Chemotherapy-induced neurotoxicity in the treatment of gynecological cancers: State of art and an innovative approach for prevention

Abstract

Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect that occurs in 20% of ovarian cancer patients treated with the combination of carboplatin/paclitaxel (CP). This toxicity is directly correlated with the dose of paclitaxel administered. Several studies have investigated whether different formulations of taxane can induce this side effect at a lower rate, but, unfortunately, no significant improvement was obtained. CIPN can be disabling in the daily lives of patients and can cause dose reduction or early termination of the treatment. Neuropathy can last for months and even years after its onset. Moreover, patients responsive to CP treatment are candidates for a reintroduction of the same drugs when disease relapse occurs, and residual neuropathy can affect the continuation of treatment. There are no approved drugs that mitigate or prevent the onset of CIPN. In this review, we summarize the evidence regarding the incidence of CIPN with different taxane formulations, regimen schedules and prevention systems. In particular, the Hilotherm^® Chemo care device is a regional cooling system that lowers the temperature of the hands and feet to reduce the flow of chemotherapy into the capillaries. We used hilotherapy during chemotherapy infusion to prevent the onset of CIPN. Updated data from 44 ovarian cancer patients treated with 6 cycle of CP show that hilotherapy was well tolerated; only two patients (4.5%) stopped hilotherapy because of cold intolerance, and only one patient (2.2%) experienced grade ≥ 2 CIPN.

Keywords: Peripheral neuropathy, Ovarian cancer, Paclitaxel, Chemotherapy-induced peripheral neuropathy prevention, Hilotherapy

Core Tip: The association of carboplatin and paclitaxel is the standard chemotherapy regimen for ovarian cancer women. One of the most common and disabling side effect of this treatment is the peripheral neuropathy caused by paclitaxel, it can occur in 20% of patients and can last months and even years after the end of chemotherapy. In this review we collected the evidence from several studies with different schedules or formulation of paclitaxel and the systems of prevention and propose a mechanical way of prevention adopted in our center through the use of the cooling system of the hilotherm device.