El Chediak Alissar, Haydar Ali A, Hakim Ayman, Massih Sarah Abdel, Hilal Lara, Mukherji Deborah, Temraz Sally, Shamseddine Ali
Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut-Medical Center, Beirut, Lebanon.
Department of Diagnostic Radiology, American University of Beirut-Medical Center, Beirut, Lebanon.
Ther Clin Risk Manag. 2018 Apr 11;14:653-657. doi: 10.2147/TCRM.S150968. eCollection 2018.
Oxaliplatin is a nonconventional third-generation platinum compound. It is an important chemotherapeutic agent in regimens used in gastrointestinal carcinomas as well as other malignancies. Oxaliplatin toxicity profile includes neurotoxicity, hepatotoxicity, and splenomegaly. The primary aim of this study was to measure the spleen volume of patients on oxaliplatin therapy before and during chemotherapy to detect any increase in splenic size as a biomarker for early oxaliplatin toxicity.
This was a prospective pilot study conducted at the American University of Beirut-Medical Center. Fifty patients newly started on oxaliplatin were included. The spleen volume was measured from the patients' baseline CT scan using the IntelliSpace Portal upgraded system (using Response Evaluation Criteria In Solid Tumors [RECIST]), for each follow-up CT scan. Side effects were evaluated at each patient visit and graded according to the severity.
Thirty-seven (74%) patients developed an increase in spleen size. Thirty-three (66%) sampled patients developed peripheral neuropathy (all grades) at 3 months, whereas only two (4%) patients developed grade 3 neuropathy. Only one (3%) patient who developed an increase in spleen size also developed grade 3 peripheral neuropathy - a result that is significantly different (<0.001) when comparing patients with an increase in spleen size who also developed peripheral neuropathy of other grades.
An increase in spleen volume possibly precedes a significant peripheral neuropathy which could be a potential marker for oxaliplatin-induced toxicity.
奥沙利铂是一种非常规的第三代铂类化合物。它是用于胃肠道癌以及其他恶性肿瘤治疗方案中的一种重要化疗药物。奥沙利铂的毒性表现包括神经毒性、肝毒性和脾肿大。本研究的主要目的是测量接受奥沙利铂治疗的患者在化疗前及化疗期间的脾脏体积，以检测脾脏大小的任何增加，作为奥沙利铂早期毒性的生物标志物。
这是一项在美国贝鲁特美国大学医学中心进行的前瞻性试点研究。纳入了50名新开始使用奥沙利铂的患者。使用IntelliSpace Portal升级系统（采用实体瘤疗效评价标准[RECIST]），对每位患者的基线CT扫描以及每次随访CT扫描测量脾脏体积。在每次患者就诊时评估副作用，并根据严重程度进行分级。
37名（74%）患者脾脏大小增加。33名（66%）抽样患者在3个月时出现外周神经病变（所有级别），而只有2名（4%）患者出现3级神经病变。只有1名（3%）脾脏大小增加的患者也出现了3级外周神经病变——与出现其他级别外周神经病变且脾脏大小增加的患者相比，这一结果有显著差异（<0.001）。
脾脏体积增加可能先于明显的外周神经病变，这可能是奥沙利铂诱导毒性的一个潜在标志物。
