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CORRESPONDENCE
Recall Reaction of a Severe
Local Peripheral Neuropathy
After Paclitaxel Extravasation
Peripheral neuropathy with numbness, tingling, and burning pain in a
glove-and-stocking distribution is the
most common nonhematologic side effect associated with paclitaxel (Taxol)
therapy, whereas nerve damage leading
to motor dysfunction is uncommon (J).
We report here on a 53-year-old man
with both non-insulin-dependent diabetes
mellitus without systemic complications
and locally advanced non-small-cell
lung cancer. The patient was started on
paclitaxel that was administered through
the right antecubital vein at 175 mg/m2
in a 3-hour infusion (total dose, 360
mg). He also received standard recommended premedication and carboplatin;
the carboplatin dose was targeted to an
area under the curve for drug concentration as a function of time of 7 (total
dose, 1080 mg). During the infusion of
paclitaxel, an extravasation of approximately one fifth of the dose occurred. The rest of the paclitaxel dose
followed by carboplatin was given
through peripheral access in the left
arm.
The patient had no immediate symptoms resulting from the extravasation,
and no specific measures were taken.
Inflammation at injection sites with
soft-tissue reactions has been reported
after paclitaxel extravasation (2), but no
specific management of this adverse effect is recommended at the present time.
One week after treatment, the patient
experienced burning pain, extending
from the right elbow to the right wrist;
paresthesia, sensory loss, and motor
weakness developed in this area. These
symptoms increased during the next
week. In the third week, they gradually
began to subside in a cranio-caudal
fashion. A physical examination at 21
days showed motor weakness with sensory deficit in the median nerve of the
right arm.
1320 CORRESPONDENCE
A second course of chemotherapy
with the same agents, doses, and schedule was conducted with infusion
through the left antecubital vein without
any incident.
Three weeks later, however, the
patient reported a worsening of the
symptoms in his right arm, with lancinating pain, sensory loss, weakness,
and severe functional deficit. Neurologic examination disclosed weakened
muscles innervated by both the right
median and radial nerves, with sensory
loss in the areas of these nerves.
Electrophysiology was consistent with
incomplete axonotmesis of both right
median and radial nerves, normal nerve
conduction, normal sensory and motor
action potentials, and the presence (in a
needle electromyographic study) of
fibrillations and positive sharp waves in
the right musculus abductor pollicis
brevis, right musculus brachioradialis,
and right triceps. Examination of the
ulnar nerve revealed no abnormalities.
No other sign or symptom of neurotoxicity was present in other areas.
Treatment for pain was intensified with
carbamazepine and amitriptyline; no
further paclitaxel was given. With a 2month follow-up period, signs and
symptoms of neutrotoxicity have been
decreasing slowly but progressively.
In our patient, the distribution of
neurologic symptoms in the area in
which paclitaxel extravasated, coupled
with the absence of any neurologic disturbances in other regions, suggests that
local exposure to paclitaxel was responsible for the clinical picture. As far as
we know, this side effect has not been
reported previously. The important recall reaction after systemic re-exposure
to paclitaxel implies that, in the case of
focal neuropathy after paclitaxel extravasation, serious consideration should
be made regarding further therapy with
this agent.
MANUEL HIDALGO
JULIAN BENITO
RAMON COLOMER
LUIS PAZ-ARES
(2) Ajani JA, Dodd LG, Daugherty K, Warkentin
D, Ilson DH. Taxol-mduced soft-tissue injury
secondary to extravasation: characterization
by histopathology and clinical course. J Natl
Cancer Inst 1994:86:51-3.
Notes
Affiliations of authors. M. Hidalgo, R. Colomer,
L. Paz-Ares (Division of Medical Oncology), J.
Benito (Division of Neurology), University
Hospital " 12 de Octubre," Madrid, Spain.
Correspondence to: Manuel Hidalgo, M.D.,
Division of Medical Oncology, University Hospital '12 de Octubre," Avd Cdrcloba Km 5, 4, 28041
Madrid, Spain.
Erratum: "Clinicopathologic and Prognostic Significance of an Angiogenic
Factor, Thymidine Phosphorylase, in
Human Colorectal Carcinoma," by
Takebayashi et al. [J Natl Cancer Inst
1996;88:1110-7 (Issue 16)1. The first
sentence of paragraph two of "Patients
and Methods" should read, "Monoclonal antibodies were raised against a
glutathione S-transferase (GST)-dThdPase
fusion product containing 244 amino
acids of dThdPase (amino acid residues
7-250)."
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tug your heart
should feel
It's never
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Call 1-S0O-4-CANCER.
References
(/) Rowinsky EK, Chaudhry V, Comblath DR.
Donehowcr RC. Neuroloxicity of Taxol.
Monogr Natl Cancer Inst 1993:15:107-15.
Journal of the National Cancer Institute, Vol. 88, No. 18, September 18, 1996