Peripheral Neuropathy
Eloxatin® (oxaliplatin) can cause two types of neuropathy: acute and chronic. While acute neuropathy can be managed by avoiding cold and certain foods that trigger it, chronic or peripheral neuropathy gets worse as the cumulative dose of oxaliplatin builds. It tends to fade after treatment with the drug ends, but it may take 18 months to 2 years to go away completely.
Acute oxaliplatin-induced neuropathy
Acute neuropathy begins shortly after an infusion of oxaliplatin and gets better within a few days. It is often triggered by eating, drinking, or touching something cold or breathing cold air. Some patients experience sharp pain in their mouth or jaw when they take a bite of cold food. Others may feel like their throat is closing and they cannot breathe, although breathing isn’t really affected (pharyngolaryngeal dysesthesia).
Management involves
- Using gloves or potholders when touching anything cold.
- Wearing scarves or face masks outdoors in cold weather if you must go outside.
- Not eating or drinking cold or even cool foods. Eat food that is room temperature.
- Avoiding excessive air-conditioning.
- Wearing socks and shoes that keep your feet warm.
It helps to be prepared for your first treatments with oxaliplatin with gloves, a shawl or blanket, warm socks, and room temperature food and drinks.
Chronic peripheral neuropathy
As the amount of oxaliplatin you take accumulates over treatments, the risk of a longer-lasting sensory neuropathy in your hands and feet goes up. Initially this may be tingling or a feeling of pins and needles. Some patients may go on to have numbness and find it difficult to do small tasks with their hands like buttoning a shirt. In some cases, neuropathy can cause pain and difficulty with daily life, including walking.
Oxaliplatin-induced neuropathy usually gets better once the drug is stopped, although some patients will experience an increase in symptoms after treatment ends that then fades. A percentage of patients will continue to have some neuropathy for one to two years, and for a very small percentage neuropathy will be permanent.
Medical management of oxaliplatin-induced peripheral neuropathy
It is very important to let your doctor know if symptoms of neuropathy last beyond a few days after a chemotherapy treatment. Keep track of tingling, pins and needles, numbness, pain, or difficulty with motor activities and let your doctor know if they are getting worse.
- Reducing the dose of oxaliplatin may prevent further development of neuropathy.
- For metastatic colorectal cancer, the OPTIMOX or “Stop and Go” strategy may reduce neuropathy and make it possible to continue treatment longer. With OPTIMOX, oxaliplatin, 5FU, and leucovorin are given as usual for 6 treatments. Then oxaliplatin is dropped from the regimen, but 5FU and leucovorin are continued for another 3 months. Finally oxaliplatin is reintroduced.
- Infusions of calcium and magnesium (Ca/Mg) before and after the oxaliplatin infusion reduces both acute neuropathy and chronic peripheral neuropathy.
- Clinical trials are underway to test other agents such as Xaliproden and alpha-lipoic acid (ALA) to prevent or lessen neuropathy.
- If pain is a problem, discuss pain medication with your doctor.
Coping with peripheral neuropathy
Sometimes knowing that most cases of peripheral neuropathy will get better after treatment and will completely disappear after a few months is enough to manage temporary symptoms.
However, it is important to stay safe when you have numbness or loss of function in hands and feet. Staying warm will also help with uncomfortable feelings.
- Wear gloves and warm socks
- Take care walking and clear your house of things to trip over, throw rugs, and slippery surfaces.
- Use handrails on stairs and keep them free of clutter.
- Consider lowering the temperature of your water heater or test water with part of your body not affected by neuropathy before you bathe, shower, or wash dishes.
- Use a skid-proof mat in the tub and consider temporary or permanent safety bars. Consider using a shower stool.
- If you have problems balancing or walking, get a referral to a physical therapist to strengthen muscles, build balance, or prescribe a walking aid.
- An occupational therapist may be able to help adapt your home so daily activities are easier and safer for you.
- Check your feet and shoes every day for small objects that you might have felt or redness, injuries, or blisters to your feet.
- Take special care with kitchen knives and tools.
Last Update: May 9, 2008
Medical Review
This page is under review by C3's medical review network.
