Incidence, Severity, and Clinical Correlations of Oxaliplatin- Induced Neuropathy in Patients with Colorectal Cancer: A Single-Institution Experience from Northeast India

Abstract

Background and objective: Colorectal cancer is the third most commonly diagnosed cancer worldwide, with increasing incidence in developing countries. Chemotherapy plays a crucial role in the treatment of locally advanced and metastatic colorectal cancer. Oxaliplatin remains a mainstay in the treatment of colorectal carcinoma, but its primary dose-limiting toxicity is neuropathy, which can impact treatment adherence and impair daily living activities. With limited data on the occurrence of oxaliplatin-induced peripheral neuropathy (OIPN) in the Indian population, this study aimed to determine the incidence and severity of oxaliplatin-induced neurotoxicity and its clinical correlations with various parameters in patients with colorectal carcinoma at a cancer care center in Northeast India.

Material and Methods: This prospective observational analysis was conducted on all histologically confirmed cases of colorectal adenocarcinoma who received oxaliplatin-based chemotherapy in an adjuvant or first-line palliative setting at Dr. B. Borooah Cancer Institute between April 2019 and March 2020.

Results: The study evaluated 76 patients with colorectal carcinoma, with a mean age of 54.07 ± 10 years. The majority (65.8%) of patients had adenocarcinoma of the colon, and 34.2% had rectal adenocarcinoma. Twenty-three (30.3%) patients presented with metastatic disease. Oxaliplatin-based chemotherapy regimens included CAPOX (72.4%) and FOLFOX (27.6%). Acute OIPN was observed in 59 patients (77.6%), with the most common symptom being cold-induced perioral paresthesia. The most frequent grade for acute OIPN was grade II (30.3%). Chronic OIPN was observed in 47 (61.8%) patients, with most developing grade II neuropathy, primarily after the fourth cycle of chemotherapy. The incidence of OIPN was higher in patients aged ≥60 years, those receiving a cumulative oxaliplatin dose > 1000 mg/m², and those with baseline low serum magnesium or calcium levels.

Conclusion: Oxaliplatin is a crucial chemotherapy drug used in colorectal cancer, but its significant dose-limiting toxicity is peripheral neuropathy. Early identification of neuropathic symptoms can improve treatment adherence and enhance patients' quality of life.