Electrophysiological Features of Taxane-Induced Polyneuropathy in Patients With Breast Cancer

Abstract

Fifty-five patients with breast cancer were analyzed for electrophysiological characteristics of taxane-induced polyneuropathy. Based on the electrodiagnostic criteria, sensory motor polyneuropathy was found in 67% (37/55) of patients ranging between mild degree and moderate to severe degree. The polyneuropathy is predominantly axonal with three unique features: (1) frequent asymmetry, (2) high sural and radial sensory amplitude ratio in patients with mild polyneuropathy, and (3) slow conduction velocity seen only at the common entrapment sites, such as the carpal tunnel. The severity of polyneuropathy correlated positively with the cumulative dose received. Our study supports the clinical utility of electrodiagnostic study in both diagnosis and monitoring of taxane-induced polyneuropathy.

Neurophysiological, nerve imaging and other techniques to assess chemotherapy-induced peripheral neurotoxicity in the clinical and research settings

“…16 Corresponding to the two main pathogenic mechanisms above, NCS findings in CIPN reveal either a sensory neuronopathy affecting DRGs with a diffuse amplitude decrease or abolishment of sensory action potential (SAP) and normal sensory conduction velocities, or a length-dependent distal, dying-back, axonal degeneration with a reduction of SAP amplitudes in a distal predominant pattern starting in the legs and then involving the arms. Neuronopathy is primarily seen in cisplatin, 17 oxaliplatin 18 19 and cisplatin plus paclitaxel combination-treated patients, 20 while a length-dependent axonal sensory neuropathy is the characteristic neurophysiological pattern in taxane, 21 bortezomib, 22 thalidomide 23 and vincristine-exposed patients. 24 Abnormal SAP have been reported in patients treated with these drugs prior to the symptoms onset, particularly in haematological malignancies, suggesting that they may represent preclinical markers of CIPN.…”

AANEM policy statement on electrodiagnosis for distal symmetric polyneuropathy

“…In these situations, nerve conduction studies can determine the presence and severity of the problem, and can be crucial in deciding whether treatment should be continued. For example, taxanes are frequently used in the treatment of a variety of cancers, including breast cancer . NCS are abnormal in 67% of patients on taxanes with symptoms of neuropathy, and the results help to guide choices about further treatment.…”

Neuromuscular ultrasound for taxane peripheral neuropathy in breast cancer

“…These findings suggest that, at compression sites, CIPN may aggravate nerve entrapment and cause an increase in CSA of peripheral nerves. This discrepancy in the effects of CIPN between compression and noncompression anatomic sites has been described in NCS and was suggested in a prior study of oxaliplatin CIPN …”

“…Quantitative sensory testing fails to predict the severity of CIPN . Nerve conduction studies (NCSs) are insensitive to small fiber changes; typical findings include mild conduction velocity slowing at sites of entrapment or reduction of sural sensory responses . Skin biopsy for measuring intraepidermal nerve fiber density (IENFD) is the gold standard for the diagnosis of sensory‐predominant small fiber neuropathy but is not an ideal test due to its invasive nature …”