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Shorter Paclitaxel Infusions Add to Neuropathy Risk

Shorter Paclitaxel Infusions Add to Neuropathy Risk

NEW ORLEANS--In combination with cisplatin (Platinol) for treatment of gynecologic malignancies, 3-hour infu-sional paclitaxel (Taxol) might be easier to administer but it produces more peripheral neuropathy than the standard 24-hour infusion, a Cleveland Clinic study shows.

"The incidence of neurological side effects is excessive," Maurie Markman, MD, reported at the Society of Gynecologic Oncologists meeting. "This is likely the result of high peak concentrations of two neurotoxic agents reaching the peripheral nerves at the same time. We recommend against its use."

The study examined 38 patients with ovarian, primary peritoneal, and endometrial malignancies, who received cis-platin (75 mg/m²) and a 3-hour infusion of paclitaxel (135 or 175 mg/m²). Therapy had to be modified in 42% of patients.

The regimen was quite active, producing a 90% reduction in CA 125 levels over pretreatment levels in 23 patients (70%). However, 27 patients (71%) developed neurological toxicity, which was severe in several cases. Sixteen patients (42%) experienced grade 2 or greater peripheral neuropathy; 21% of these had grade 3 or 4 neuropathy.

In contrast, patients receiving pacli-taxel over 24 hours and the same dose of cisplatin in the Gynecologic Oncology Group ovarian cancer protocol had only a 13% incidence of grade 2 or greater peripheral neuropathy, said William McGuire III, MD, of Emory University. "The message is that changing the schedule of administration significantly changes the toxicity," he said.

 
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