Treatment algorithm for oxaliplatin-lnduced peripheral neuropathy

Oxaliplatin (L-OHP) is a key drug in the treatment of colorectal cancer; however, L-OHP-induced peripheral neuropathy becomes a dose-limiting factor for which withdrawal is the only effective option. In the present study, we attempted to treat L-OHP-induced peripheral neuropathy using the algorithm consisting of pregabalin, duloxetine, and oxycodone at Iwate Medical University Hospital. The first, second, and third stages of the algorithm consist of pregabalin, duloxetine, and oxycodone, respectively. We examined the usefulness and safety of the treatment algorithm for 27 patients with colorectal cancer by evaluating the side effects and degree of improvement of subjective symptoms. When discontinuation was necessary due to adverse events or invalid treatment during the 4-week study period, the patient was transitioned to the next stage. The response rates of the first, second, and third stages of the algorithm were 33% (9/27), 33% (6/18), and 17% (1/6), respectively, whereas the overall response rate was 59% (16/27). The side effect rates of the first, second, and third stages were 37% (10/27), 33% (6/18), and 83% (5/6), respectively. Somnolence was the most common side effect of these drugs. Thus, our treatment algorithm appears to be useful for L-OHP-induced peripheral neuropathy. However, pregabalin, duloxetine, and oxycodone should be administered with specific attention on the potential side effects.