Platinum\centered chemotherapy is commonly associated with toxic sensory neuropathies, but also, although rarely, with Guillain\Barr syndrome (GBS). common dose\dependent side effect. The authors propose that Guillain\Barr syndrome may constitute an immune\mediated, non\dose\related side effect of platinum\based chemotherapy. Prompt diagnosis of Guillain\Barr syndrome and distinction from classical toxic neuropathy are crucial for optimal treatment. Platinum discontinuation, associated if needed to intravenous immunoglobulin administration, radically changes the course of the disease and minimizes neurological sequelae. Brief abstract To improve knowing of a existence\intimidating problem of platinum chemotherapy possibly, this brief conversation describes five individuals who created GBS while getting platinum\centered chemotherapy for a good tumor and reviews the outcomes of an assessment of the books upon this subject. Introduction Platinum\centered chemotherapy is often connected with sensory neuropathies linked to a dosage\dependent harm of dorsal main ganglia 1, 2. Nevertheless, although hardly ever, peripheral neuropathies resembling Guillain\Barr symptoms (GBS) have already been reported in individuals receiving platinum substances, suggesting an immune system\mediated process. GBS can be an immune system\mediated polyradiculoneuropathy that typically happens after disease or presents and vaccination with intensifying muscle tissue weakness, sensory impairment, Voglibose and reduced tendon reflexes. GBS could be a existence\intimidating condition when connected with bulbar muscle tissue participation possibly, respiratory dysautonomia and failure. non-etheless, treatment with intravenous immunoglobulin (IVIG) or plasma exchange can result in a favorable result. Here we explain five individuals who created GBS while getting platinum\based chemotherapy for a solid tumor and report the results of a literature review on this topic. The aim of this study is to increase the awareness of Voglibose oncologists on this rare but potentially life\threatening complication of platinum chemotherapy. Subjects, Materials, and Methods We performed a retrospective research in the OncoNeuroTox database (French network for patients with neurological complications from oncologic treatments) for patients diagnosed with polyradiculoneuropathy while receiving chemotherapy for a solid tumor between January 2012 and January 2019. Out of 449 patients diagnosed with peripheral neuropathies during the period of interest, five patients presented with acute polyradiculoneuropathy. All patients met the Brighton criteria for the diagnosis of GBS (level 1 of diagnostic certainty: three patients; level 2 of diagnostic certainty: two patients) 3. The clinical, electrophysiological, and biological data of these five patients were collected and reviewed in detail. We then conducted a comprehensive literature review in search for similar cases published in the PubMed, Embase, and Cochrane databases up to December 2018. The study was approved by the French Region Committees on Health Research Ethics and the French Data Protection Agency. Data were stored and collected anonymized based on the recommendations from the People from france Data Safety Company. Outcomes Present Series Desk ?Desk11 summarizes paraclinical and clinical features, treatment, and result from the five individuals contained in the present series. All individuals got received platinum substances within their tumor treatment. Cumulative platinum dosages were in every instances below the founded threshold for neurological toxicity (we.e., significantly less than Voglibose 300C450 mg/m2 of cisplatin and significantly less than 750C850 mg/m2 of oxaliplatin 1). Neurological symptoms made an appearance after a median hold off of 4?times (range, 1C8?times) from last platinum administration; all individuals experienced severe weakness from the four limbs and modified feeling of lower (or top and lower) limbs. Electrophysiological Rabbit Polyclonal to TNF14 results had been in every instances appropriate for GBS, consisting of either demyelinating (patients 3C5) or axonal (patients 1C2) features. Cerebrospinal fluid analysis showed albumino\cytologic dissociation (i.e., increased protein levels with normal cell count) in three out of the five patients. Screening for metabolic, infectious, and autoimmune causes of acquired peripheral neuropathy (e.g., vitamin B deficiencies, diabetes, thyroid disease, uremia, hepatitis B and C, human immunodeficiency computer virus, Lyme contamination, or antiganglioside antibodies) was unfavorable in all cases. Table 1 Our case series Open in a separate windows
Age, years5262585869TumorOvarian adenocarcinomaPancreatic adenocarcinomaPulmonary adenocarcinomaRectal adenocarcinomaSquamous cell carcinoma of the penisChemotherapy regimen Carboplatin Paclitaxel Oxaliplatin 5\Fluorouracil Folic acid Irinotecan Cisplatin Pemetrexed Oxaliplatin 5\Fluorouracil Capecitabine Cisplatin 5\Fluorouracil Docetaxel Cumulative platinum doseAUC 5510 mg/m2 75 mg/m2 260 mg/m2 100 mg/m2 Interval from onset to nadir10?days7?days3?days11?days8?daysSigns.