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Objective To study the protective effect of aminophosphate on peripheral neurotoxicity in patients with gastrointestinal cancer undergoing chemotherapy.Methods Eighty patients receiving mFOLFOX6 regimen chemotherapy in the Eighth Affiliated Hospital of Sun Yat-sen University from June 2015 to February 2018 were selected as the study subjects.They were divided into study group and control group according to random number table method.The control group was given mFOLFOX6 regimen for chemotherapy,while the study group was given intravenous infusion of amphostatin before using mFOLFOX6 regimen for chemotherapy.The occurrence of peripheral neurotoxicity,motor nerve conduction velocity (MSV),sensory nerve conduction velocity (SCV) levels of median nerve and peroneal nerve before and after chemotherapy,short-term efficacy and blood toxicity were compared between the two groups.Results The total incidence of peripheral neurotoxicity was 17.50％ (7/40) in the study group and 82.50％ (33/40) in the control group,and the difference was statistically significant (x2 =33.800;P =0.000).The SCV levels of median nerve and peroneal nerve in the study group after chemotherapy was (53.68±3.02) m/s,(54.96 ±3.01) m/s,and those in the control group were(45.17±3.07) m/s、(44.97±3.03) m/s,and the difference was statistically significant (t =12.498,14.794;P =0.000,0.000).There was no significant difference in the total effective rate (87.50％,35/40) between the study group and the control group(90.00％,36/40) (x2 =0.125;P =0.723).The total incidence of hematotoxicity was 42.50％ (17/40) in the study group and 77.50％ (31/40) in the control group,and the difference was statistically significant(x2 =10.208;P=0.000).Conclusion Amfostine has a better preventive effect on peripheral neurotoxicity incancer patients undergoing chemotherapy,which is conducive to reducing the risk of hematotoxicity.which is worthy of clinical application.
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Objective To investigate clinical efficacy of Xiaotan Tongluo Gel combined with mecobalamin tablets in treating chemotherapy-induced peripheral neuropathy (CIPN). Methods Totally 67 cases of CIPN were divided into the treatment group (36 cases) and the control group (31 cases). Both groups were given mecobalamin tablets, 0.5 mg each time, three times a day, orally. Patients in the treatment group were treated with Xiaotan Tongluo Gel for external use at the same time. The patients in control group were treated with placebo gel for external use, 1 mL/cm2, rubbed on the skin 1 cm more than sensory obstruction in diameter. The treatment for both groups lasted for 14 d as a treatment course, and the treatment lasted for 2 courses. The changes of peripheral nerve toxicity, TCM syndrome scores and the nerve conduction velocity were observed in the two groups. Results On the 14th and 28th days of treatment, the total effective rates of peripheral nerve toxicity were 75.00% and 91.67% in the treatment group, and 38.71% and 67.74% in the control group, and the treatment group was significantly better than those of the control group (P=0.002, P=0.005); On the 14th and 28th days of treatment, the total effective rate of TCM efficacy in the treatment group was 75.00% and 94.44% respectively, and that in the control group was 45.16% and 64.52% respectively, and the treatment group was significantly better than the control group (P=0.018, P=0.005). Compared with before treatment, the TCM syndrome scores in both groups were significantly reduced on the 14th and 28th days (P＜0.01); The TCM syndrome scores in the treatment group were significantly lower than those in the control group at the same time points after treatment (P＜0.01). Compared with before treatment, the sensory and motor nerve conduction speeds of the peroneal and median nerves in the two groups at 14th and 28th days were significantly increased (P＜0.01); Comparing the two groups at the same time point after treatment, the sensory and motor nerve conduction velocity of the peroneal and median nerves in the treatment group was significantly better than that in the control group (P＜0.05, P＜0.01). Conclusion Xiaotan Tongluo Gel combined with mecobalamin tablets can effectively improve the peripheral neurotoxicity induced by chemotherapy, TCM syndrome scores, and the nerve conduction velocity.
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OBJECTIVE:To systematically evaluate the efficacy and safety of glutathione (GSH) in preventing oxaliplatin-in-duced peripheral neurotoxicity(OIPN),and to provide evidence-based reference in the clinic. METHODS:Randomized controlled trials (RCTs) about therapeutic efficacy of GSH vs. placebo/no any measures (called placbo group) or other drug in preventing OIPN were retrieved from PubMed,EMBase,Cochrane library,CJFD,Wanfang database and VIP. Meta-analysis was performed with Rev Man 5.3 statistical software after data extraction and quality evaluation with Jadad scale. RESULTS:18 RCTs were in-cluded,involving 1200 patients. The results of Meta-analysis showed that:total incidence of oxaliplatin-induced chronic peripheral neurotoxicity (OICPN)[RR=0.71,95%CI(0.59,0.87),P<0.001] and the incidence of severe OICPN [RR=0.50,95%CI(0.42, 0.60),P<0.001] in GSH group were significantly lower than placebo group,with statistical significance;there was statistical signif-icance in the incidence of oxaliplatin-induced acute peripheral neurotoxicity(OIAPN)[RR=0.89,95%CI(0.72,1.09),P=0.25]. The incidence of severe OICPN in GSH group was significantly higher than mecobalamine group,with statistical significance [RR=2.06,95%CI(1.07,3.99),P=0.03]. There was no statistical significance in the incidence of OICPN[RR=1.38,95%CI(0.83,2.31), P=0.21] and severe OICPN [RR=1.91,95%CI(0.85,4.30),P=0.12] between GSH group and Ca+Mg mixture group. CONCLU-SIONS:GSH can effectively prevent the occurrence of OICPN,however,its therapeutic efficacy is equivalent to Ca+Mg mixture and inferior to mecobalamine in preventing severe OICPN.
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Objective Oxaliplatin-induced peripheral neurotoxicity (OIPN) is the main limitation for its continuation in cancer patients. Traditional Chinese medicines (TCMs) have been used to prevent OIPN in China and have been demonstrated to be effective. However, due to the lack of direct comparison among TCMs, it remains unclear that which TCM is the best for OIPN prevention. Consequently, the present study aimed to compare the relative efficacies of TCMs to find out the best TCM by applying a network meta-analysis. Methods Studies were identified by searching PubMed, EMbase, Cochrane Libraries, CNKI, WanFang, and WeiPu database from January 1990 to May 2016. Randomized controlled trials (RCTs) that evaluated the efficacy of TCMs in preventing OIPN in cancer patients were included. Statistical analysis was performed with ADDIS 1.16.6. Results Twenty-five RCTs (1572 patients) involving five TCMs were included. The results of network meta-analyses showed that compared with oxaliplatin-based chemotherapy alone, the combination with Huangqi Injection (HQI), Shenmai Injection (SMI), Shenfu Injection (SFI), Buyang Huanwu Decoction (BHD), and Huangqi Guizhi Wuwu Decoction (HGWD) could decrease the overall OIPN incidence and the severe OIPN incidence in cancer patients. In addition, probability ranking results showed the order of efficacy in preventing overall OIPN incidence was HQI > HGWD > SFI = SMI > BHD, while the order of efficacy in preventing severe OIPN incidence was HQI > HGWD > BHD > SFI = SMI. Conclusion All five TCMs are effective neuroprotective agents against OIPN. Among these TCMs, HQI and HGWD were superior to others in clinical efficacy. Moreover, Astragalus membranaceus might be a more promising herb for the OIPN prevention. However, more direct head-to-head RCTs with high quality and large sample size are still needed to further confirm the conclusion.
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Objective To discuss the treatment action and mechanism of Wenjing Tongluo Formula on oxaliplatin-induced perpheral neurotoxicity in rats. Methods Intraperitoneal injection was used to inject oxaliplatin 4 mg/kg to establish oxaliplatin-induced peripheral neurotoxicity rat models. Female Wistar rats were randomly divided into normal group, model group, and TCM group. TCM group was given Wenjing Tongluo Formula to soak rats’ limbs and tails. Rats in the model group were soaked with deionized water for comparison. Rats in the normal group received intraperitoneal injection with 5%glucose. Algesia hypersensitivity and anaphylaxis were detected under the mechanical stimulation and temperature. Immunohistochemical method was used to detect the expression of GFAP in L4-L6 spinal dorsal horn of rats. Explore the level of GLT-1 in L4-L6 dorsal root ganglia by RT-PCR. Results Rats in model group showed obvious behavioral changes compared with normal group (P<0.05);Rats in the TCM group improved in behavioristics compared with model group (P<0.01);number of positive cells in GFAP of rats in the model group increased compared with normal group (P<0.05);the increase in the TCM group was not obvious. Compared with normal group, astrocytes in spinal dorsal horn of model group were enlarged, protuberances increased, became coarse, and GLT-1 mRNA is decreased (P<0.05, P<0.01). Compared with model group, active cells and protuberances in the TCM group decreased (P<0.01), GLT-1 mRNA is increased (P<0.01). Conclusion Wenjing Tongluo Formula can improve behavioral changes of model rats under temperature and mechanical stimulation, probably related to harmful signal transmission induced by inhibition of astrocyte in spinal dorsal horn.
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Objective To observe clinical efficacy of external bath of modified Huangqi Guizhi Wuwu Decoction in relieving peripheral neurotoxicity induced by oxaliplatin.Methods Sixty patients were randomly divided into control group and treatment group (30 cases in each group). Both groups received intramuscular injection of mecobalamine (0.5 mg/d, three times a week). At the same time, the treatment group received external bath of modifiedHuangqi Guizhi Wuwu Decoction. All the courses of treatment lasted for 14 days. Clinical efficacy and adverse reactions of the two groups were observed.Results The total effective rate of treatment group was 73.3% (22/30), which was superior to that of 40.0% (12/30) in the control group, with statistical significance (P<0.05), without any adverse reaction.Conclusion External bath of modifiedHuangqi Guizhi Wuwu Decoction is effective as supportive care for alleviating chronic peripheral neurotoxicity induced by oxaliplatin.
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ObjectiveTo observe the efficacy of L-carnitine in prevention and treatment of toxicity of LFP chemotherapy with gastrointestinal cancer. Methods60 cases of gastrointestinal cancer were divided into 2 groups according to the admission date. The treatment groups received LFP chemotherapy and L-carnitine, while the control group received LFP chemotherapy alone.Both groups received 3 cycles chemotherapy. The gastrointestinal toxicity, neurotoxicity, hematologic toxicity and physical state were compared.ResultsThere were 12 cases of peripheral neurotoxicity in treatment group,the incidence rate was 40.0 ％;but in control group there were 21 patients, and the incidence rate was 70.0 ％. There was a significant difference between the two groups(x2=5.4545,P =0.0195). Anemia in the treatment group was 56.7 ％ (17/30); in the control group the rate was 86.7 ％ (26/30).There was a significant difference between the two groups (x2 =6.698,P =0.0351).After chemotherapy,in the treatment group,there were 4 cases with increasing Karnofsky score ≥ 10,19 patients whose Karnofsky score did not change,and 7 cases with reduced Karnofsky score ≥ 10; in the control group,there was 1 case with increasing Karnofsky score ≥ 10,13 cases with Karnofsky score no changing,and 16 cases with reduced Karnofsky score ≥ 10.The changes in physical state of two groups had a significant difference(x2 =5.711,P =0.0169).The gastrointestinal toxicity,thrombocytopenia,and neutropenia of two groups had no significant difference.ConclusionL-carnitine can reduce peripheral neurotoxicity and hematologic toxicity,improve the patient's physical state in patients received LFP chemotherapy.