Chemotherapy-induced peripheral neuropathy persists for years in childhood cancer survivors
Chemotherapy-induced peripheral neuropathy commonly occurred in long-term childhood cancer survivors and persisted for years after treatment, according to findings published in JAMA Neurology.
When screening survivors of childhood cancer for neuropathy, clinicians should consider both the type of agent used in treatment and a targeted clinical assessment, according to the researchers.
“Chemotherapy-induced peripheral neuropathy is a potentially long-lasting adverse effect of commonly used chemotherapy agents in pediatric practice, principally vincristine and other vinca alkaloids, cisplatin and carboplatin,” Susanna Park, PhD, senior lecturer at Sydney Medical School in Australia, and colleagues wrote. “To our knowledge, long-term outcomes of peripheral neuropathy from these agents in children remain to be fully delineated.”
The researchers performed a cross-sectional observational study, comparing 121 cancer survivors (53.7% male) who were diagnosed when aged younger than 17 years with healthy age-matched controls. All participants were recruited between April 2015 and December 2016 from a single comprehensive cancer survivorship clinic. Investigators were blinded to the type of chemotherapy used in patients’ treatment.
Patients received neurotoxicity assessments — using the Total Neuropathy Score (TNS), the Movement Assessment Battery for Children (MABC) for functional measures, nerve conduction studies, and the Pediatric Quality of Life Inventory Generic Core Scales — at a median 16 years of age, or a median of 8.5 years after completing treatment.
The most common neurotoxic agents were vinca alkaloids (n = 86; 71.1%) and platinum compounds (n = 20; 16.5%). Thirteen patients were prescribed a combination of platinum agents and vinca alkaloids (10.7%).
Approximately half of patients (50.5%; n = 54 of 107) treated with neurotoxic chemotherapy demonstrated clinical abnormalities that were consistent with peripheral neuropathy (mean TNS increase, 2.1; 95% CI, 1.4-2.9). These abnormalities were associated with lower limb predominant sensor axonal neuropathy (mean amplitude reduction, 5.8 µV; 95% CI, 2.8-8.8).
Researchers observed functional deficits in manual dexterity, distal sensation and balance.
Patient-reported outcomes showing a reduction in global quality of life and physical functioning appeared associated with TNS.
Long-term neurotoxicity occurred more often among patients treated with cisplatin treatment (n = 10 of 12; 85%) than with vinca alkaloids (n = 23 of 80; 29%), carboplatin without cisplatin (n = 2 of 7; 29%) or no neurotoxic agents (n = 2 of 13; 15%), as well as compared with controls (n = 1 of 36; 3%; P = .001).
“Both the type of neurotoxic agent used and a targeted clinical neurological assessment are important considerations when screening childhood cancer survivors for long-term neuropathy,” the researchers wrote. “The effect of chemotherapy-induced peripheral neuropathy may be greater in the presence of other comorbidities, such as diabetes and also as childhood cancer survivors get older.
“Development of standardized, chemotherapy-induced peripheral neuropathy-specific pediatric assessment tools, further research into the acute development and progression of neuropathy and delineation of genetic and nongenetic predisposing factors are essential for the development of neuroprotective interventional and rehabilitative strategies to optimize the long-term quality of life for childhood cancer survivors,” they added. – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.