Incidence of uncommon acute hyperexcitability symptoms in oxaliplatin-treated patients with colorectal cancer.

Objectives: Peripheral, acute or chronic, neurotoxicity is one of the main dose limiting adverse effects of oxaliplatin (OXA). Acute neurotoxicty is typically characterized by distal and perioral cold-induced paresthesias and dysesthesias, but other uncommon symptoms might also be present. Our aim was to prospectively assess the incidence of uncommon acute OXA neurotoxicity symptoms in patients undergoing OXA-based chemotherapy. Patients and methods: One hundred chemotherapy-naïve patients (62 males, 38 females, aged 64.7±8.7 years) with colorectal cancer scheduled to receive OXA-based therapy (FOLFOX-4, FOLFOX-6, XELOX) underwent neurological evaluation after the 1st infusion and then after 3 and 6 months of OXA-based chemotherapy (after 6th or 4th and 12th or 8th cycles respectively, according to regimen). At evaluation patients were asked to report the presence and characteristics of acute hyperexcitability symptoms. Results: Eighty two patients presented typical symptoms of acute OXA neurotoxicity in the form of cold-induced paresthesias and dysesthesias. In 45/82 (54.9%) of patients, uncommon symptoms were also present; shortness of breath (32%), jaw spasm (26%), fasciculations (25%), cramps (20%) and difficulty in swallowing (18%) were more frequently reported, while voice (4%) and visual changes, ptosis and pseudolaryngospasm (1%) occurred rarely. No significant correlation was disclosed between acute OXA neurotoxicity and chemotherapy regimen, cumulative dose of OXA or patients’ age. Conclusion: A high percentage of patients treated with OXA-based chemotherapy develop acute neurotoxicity also with uncommon manifestations. Since OXA acute neurotoxicity might be related to the onset of chronic neurotoxicity, these patients should be closely monitored to avoid this dose-limiting adverse effect.