Identification of high-risk drugs related to chemotherapy-induced peripheral neuropathy in Cancer Therapy Evaluation Program-sponsored phase I trials.

BACKGROUND

Chemotherapy-induced peripheral neuropathy (CIPN) is a significant and debilitating side effect. However, there have been no studies of the relative risk of CIPN with known causative agents. We examined the risk of CIPN in patients taking such agents as a part of the National Cancer Institute (NCI) Cancer Therapy Evaluation Program-sponsored phase I trials.

METHODS

CIPN events in each patient were graded according to the Clinical Terminology of Common Adverse Effects and compared among several high-risk chemotherapeutic agent groups, adjusting for possible confounding factors. Patients receiving tubulin-targeted agents were analysed separately for specific background factors associated with CIPN.

RESULTS

In 135 phase I clinical trials, 259 of 3614 patients were identified as developing CIPN during chemotherapy. Tubulin-targeting agents and proteasome inhibitors were identified as high-risk agents (hazard ratio 9.04 and 5.01, respectively) for CIPN, whereas platinum-complex agents and thalidomide analogues imparted lower risk (hazard ratio 1.52 and 1.11, respectively). Age, sex and medical history of diabetes were not significantly related to CIPN. CIPN developed over time as the number of chemotherapy cycles increased. Among patients with CIPN, treatment with tubulin-targeting agents resulted in a significantly higher rate of chemotherapy schedule modification compared with treatments with other chemotherapeutic agents.

CONCLUSIONS

Tubulin-targeting agents and proteasome inhibitors were associated with a greatly increased risk of CIPN compared with other agents. CIPN tended to develop in later chemotherapy cycles. These findings will help to minimise the risk of CIPN by encouraging increased surveillance and earlier dose adjustment of high-risk agents in phase I trials.