683, EPHA6-rs301927, LIMK2-rs5749248, and XKR4-rs4737264) were analyzed based on the results of a previous genome-wide association study. Per-allele SNP associations were assessed by a Cox regression to model the cumulative dose of nab-PTX up to the onset of severe or worsening sensory neuropathy. A total of 141 patients were enrolled in the parent study; 91(65%) were included in this sub-study. Worsening of CIPN was significantly greater in the cases with XKR4 AC compared to those with a homozygote AA (HR 1.86, 95%CI: 1.00001-3.46, p=0.049). There was no significant correlation of CIPN with any other SNP. A multivariate analysis showed that the cumulative dose of nab-PTX was most strongly correlated with CIPN (p<0.01).
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Affiliation(s)
- Yuko Abe
- Department of Thoracic, Breast, and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Naruto Taira
- Department of Breast and Endocrine surgery, Kawasaki Medical School Hospital
| | | | - Junji Tsurutani
- Advanced Cancer Translational Research Institute, Showa University
| | - Masahiro Kitada
- Breast Disease Center, Asahikawa Medical University Hospital
| | - Masato Takahashi
- Department of Breast Surgery, National Hospital Organization Hokkaido Cancer Center
| | - Hiroaki Kato
- Department of Breast Surgery, Teine Keijinkai Hospital
| | - Yuichiro Kikawa
- Department of Breast Surgery, Kansai Medical University Hospital
| | - Eiko Sakata
- Department of Breast Surgery, Niigata City General Hospital
| | - Yoichi Naito
- Department of Medical Oncology, National Cancer Center Hospital East
| | | | - Tsuyoshi Saito
- Department of Breast Surgery, Japanese Red Cross Saitama Hospital
| | - Tsutomu Iwasa
- Department of Medical Oncology, Kindai University Faculty of Medicine
| | - Tsutomu Takashima
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine
| | | | - Hirofumi Mukai
- Department of Medical Oncology, National Cancer Center Hospital East
| | - Fumikata Hara
- Breast Oncology Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research
| | - Tadahiko Shien
- Department of Breast and Endocrine surgery, Okayama University Hospital
| | - Hiroyoshi Doihara
- Department of Breast surgery, Kawasaki Medical School General Medical Center
| | - Shinichi Toyooka
- Department of Thoracic, Breast, and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
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Martínez-Martel I, Bai X, Batallé G, Pol O. New Treatment for the Cognitive and Emotional Deficits Linked with Paclitaxel-Induced Peripheral Neuropathy in Mice. Antioxidants (Basel) 2022; 11:antiox11122387. [PMID: 36552595 PMCID: PMC9774817 DOI: 10.3390/antiox11122387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/04/2022] Open
Abstract
Chemotherapy-provoked peripheral neuropathy and its linked comorbidities severely reduce the quality of a patient's life. Its therapy is not completely resolved and has become an important clinical challenge. The protective actions of molecular hydrogen (H2) in many neurological disorders have been described, but its effects on memory and the emotional deficits accompanying neuropathic pain induced by chemotherapy remain unknown. In this study, using male mice injected with paclitaxel (PTX), we examined the effects of systemic treatment with hydrogen-rich water (HRW) in: (i) the mechanical and thermal allodynia provoked by PTX and the pathways involved; (ii) the memory deficits, anxiety- and depressive-like behaviors associated with PTX-induced peripheral neuropathy (PIPN); and (iii) the plasticity (p-extracellular signal-regulated protein kinase; p-ERK ½), nociceptive (p-protein kinase B, p-Akt), inflammatory (p-nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor, alpha; p-IKBα), and oxidative (4-hydroxynonenal: 4-HNE) alterations provoked by PIPN in the prefrontal cortex (PFC). The results revealed: (1) the antiallodynic actions of HRW administered at one or two times per day during 7 and 3 consecutive days; (2) the participation of Kv7 potassium channels and the Nrf2-heme oxygenase 1-NAD(P)H: quinone oxidoreductase 1 pathway in the painkiller effects of HRW; (3) the inhibition of memory deficits and the anxiodepressive-like behaviors related with PIPN induced by HRW; and (4) the normalization of p-ERK ½, p-Akt and 4-HNE up-regulation and the activation of antioxidant enzymes produced by this treatment in PFC. This study proposes HRW as a possible effective and safe therapy for PIPN and its associated cognitive and emotional deficits.
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Affiliation(s)
- Ignacio Martínez-Martel
- Grup de Neurofarmacologia Molecular, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
- Grup de Neurofarmacologia Molecular, Institut de Neurociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Xue Bai
- Grup de Neurofarmacologia Molecular, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
- Grup de Neurofarmacologia Molecular, Institut de Neurociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Gerard Batallé
- Grup de Neurofarmacologia Molecular, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
- Grup de Neurofarmacologia Molecular, Institut de Neurociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Olga Pol
- Grup de Neurofarmacologia Molecular, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
- Grup de Neurofarmacologia Molecular, Institut de Neurociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Correspondence: ; Tel.: +34-619-757-054
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Tanay MAL, Armes J, Oakley C, Bryson L, Johnston R, Moss‐Morris R, Rafferty AM, Roca J, Sage L, Tanner D, Urwin L, Wyatt T, Robert G. Co-designing a behavioural intervention for reducing the impact of chemotherapy-induced peripheral neuropathy symptoms: An evidence- and theory-driven approach. Eur J Cancer Care (Engl) 2022; 31:e13671. [PMID: 35959639 PMCID: PMC9786800 DOI: 10.1111/ecc.13671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/22/2022] [Accepted: 07/28/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study aims to co-design an evidence- and theory-based behavioural intervention to reduce the impact of chemotherapy-induced peripheral neuropathy (CIPN) symptoms on patients' quality of life. METHODS Guided by the Medical Research Council Framework for developing and evaluating complex interventions, our intervention development process was guided by (a) findings of systematic reviews, (b) inductive analysis of 39 h of observational fieldwork, 12 patient and 11 clinician interviews, (c) deductive analysis using the Common-Sense Model to develop a Self-Regulation Model of CIPN and (d) 17 patients and 18 clinicians co-designing the intervention. RESULTS CIPN perception and coping behaviours were highlighted as processes to target when co-designing an intervention. The processes targeted in our intervention are CIPN perception and coping behaviours, namely, (a) self-monitoring of symptoms, (b) communicating and early reporting of symptoms to clinicians, (c) participating in making chemotherapy dose reduction decisions with their clinicians and (d) engaging in self-management and safety strategies to reduce impact of CIPN symptoms. To address these, a behavioural intervention was deemed suitable. CONCLUSION We developed a self-regulation model of CIPN and a logic model for documenting the proposed mechanism of action of our co-designed behavioural intervention for reducing impact of CIPN symptoms.
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Affiliation(s)
- Mary Anne Lagmay Tanay
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
| | - Jo Armes
- School of Health Sciences, Faculty of Health and Medical SciencesUniversity of SurreyGuildfordUK
| | | | | | | | - Rona Moss‐Morris
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
| | - Jose Roca
- Guy's CancerGuy's and St. Thomas' NHS Foundation TrustLondonUK
| | | | | | - Lauren Urwin
- Oncology and Haematology Rehabilitation UnitGuy's and St. Thomas' NHS Foundation TrustLondonUK
| | - Toni Wyatt
- Oncology and Haematology Rehabilitation UnitGuy's and St. Thomas' NHS Foundation TrustLondonUK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
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Wechsler S, Kneiss J, Adams B, Wood Magee LJ. Persistent cancer-related fatigue after breast cancer treatment predicts postural sway and post-exertional changes in sit-to-stand strategy. Rehabil Oncol 2022; 40:162-171. [PMID: 36212795 PMCID: PMC9534381 DOI: 10.1097/01.reo.0000000000000308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Background Chemotherapy-induced peripheral neuropathy (CIPN) is considered a primary mechanism of imbalance among women diagnosed with breast cancer. Recent evidence, however, suggests that cancer-related fatigue (CRF) may also influence balance. Purpose Examine the contributions of CRF and CIPN to static and dynamic balance before and after a period of fatiguing exercise. Methods This is a secondary analysis of data examining functional differences between women with breast cancer with and without persistent CRF. Postural sway was measured during static standing and the rising phase of an instrumented sit-to-stand (ISTS) before and after exercise. Regression analyses were performed to determine how CRF and severity of CIPN predicted sway and how much variance was attributable to each. Results Greater CRF predicted increased pre-, p=.04, and post-exertional, p=.02, static sway in the anterior-posterior plane. CRF accounted for 10.5% and 9.5% of the variance in pre- and post-exertional sway (respectively) compared to the 0.9% and 1.4% accounted for by CIPN severity which was not a significant predictor. After exercise, greater CRF predicted smaller, more conservative, anterior weight shifting during the ISTS, p=.01, and accounted for 6.6% of the variance in sway compared to 3% attributed to CIPN which was not a significant predictor. Limitations This analysis is limited by its small and demographically homogenous sample. Conclusions These results suggest that CRF may influence balance independent of CIPN symptoms. While CIPN remains a risk factor for imbalance in this population, CRF warrants consideration in clinical practice and research as a mechanism of postural instability.
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Affiliation(s)
- Stephen Wechsler
- MGH Institute of Health Professions, 36 1 Avenue, Charlestown, MA 02129
| | | | - Benjamin Adams
- MGH Institute of Health Professions, 36 1 Avenue, Charlestown, MA 02129
| | - Lisa J Wood Magee
- William F. Connell School of Nursing, Boston College, Chestnut Hill MA 02647
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Ben-Arye E, Hausner D, Samuels N, Gamus D, Lavie O, Tadmor T, Gressel O, Agbarya A, Attias S, David A, Schiff E. Impact of acupuncture and integrative therapies on chemotherapy-induced peripheral neuropathy: A multicentered, randomized controlled trial. Cancer 2022; 128:3641-3652. [PMID: 35960141 DOI: 10.1002/cncr.34422] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND To explore the impact of acupuncture with other complementary and integrative medicine (CIM) modalities on chemotherapy-induced peripheral neuropathy (CIPN) and quality of life (QoL) in oncology patients. METHODS In this prospective, pragmatic, and patient-preference study, patients with CIPN were treated with acupuncture and CIM therapies (intervention group) or standard care alone (controls) for 6 weeks. Patients in the intervention arm were randomized to twice-weekly acupuncture-only (group A) or acupuncture with additional manual-movement or mind-body CIM therapies (group B). Severity of CIPN was assessed at baseline and at 6 weeks using the Functional Assessment of Cancer Therapy-Taxane (FACT-Tax) tool. Other QoL-related outcomes were assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC); and the Measure Yourself Concerns and Well-being questionnaire. Von Frey measurements examined perception thresholds. RESULTS Of 168 participants, 136 underwent the study intervention (group A, 69; group B, 67), with 32 controls. Baseline-to-6-week assessment scores improved significantly in the intervention arm (vs controls) on FACT-Tax (p = .038) and emotional well-being (p = .04) scores; FACT-TAX scores for hand numbness/tingling (p = .007) and discomfort (p < .0001); and EORTC physical functioning (p = .045). Intervention groups A and B showed improved FACT-Tax physical well-being (p < .001), FACT-TAX total score (p < .001), FACT-TAX feet discomfort (p = .003), and EORTC pain (p = .017) scores. CONCLUSIONS Acupuncture, with or without CIM modalities, can relieve CIPN-related symptoms during oncology treatment. This is most pronounced for hand numbness, tingling, pain, discomfort, and for physical functioning.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - David Hausner
- Tal Center for Integrative Medicine, Institute of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel.,Palliative Care Service, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Shaarei Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dorit Gamus
- Tal Center for Integrative Medicine, Institute of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel.,Complementary and Integrative Medicine Service, Sheba Medical Center, Ramat-Gan, Israel
| | - Ofer Lavie
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
| | - Tamar Tadmor
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Unit of Hematology, Bnai Zion Medical Center, Haifa, Israel
| | - Orit Gressel
- Integrative Oncology Program, The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Abed Agbarya
- Integrative Oncology Program, The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel.,Institute of Oncology, Bnai Zion Medical Center, Haifa, Israel
| | - Samuel Attias
- Department of Internal Medicine & Integrative Medicine Service, Bnai-Zion, Medical Center, Haifa, Israel
| | - Adi David
- Palliative Care Service, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Elad Schiff
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Internal Medicine & Integrative Medicine Service, Bnai-Zion, Medical Center, Haifa, Israel
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Chen SC, Jane SW, Lin YC, Huang HP. [The Effect of Exercise Interventions on Alleviating Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review]. Hu Li Za Zhi 2022; 69:99-110. [PMID: 35893341 DOI: 10.6224/jn.202208_69(4).12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND 85%-95% of patients with cancer experience chemotherapy-induced peripheral neuropathy (CIPN), which may lead to neuropathic pain, emotional distress, functional difficulties, and interpersonal problems. Although exercise interventions have been proposed for improving and preventing CIPN, evidence regarding the efficacy of these interventions has been inconsistent and of inadequate quality. In addition, few domestic systematic reviews have examined the effects of exercise on CIPN. PURPOSE To examine the effects of exercise interventions in cancer patients with CIPN using a systematic review (SR) method. METHODS An SR method was used in this paper by applying the concept of PICO using keywords P "cancer", I "rehabilitation", "exercise", C "usual care, standard of care", and O "chemotherapy-Induced peripheral neuropathy" in a search of the Ovid Medline, PubMed, Cochrane Library, EMBASE and Airiti Library databases for articles published from 2002 to 2021. Based on the inclusion and exclusion criteria, a total of 13 research articles were identified for review in this study. RESULTS The 13 randomized controlled trials reviewed in this SR included 909 cancer patients during or after chemotherapy who were receiving exercise interventions. The results indicate that single or combined exercise protocols have consistent benefits in terms of improving CIPN symptoms. However, because of the relatively small sample sizes (n = 19-355) and the multiple types (n = 9), frequencies (1-7 day/week), and durations (5-60 minutes/time) of exercise protocols used in these studies, future research is necessary to explore differences in the types and subgroup effects of exercise. CONCLUSIONS The results from this systematic review indicate that the combined exercise model has consistent benefits in terms of helping prevent and alleviate the symptoms of CIPN. In clinical practice, healthcare providers may consider encouraging cancer patients to initiate mild physical activity when their physical conditions are stable and without evident side effects from chemotherapy to minimize the impacts of CIPN on daily functioning and quality of life.
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Affiliation(s)
- Shu-Chen Chen
- MSN, RN, Supervisor, Department of Nursing, Chang Gung Memorial Hospital, Chia-Yi, Taiwan, ROC
| | - Sui-Whi Jane
- PhD, RN, FAAN, Professor, Chang Gung University of Science and Technology, and Research Fellow, Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linko, Taiwan, ROC
| | - Yung-Chang Lin
- MD, Associate Professor, Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linko, Taiwan, ROC
| | - Hsiang-Ping Huang
- PhD, RN, Associate Professor, Department of Nursing, Chang Gung University of Science and Technology, Taiwan, ROC.
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Cho KH, Han EY, Shin JC, Ha MC, Ahn KH, Cho SH, Im SH. Comparison of Clinical Symptoms and Neurophysiological Findings in Patients With Chemotherapy Induced Peripheral Neuropathy. Front Neurol 2022; 13:838302. [PMID: 35720059 PMCID: PMC9198442 DOI: 10.3389/fneur.2022.838302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/13/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Taxanes are associated with a distal sensory neuropathy, significantly affecting cancer survivor quality of life. However, chemotherapy-induced peripheral neuropathy (CIPN) assessments are primarily based on clinical symptoms rather than objective neurophysiologic findings. Therefore, we investigated neurophysiologic changes in symptomatic subjects, comparing them with symptom severity. Materials and Methods Medical charts of 111 subjects who were referred for CIPN diagnosis after chemotherapy for breast or ovarian cancer between May 1, 2016, and December 31, 2019, were retrospectively reviewed. Demographics, anthropometric parameters, and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale data were collected. The nerve conduction study (NCS) results, including sensory nerve action potentials recorded from sural nerves, were analyzed relative to clinical symptoms. To optimize follow-up (FU) NCS diagnostic sensitivity, relative references of FU sural amplitude reductions to >30% and an absolute reference <10 μV were used. Results Eighty-eight female patients met the criteria, and 20 underwent FU NCS. Baseline and FU sural amplitudes showed significant positive correlation with respective LANSS scores (p < 0.01). FU sural amplitude was significantly lower than the initial result (p < 0.05). The FU LANSS score was not different from the initial score. Initial NCS sensitivity and specificity for clinically suspected CIPN diagnoses with LANSS were 69.7 and 47.3%, respectively. All 20 subjects with FU evaluation were clinically compatible with CIPN (LANSS >12) at initial and FU assessments. Among them, only six (30.0%) had abnormal sural amplitudes (<10μV for ≤50 s, <3 μV for 60 s, <1 μV for 70 s) in the initial NCS. In the FU NCS, sural amplitude became abnormal in five additional subjects. Between the initial and FU NCS, sural amplitude was reduced by > 30% in eight subjects (40.0%). NCS sensitivity increased to 65.0% when including either abnormal sural amplitudes or a > 30% reduction in sural amplitude in FU studies. Conclusions Although clinical symptoms and NCS results were positively correlated, a single NCS point had limited value for suspected CIPN electrophysiological diagnoses. Serial NCS during chemotherapy might help assess the degree of chemotherapy-induced nerve damage, attain evidence of CIPN prior to symptom aggravation, and monitor the progression of CIPN. Further study is needed to find specific relative references for variable patient factors to increase the sensitivity of electrophysiological studies of clinically suspected CIPN.
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Affiliation(s)
- Kye Hee Cho
- Department of Rehabilitation Medicine, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang, South Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju, South Korea
| | - Ji Cheol Shin
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Cheol Ha
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kwang Ho Ahn
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Su Hyun Cho
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Hee Im
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Pei LX, Yi Y, Guo J, Chen L, Zhou JY, Wu XL, Sun JH, Chen H. The effectiveness and safety of acupuncture/electroacupuncture for chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis. Acupunct Med 2022; 41:73-85. [PMID: 35695033 DOI: 10.1177/09645284221076512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting adverse effect of anticancer agents with virtually no effective treatment. Safe and effective therapies are needed urgently. Acupuncture shows therapeutic possibilities in this regard but needs to be further evaluated. METHODS A systematic search was conducted in seven databases from their inception to April 2020. Randomized controlled trials (RCTs) focused on acupuncture/electroacupuncture (EA) for the treatment of CIPN were included. Revman 5.3 software was used for meta-analysis if there was no significant heterogeneity. Otherwise, qualitative analysis was utilized. RESULTS Nine studies involving 582 patients were included in this review. Most of the studies exhibited unclear risk of bias because some details were not mentioned. As the clinical heterogeneity was significant, qualitative analysis was performed to describe nerve conduction velocity, effective rate for motor neuropathy, pain scores, quality of life and adverse events. Meta-analysis was performed on four studies to analyze the effective rate for sensory neuropathy due to inconspicuous heterogeneity. The results indicated that acupuncture may generate a better effect on sensory neuropathy than vitamin B (risk ratio = 1.60, 95% confidence interval = 1.31-1.95, I2 = 0%, p < 0.00001). The efficacy of EA plus glutathione (GSH) appeared to be better than that of GSH alone in alleviating sensory neurotoxicity and in improving nerve conduction velocity. Acupuncture plus methylcobalamin showed more favorable effects than methylcobalamin alone in relieving neuralgia, restoring nerve conduction velocity and improving quality of life. In terms of pain relief and improved CIPN-specific quality of life, acupuncture plus standard care was better than standard care alone. In terms of pain relief, EA was more effective than usual care. CONCLUSION Acupuncture may be effective and safe in the treatment of CIPN according to the analyzed studies. However, more studies with higher methodological quality are warranted in order to be able to draw firmer conclusions. Future rigorous RCTs will be necessary to confirm the effectiveness and safety of acupuncture for CIPN.
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Affiliation(s)
- Li-Xia Pei
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Yue Yi
- Wuxi Hospital of Traditional Chinese Medicine, Wuxi, China
| | - Jing Guo
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China.,Nanjing University of Chinese Medicine, Nanjing, China
| | - Lu Chen
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Jin-Yong Zhou
- Central Laboratory, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiao-Liang Wu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Jian-Hua Sun
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Hao Chen
- Nanjing University of Chinese Medicine, Nanjing, China
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Crichton M, Yates PM, Agbejule OA, Spooner A, Chan RJ, Hart NH. Non-Pharmacological Self-Management Strategies for Chemotherapy-Induced Peripheral Neuropathy in People with Advanced Cancer: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:2403. [PMID: 35745132 DOI: 10.3390/nu14122403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/12/2022] [Accepted: 06/07/2022] [Indexed: 02/01/2023] Open
Abstract
Non-pharmacological self-management interventions for chemotherapy-induced peripheral neurotherapy (CIPN) are of clinical interest; however, no systematic review has synthesized the evidence for their use in people with advanced cancer. Five databases were searched from inception to February 2022 for randomized controlled trials assessing the effect of non-pharmacological self-management interventions in people with advanced cancer on the incidence and severity of CIPN symptoms and related outcomes compared to any control condition. Data were pooled with meta-analysis. Quality of evidence was appraised using the Revised Cochrane Risk of Bias Tool for Randomized Trials (RoB2), with data synthesized narratively. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was applied to assess the certainty of the evidence. Thirteen studies were included, which had a high (69%) or unclear (31%) risk of bias. Greatest confidence was found for physical exercise decreasing CIPN severity (SMD: −0.89, 95% CI: −1.37 to −0.41; p = 0.0003; I2 = 0%; n = 2 studies, n = 76 participants; GRADE level: moderate) and increasing physical function (SMD: 0.51, 95% CI: 0.02 to 1.00; p = 0.04; I2 = 42%; n = 3 studies, n = 120; GRADE level: moderate). One study per intervention provided preliminary evidence for the positive effects of glutamine supplementation, an Omega-3 PUFA-enriched drink, and education for symptom self-management via a mobile phone game on CIPN symptoms and related outcomes (GRADE: very low). No serious adverse events were reported. The strongest evidence with the most certainty was found for physical exercise as a safe and viable adjuvant to chemotherapy treatment for the prevention and management of CIPN and related physical function in people with advanced cancer. However, the confidence in the evidence to inform conclusions was mostly very low to moderate. Future well-powered and appropriately designed interventions for clinical trials using validated outcome measures and clearly defined populations and strategies are warranted.
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