Nagashima, M., Ooshiro, M., Moriyama, A., Sugishita, Y., Kadoya, K., Sato, A., . . . Katoh, R. (2014). Efficacy and tolerability of controlled-release oxycodone for oxaliplatin-induced peripheral neuropathy and the extension of FOLFOX therapy in advanced colorectal cancer patients. Supportive Care in Cancer, 22, 1579–1584.
To investigate the efficacy and tolerability of oxycodone for oxaliplatin-induced peripheral neuropathy (OIPN) with FOLOFOX therapy in patients with colorectal cancer (CRC)
This was a single-center retrospective study of 64 patients with CRC receiving FOLFOX therapy. Controlled-release (CR) oxycodone was concomitantly administered to 29 patients (OXY group). An additional 35 patients (non-OXY group) were not given oxycodone during FOLFOX therapy. The incidence and severity of OIPN and the number of FOLFOX treatments were measured and compared.
Patients in the OXY and non-OXY groups were evaluated for neurotoxicity. Severity of pain, sensory status, and motor dysfunction were evaluated.
The National Cancer Institute's (NCI's) Common Terminology Criteria for Adverse Events (CTCAE) was used to evaluated neurologic toxicity. A peripheral sensory neuropathy subscale was used to grade clinical severity. Grade 1 could be asymptomatic or could include a loss of deep tendon reflex or paresthesia (including tingling) that did not interfere with function; grade 2 included sensory alterations or paresthesia (including tingling) that interfered with function but not with activities of daily living (ADL); and grade 3 included sensory alterations or paresthesia that interfered with ADL. Pain intensity was measured on a numeric scale after each cycle of FOLFOX therapy.
All patients in the OXY group and 33 out of 35 patients in the non-OXY group experienced grades 1 or 2 sensory neuropathy. Grade 3 neurotoxicity was not observed in the OXY group whereas two patients (5.7%) in the non-OXY group reported grade 3 sensory neuropathy. In the OXY group, sensory neuropathy grades improved in all patients. CR oxycodone was discontinued in 10 patients (34.5%) in the OXY group after completions of FOLFOX therapy. No discontinuations because of OIPN occurred in the OXY group, and 10 discontinuations occurred in the non-OXY group. Patients in the OXY group received a median of 13 cycles. Those in non-OXY group received a median of seven cycles. The median total oxaliplatin dose was higher in OXY group than the non-OXY group (1072.3 mg/m2 versus 483 mg/m2, respectively).
CR oxycodone may attenuate OIPN and extend FOLFOX therapy in patients with CRC.
Additional research on oxycodone and other opioid use for OIPN is needed. This study suggests changes caused by oxycodone, but it has several limitations.