COMPARATIVE STUDY OF PERIPHERAL NEUROPATHY AMONG COLORECTAL CANCER PATIENTS RECEIVING FOLFOX-4 AND XELOX

Sumana Das*, Mohammad Habibur Rahaman, Muhammad Rafiqul Islam, Nazrina Khatun, Radia Afnin, Md. Rashedul Islam and Salman Bashar Al Ayub

ABSTRACT

Background: Oxaliplatin, in combination with 5-fluorouracil (FOLFOX) or capecitabine (XELOX), is standard in colorectal cancer treatment but is associated with peripheral neuropathy (OXA-IPN). This study compares the incidence and pattern of OXA-IPN between patients receiving FOLFOX-4 and XELOX. Aim and objective: To evaluate and compare the incidence and pattern of oxaliplatin-induced peripheral neuropathy in patients with colorectal cancer receiving FOLFOX-4 and XELOX. Methods: Sixty patients were selected via purposive sampling; 30 received FOLFOX-4 biweekly, and 30 received XELOX triweekly. OXA-IPN symptoms were assessed using the National Cancer Institute Neurosensory grading, NCI-CTCv5, Total Neuropathy Score (TNSc), and electrophysiological tests. Statistical analysis employed Chi-square and 'T' tests with significance set at p < 0.05. Method: Sixty patients were selected via purposive sampling; 30 received FOLFOX-4 biweekly, and 30 received XELOX triweekly. OXA-IPN symptoms were assessed using the National Cancer Institute Neurosensory grading, NCI-CTCv5, Total Neuropathy Score (TNSc), and electrophysiological tests. Statistical analysis employed Chi-square and 'T' tests with significance set at p < 0.05. Result: The incidence of acute OXA-IPN in group A receiving FOLFOX-4 is 86.7% & in group B receiving XELOX is 80.0%. Incidence of chronic OXA-IPN in group A & B is 80.0% & 56.7%, respectively. There was no significant difference in the incidence and severity of acute OXA-IPN, but the incidence of chronic OXA-IPN in patients receiving FOLFOX-4 was significantly higher (p-value -0.009). When the severity of chronic OXA-IPN is graded via NCI-CTC v5 and according to TNSc, the p-value is determined as 0.001 & 0.001, respectively, which is significant. Between-group comparisons of SAP changes of all three sensory nerves tested on two different follow-ups revealed significant differences. However, CMAP & MCV recorded on the peroneal nerve were insignificant. Conclusion: The incidence and severity of chronic oxaliplatin-induced peripheral neuropathy were significantly higher (p-value-0.009) in patients treated with FOLFOX-4 than with XELOX.

Keywords: Oxaliplatin, peripheral neuropathy, FOLFOX-4, XELOX, colorectal cancer.