Prospective Study of the Clinical, Electrophysiologic, and Sonographic Characteristics of Oxaliplatin‐Induced Neuropathy

BACKGROUND AND PURPOSE: Oxaliplatin-induced neuropathy is a major dose limiting side effect of the highly effective combination chemotherapy with oxaliplatin, irinotecan, and 5-fluorouracil (FOLFIRINOX) in patients with metastastic pancreatic cancer. We present the first longitudinal sonographical-electrophysiological study on oxaliplatin-induced neuropathy. METHODS: Thirteen patients with metastatic pancreatic cancer underwent clinical, sonographic, and electrophysiological evaluation before, 3 and 7 months after treatment with 12 two-week cycles of FOLFIRINOX. RESULTS: The majority of patients (61%) developed symptoms and electrophysiological signs of a length-dependent sensorimotor axonal neuropathy 7 months after treatment initiation. Oxaliplatin-induced neuropathy presented with a cross-sectional area (CSA) increase of mostly the tibial and fibular nerve, which developed parallel or prior to clinical signs and electrophysiological changes. Furthermore, isolated CSA at entrapment sites of the upper and lower extremities was measured without relevant symptoms. No correlation between sonographic and electrophysiological findings or clinical severity was detected. CONCLUSIONS: Oxaliplatin-induced neuropathy is characterized by an axonal length-dependent nerve affection presenting with a combination of sonographical and electrophysiological alterations.