- Design
- Prospective exploratory biomarker study within a randomised trial
- Population
- 30 patients with advanced colorectal cancer on CapeOX plus bevacizumab
- Primary outcome
- Association of plasma pNF-H with clinically graded neuropathy
- Effect
- No association with onset, severity or persistence of neuropathy
This exploratory study measured plasma phosphorylated neurofilament-heavy chain (pNF-H), a marker of axonal injury, in 30 Japanese patients receiving CapeOX plus bevacizumab for advanced colorectal cancer, within a trial of a herbal extract.
Levels varied widely between patients without a consistent pattern over time. They rose modestly by the later sampling point, but were not associated with the onset, severity or persistence of neuropathy graded clinically.
The authors suggest that oxaliplatin injures the dorsal root ganglion cell body rather than the axon, which pNF-H reflects. Clinical grading remains the only reliable guide to oxaliplatin dose modification.
- Assess oxaliplatin neuropathy clinically at each cycle; no blood test replaces this.
- Ask specifically about cold-induced and persistent numbness or tingling.
- Reduce or stop oxaliplatin according to clinical grade, as standard.
- Do not use neurofilament levels to guide oxaliplatin dosing.
Why it matters
Biomarkers promising elsewhere in neurology do not automatically transfer to chemotherapy neuropathy.
Don't overread it
With 30 patients, this exploratory study cannot rule out a role for other neurofilament markers.
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