Open Access Highly Accessed Research article

Residual neurotoxicity in ovarian cancer patients in clinical remission after first-line chemotherapy with carboplatin and paclitaxel: The Multicenter Italian Trial in Ovarian cancer (MITO-4) retrospective study

Sandro Pignata1*, Sabino De Placido2, Rosalbino Biamonte3, Giovanni Scambia4, Giovanni Di Vagno5, Giuseppe Colucci6, Antonio Febbraro7, Marco Marinaccio8, Alessandra Vernaglia Lombardi9, Luigi Manzione10, Giacomo Cartenì11, Mario Nardi12, Saverio Danese13, Maria Rosaria Valerio14, Andrea de Matteis15, Bruno Massidda16, Giampietro Gasparini17, Massimo Di Maio18, Carmela Pisano1 and Francesco Perrone18

Author Affiliations

1 Medical Oncology B, National Cancer Institute, Naples, Italy

2 Department of Molecular and Clinical Endocrinology and Oncology, University Federico II, Naples, Italy

3 Medical Oncology, Mariano Santo Hospital, Cosenza, Italy

4 Gynecologic Oncology Unit, Catholic University of Rome, Rome, Italy

5 Obstetrics II, Department of Obstetrics and Gynecology, University of Bari, Bari, Italy

6 Medical and Experimental Oncology Unit, Oncology Institute, Bari, Italy

7 Medical Oncology, Fatebenefratelli Hospital, Benevento, Italy

8 Obstetrics I, Department of Obstetrics and Gynecology, University of Bari, Bari, Italy

9 Malzoni Clinic, Avellino, Italy

10 Medical Oncology, San Carlo Hospital, Potenza, Italy

11 Medical Oncology, Cardarelli Hospital, Naples, Italy

12 Division of Medical Oncology, Ospedali Riuniti, Reggio Calabria, Italy

13 Ginecology, S Anna Hospital, Turin, Italy

14 Medical Oncology, University of Palermo, Palermo, Italy

15 Medical Oncology C, National Cancer Institute, Naples, Italy

16 Medical Oncology, University of Cagliari, Cagliari, Italy

17 Division of Medical Oncology, San Filippo Neri Hospital, Rome, Italy

18 Clinical Trials Unit, National Cancer Institute, Naples, Italy

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BMC Cancer 2006, 6:5  doi:10.1186/1471-2407-6-5

Published: 7 January 2006

Abstract

Background

Carboplatin/paclitaxel is the chemotherapy of choice for advanced ovarian cancer, both in first line and in platinum-sensitive recurrence. Although a significant proportion of patients have some neurotoxicity during treatment, the long-term outcome of chemotherapy-induced neuropathy has been scantly studied. We retrospectively assessed the prevalence of residual neuropathy in a cohort of patients in clinical remission after first-line carboplatin/paclitaxel for advanced ovarian cancer.

Methods

120 patients have been included in this study (101 participating in a multicentre phase III trial evaluating the efficacy of consolidation treatment with topotecan, and 19 treated at the National Cancer Institute of Naples after the end of the trial). All patients received carboplatin (AUC 5) plus paclitaxel (175 mg/m2) every 3 weeks for 6 cycles, completing treatment between 1998 and 2003. Data were collected between May and September 2004. Residual sensory and motor neurotoxicity were coded according to the National Cancer Institute – Common Toxicity Criteria.

Results

55 patients (46%) did not experience any grade of neurological toxicity during chemotherapy and of these none had signs of neuropathy during follow-up. The other 65 patients (54%) had chemotherapy-induced neurotoxicity during treatment and follow-up data are available for 60 of them. Fourteen out of 60 patients (23%) referred residual neuropathy at the most recent follow-up visit, after a median follow up of 18 months (range, 7–58 months): 12 patients had grade 1 and 2 patients grade 2 peripheral sensory neuropathy; 3 patients also had grade 1 motor neuropathy. The remaining 46/60 patients (77%) had no residual neuropathy at the moment of interview: recovery from neurotoxicity had occurred in the first 2 months after the end of chemotherapy in 22 (37%), between 2 and 6 months in 15 (25%), or after more than 6 months in 9 patients (15%). Considering all 120 treated patients, there was a 15% probability of persistent neurological toxicity 6 months after the end of chemotherapy.

Conclusion

A significant proportion of patients with advanced ovarian cancer treated with first-line carboplatin/paclitaxel suffer long-term residual neuropathy. This issue should be carefully taken into account before considering re-treatment with the same agents in sensitive recurrent disease.