FACULTY COMMENTS
DR ORLOWSKI: Peripheral neuropathy is a complication of
myeloma that can be particularly bothersome for patients
and healthcare providers. Paul Richardson has data showing
that up to 70 or 80 percent of newly diagnosed patients experience
some element of neuropathy even before any drugs are
introduced.
In addition, we know that some of the drugs we use can increase the incidence of neuropathy, or at least worsen the severity, including thalidomide, bortezomib and even other drugs like dexamethasone, which can be problematic if the patient develops diabetes.
In this retrospective analysis, they examined neurotoxicity, reviewing their own institutional experience and the literature. They emphasized the importance of following some of the dose-adjustment criteria that have been developed. Patients on bortezomib with worsening symptoms should be considered for early dose reduction because that’s one of the best ways to reduce the potential for the neuropathy becoming permanent.
In deciding when to reduce the dose, we need to know the patient’s baseline level of neuropathy so that we are aware when it begins to worsen. In patients with neuropathy at baseline, I try to intervene with agents that can help with symptoms, including gabapentin or tricyclic antidepressants.
Studies of bortezomib-associated neuropathy show that it tends to be slow in onset and the peak is usually not reached until the fifth cycle. I try to have a careful discussion with patients each cycle regarding their symptoms, and if there is any worsening, I start to consider reducing the dose from 1.3 to maybe 1.0 mg/m2.
DR JAKUBOWIAK: This paper by Badros and colleagues essentially
supports the prior observations reported by Dr Richardson
that a high percentage of patients with newly diagnosed multiple
myeloma experience neuropathy before treatment, and those
patients with pre-existing peripheral neuropathy are at greater
risk for exacerbation of those problems when treated with
bortezomib.
| Table of Contents | Top of Page |
