Central vs. Peripheral Venous Oxaliplatin Administration and Chemotherapy-Induced Peripheral Neuropathy Severity.

Abstract

Purpose: To determine whether central-venous (CV) administration of oxaliplatin is associated with less severe chemotherapyinduced peripheral neuropathy (CIPN) than peripheral-venous (PV) administration, using the Comprehensive Assessment Scale for Chemotherapy-Induced Peripheral Neuropathy (CAS-CIPN).

Design: Prospective, observational cohort study.

Methods: This prospective observational cohort study involved patients receiving oxaliplatin-based chemotherapy from the Cancer Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College between February 1, 2023, and March 30, 2024. Participants were categorized into CV or PV groups based on infusion route. The primary outcome was the overall CAS-CIPN score, assessed using a questionnaire adapted from the Japanese version of the Chemotherapy-Induced Peripheral Neuropathy Assessment Scale. Statistical analyses included univariate tests (Mann-Whitney U test) and multivariate logistic regression(adjusting for age, gender, number of chemotherapy cycles, and cancer types),and subgroup evaluations.

Results: A total of 260 eligible patients were included in this study, with 200 receiving PV infusion and 60 receiving CV infusion. Univariate analysis showed significantly lower overall CAS-CIPN scores in the CV group compared to the PV group (p = 0.005). Significant differences in specific symptom scores (S1, S3, S5, S6, S9) were observed, favoring the CV group. Multivariate analysis identified CV administration as a protective factor against CIPN (OR = 0.23, 95% CI: 0.09-0.58, p = 0.024). Subgroup analysis demonstrated that CV administration significantly reduced neurotoxicity in middle-aged patients (OR = 0.00, 95% CI: 0.00 -0.36, p = 0.005), those receiving only one chemotherapy cycle (OR = 0.01, 95% CI: 0.00 - 0.73, p = 0.03), and patients with hepatobiliary and pancreatic cancers. (OR = 0.00, 95% CI: 0.00 - 0.16, p = 0.015) CONCLUSION: CV administration of oxaliplatin is associated with reduced neurotoxicity compared to peripheral venous infusion, particularly benefiting middle-aged patients, those receiving single-cycle therapy, and hepatobiliary and pancreatic cancer patients.

Clinical: Implications Adopting CV access for oxaliplatin administration could be a simple, low-cost strategy to mitigate CIPN, particularly in middle-aged patients, single-cycle regimens, and hepatobiliary or pancreatic cancer populations.

Conclusion: CV administration of OXL is associated with reduced neurotoxicity compared to PV infusion, particularly benefiting middle-aged patients, those receiving single-cycle therapy, and hepatobiliary and pancreatic cancer patients.