What chemotherapy drugs commonly used to treat ovarian cancer have
the potential to cause peripheral neuropathy???
The drug literature (from inserts and the PDR 2000) is silent on the subject of prevention or relief of symptoms. Remember, these are generalities, and what happens in your body may vary from a general group. These are risks and not certainties. Each of us must decide what is right for each of us, and how much quality of life we are willing to risk in trade for potentially increasing the length of life.
In all of the descriptions below, what was meant by terms such as "mild" or "severe" was not described. Grade I is mild, while Grade IV is severe.
Bristol-Myers Squibb on Taxol (Paclitaxel): The occurrence of peripheral neuropathy is frequent. Severe neuropathy is unusual and requires a dose reduction of 20% for all subsequent courses. Neuropathy may worsen at doses greater than 200 mg/m2. It is more likely if given over 3 hours than if given over 24 hours, or if given with Cisplatin (Platinol). In 402 women on Taxol, 62% had mild neuropathy, while 4% had severe symptoms. As dose increased, the symptoms also tended to increase.
Bristol-Myers Squibb on Cisplatin (Platinol): Neuropathy usually occurs after prolonged therapy (after 4-7 months), but has been reported after a single dose. Therapy should be stopped when the symptoms are first observed. It may be more severe in those who are getting higher doses or more frequent doses than recommended. The results may be irreversible.
Bristol-Myers Squibb on Carboplatin (Paraplatin): Only a few, 4%, may experience peripheral neuropathy, or in 6% if previously treated with Carboplatin. Neuropathy is mild in 16% in comparison to 42% of those on Cisplatin therapy. When treated with Carboplatin, those over 65 years of age and/or those "previously treated with Cisplatin appear to have an increased risk" and "prolonged treatment, particularly in Cisplatin pre-treated patients, may result in cumulative" neuropathy. In 70% of those with Cisplatin-caused pre-existing neuropathy, there was no worsening.
SmithKline Beecham on Topotecan (Hycamtin): "Paresthesia occurred in 9% of patients, but was generally Grade 1." Paresthesia means numbness, prickling, or a tingling, heightened sensitivity.
U.S. Bioscience on Hexalen (Hexamethylmelamine): Peripheral neuropathy is more likely to occur in those taking continuous high doses of Hexalen than in those taking lower doses or on an intermittent schedule. It may worsen Cisplatin related neuropathy. Neurologic toxicity has been reported to be reversible when Hexalen is stopped. Randomized trials of Hexalen and Cisplatin, plus or minus Pyridoxine, significantly reduced neurotoxicity; but use of B6 adversely affected response duration, suggesting that Pyridoxine should not be given with Hexalen and/or Cisplatin (Cancer Investigator, 10(1): 1-9, 1992).
Rhone-Poulenc Rorer on Taxotere (Docetaxel): Severe neurosensory symptoms (paresthesia, dysesthesia, pain) were observed among 7%. When these occur, dosage must be adjusted. If symptoms persist, treatment should be discontinued. Spontaneous reversal of symptoms within a median of 9 weeks from onset (range of 0 to 106 weeks).
GlaxoWellcome on Navelbine (Vinorelbine): Mild to moderate neuropathy occurred in 1-2%. The development of severe peripheral neuropathy was infrequent and generally reversible.
Bristol-Myers Squibb on Cytoxan (Cyclophosphamide): No side effect of neuropathy was reported.
EliLilly on Gemzar (Gemcitabine): Mild neuropathy occurred in 10%, but the rate of mild neuropathy increased to 23% when Gemzar was combined with Cisplatin.
Alza on Doxil (Liposomal Doxirubicin): Less than 1% experienced neuropathy.
Sanofi-Synthelabo on Eloxatin (oxaliplatin): Associated with 2 types of neuropathy. One is an acute reversible form occuring in more than 50% within 1-2 days of the treatment, goes away within 14 days and frequently recurs with further doses. This type worsened with exposure to cold temperatures and objects. The second type is persistent, occurs in 48%, was more severe in peripheral neuropathy already existed from other drugs, and may improve after the drug is stopped.
Celgene on Thalomid(thalidomide): "Peripheral neuropathy is a common, potentially severe, side effect...that may be irreversible." "Medications known to be associated with peripheral neuropathy should be used with caution in patients receiving thalomid."
Bristol-Myers Squibb on VePerid (VP-16 or etoposide): 1-2 % peripheral neurotoxicity.
Other cancer-treatment agents which have the potential to cause neuropathy are the interferons.