sen·so·ri·mo·tor
ˌsen(t)sərēˈmōdər/adjective
Physiology adjective: sensorimotor (of nerves or their actions) having or involving both sensory and motor functions or pathways.
open access - | BMC Neurology | Full Text
October 1, 2016
Background
Paclitaxel-based regimens are
frequently associated with the development of peripheral neuropathy. The
autonomous nervous system (ANS) effects, however, of this
chemotherapeutic agent remain unexplored.
Methods
We investigated a group of 31
female patients with ovarian cancer receiving treatment with paclitaxel
and carboplatin, as well as a group of 16 healthy age- and
gender-matched healthy volunteers. All study participants completed a
questionnaire and were assessed neurophysiologically at three time
points (baseline, 3–4 months and 6–8 months following the onset of
chemotherapy). The evaluation of the ANS included assessment of the
adrenergic cardiovascular function (orthostatic hypotension-OH),
parasympathetic heart innervation (30/15 ratio) and sympathetic skin
response (SSR).
Results
At the 3–4 months ANS
assessment, 19.2 % of the patients had systolic OH and the same
percentage had diastolic OH, but at the 6–8 months evaluation no patient
had systolic OH and only 13.8 % had diastolic OH. The values of the
30/15 ratio were significantly reduced at both time points, whereas the
SSR was not affected.
Conclusions
Combined paclitaxel and
carboplatin chemotherapy is associated with significant effects on the parasympathetic heart innervation and occasionally with effects on the
adrenergic cardiovascular reaction. The SSR remained unaffected.
Physicians should be alert to the possibility of these
treatment-emergent side effects, so as to monitor ANS parameters and
introduce treatment modifications accordingly. Our findings however,
should be validated in larger cohorts.
Background
Paclitaxel
is commonly used as first-line chemotherapy for advanced ovarian cancer
and as adjuvant treatment, in combination with cisplatin or
carboplatin, for residual disease. Taxanes (paclitaxel and docetaxel)
are associated with numerous side effects, particularly including
neurotoxic phenomena [1] . For instance, severe peripheral neuropathy is known to occur in patients receiving cumulative doses of around 1000 mg/m2 paclitaxel and 400 mg/m2 docetaxel [2].
In recent years, research interest focused on maximizing the
therapeutic efficacy of paclitaxel, while minimizing the associated side
effects. Despite these efforts, primarily sensory and occasionally
sensorimotor [3, 4] peripheral neuropathy occurs in 59 to 78 % of treated patients [5, 6, 7].
Generalized peripheral neuropathies are frequently accompanied by autonomous nervous system (ANS) dysfunction [8].
However, it is currently unknown whether paclitaxel or its combination
with carboplatin affects the ANS and whether paclitaxel-induced
neuropathy comprises autonomic phenomena, as well.
The
present study was designed to address this issue and investigate the
effects of the combination of paclitaxel and carboplatin chemotherapy on
the ANS. From a clinical point of view, paclitaxel is occasionally
associated with hypotension, bradycardia and hypertension. Accordingly,
we investigated the impact of paclitaxel on the sympathetic and
parasympathetic innervation of the heart....
Conclusions
The
present study highlights the fact that combined paclitaxel and
carboplatin chemotherapy for ovarian cancer is associated with
significant effects on the sympathetic and parasympathetic heart
innervation, whereas the SSR remains relatively untouched. Physicians
caring for patients with ovarian cancer should be alert to the
possibility of these treatment-emergent side effects, so as to monitor
ANS parameters (BP, cardiac rhythm and their alterations upon standing)
and introduce treatment modifications accordingly. Our findings however,
should be validated in larger cohorts.
Abbreviations
- ANS:
-
Autonomous nervous system
- BP:
-
Blood pressure
- DBP:
-
Diastolic blood pressure
- NCVs:
-
Nerve conduction velocities
- OH:
-
Orthostatic hypotension
- OS:
-
Overall survival
- PFS:
-
Progression-free survival
- SBP:
-
Systolic blood pressure
- SD:
-
Standard deviation
- SSR:
-
Sympathetic skin response
5 years vs never: 0.70; 95
50 vs >50 years
The Cancer in Central and South America Project is a collaboration
between the Section of Cancer Surveillance of the International Agency
for Research on Cancer (IARC), the Red de Institutos e Instituciones
Nacionales de Cáncer (RINC) and cancer registries in the Central and
South American region. The project commenced in 2013, with the primary
objective of collating data collected by these cancer registries;
presenting the data in a standardized, comparable format; and making
them available to cancer research and control communities within the
region and elsewhere. 
