A
comparison of the neurological toxicities of cisplatin-paclitaxel and cisplatin-cyclophosphamide.
Bacon M, Zee B, James K, Stuart G, Soroka D, Walsh W, Bacon E, NCIC Clinical
Trials Group Queen's University, Kingston, ON, Canada.
PT is known to be neurotoxic initially but there is little data on toxicity
after completion of treatment. The objective of this study is to assess
both the acute and delayed toxicities in PT. Methods: This study was based
on data prior to diseaseprogression on 160 Canadian patients from an international
trial (Proc. ASCO 17.361a #1394). Standard NCIC CTG Common Toxicity Criteria
(tox) and patient self-administered QOL (qol) questionnaire (EORTC QLQ-C30+3)
on sensory, motor, hearing and insomnia toxicities were compared during
two periods: chemotherapy delivery (< 9 cycles) [acute toxicity (A)]
and from the end of chemotherapy to disease progression [delayed toxicity
(D)]. The number of occasions when a particular toxicity was observed was
taken as a surrogate measure of its duration. The average durations observed
with PT were compared to PC. Results: The incidence of mild insomnia (tox)
in A was higher with PT (10.1 v 1.4, p=0.035) and this is confirmed by
insomnia (qol) (19.0 v 2.7, p=0.002). There were no differences in D. Hearing
(tox) showed no difference in A but, although over the whole of D the cumulative
incidences did not quite differ significantly (7.0 v 18.9, p=0.055), at
the 3month postchemotherapy point PC was worse (2.8 v 17.0, p=0.009) and
the duration indicated that hearing (tox) lasts longer with PC (2.1 v 10.6,
p=0.036). Motor (tox) was not different between the two arms in either
A or D but motor (qol) was worse with PT in A (44.3 v 6.9 p<0.001) but
not in D. Sensory (tox) was more common with PT in A (88.6 v 46.6 p<0.001)
and this was confirmed by sensory (qol) (79.8 v 34.3 p<0.001). Also,
the duration was longer with PT during A (52.4 v 17.5 p<0.001) compatible
with the earlier rise in incidence of sensory (tox). During D, only mild
sensory (tox) remained different (85.9 v 58.5, p=0.0008) and the duration
was longer with PT (69.6 v 45.5, p=0.005). Sensory (qol) showed no significant
difference. Conclusion: There is a greater incidence of mild insomnia,
sensory toxicity of earlier onset and patientreported motor toxicity with
PT during A. In contrast, during D, only mild sensory toxicity with no
difference being detectable by questionnaire, was more frequent and lasted
longer in PT. Posttreatment impairment of hearing was probably worse with
PC.
