McNally Spotlights Need for Better CIPN Research in Aggressive Lymphomas

Gretchen McNally, PhD, ANP-BC, AOCNP

When attending to patients with lymphoma receiving multi-agent chemotherapy regimens, Gretchen McNally, PhD, ANP-BC, AOCNP, acknowledges that there a variety of factors to pay attention. However, she argues that nurses should be conscience of the risk of chemotherapy-induced peripheral neuropathy (CIPN) and be diligent in querying about their physical functioning in terms of buttoning, zipping, or writing.

“Historically, peripheral neuropathy is [more] well-studied, in different types of cancer,” McNally, who is a nurse practitioner in hematology at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC), said in an interview with Oncology Nursing News®. “For example, it is better understood in patients with breast cancer receiving taxanes or patients with colorectal cancer receiving oxaliplatin.”

However, according to McNally, although a smaller subset of patients with lymphoma might experience chemotherapy-induced neuropathy, this does not mean their symptoms are less substantial.

“I primarily work in hematology, and focus on lymphomas,” she said. “I noticed several years ago that one of the [adverse] effects that my patients experience if they had aggressive lymphoma and were treated with R-CHOP was peripheral neuropathy.”

“These patients can have severe peripheral neuropathy, which means that it is impacting their activities of daily living, [where] they cannot button, [or], if it’s in their feet, they are at an increased risk falls, [or] they can’t stand and are not able to work,” she explained. “So, it’s a really a huge issue, long term and short term.”

McNally acknowledges that there has not been great clinical-rated or patient-reported outcome (PRO) measurement data for this adverse event in this population. Thus, she decided to launch a study to assess how this is affecting her patients.

The prospective pilot study will enroll up to 23 individuals with lymphoma receiving vincristine containing regimens. Using the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire–CIPN-20 (EORTC QLQ CIPN 20) and the Brief Pain Inventory Short Form (BPI-SF), clinicians will collect and assess PROs. Clinician-rated outcomes will be assessed via the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE v 5.0). Neurofilament light chains (NF-L) will be assessed as a possible serum biomarker.

The correlation between NF-L levels and future CIPN 20, CTCAE, and BPI scores will be evaluated via Spearman’s correlation. Linear and ordinal regression models will be utilized to assess the effects on future CIPN.

CIPN, including vincristine neurotoxicity, is a high priority research area for the NCI. This progressive, debilitating adverse effect of cancer treatment potentially negatively affects both disease outcomes as well as the long-term quality of life of cancer survivors.

Investigators believe that vincristine’s interference with microtubule formation is the driving force behind neuropathy, as the interference with these critical components of nerve fiber axons leads to mitotic arrest and cell death.

“We’re collecting a serum blood samples from patients that we’ll be sending that for neurofilament analysis,” McNally said. “Neurofilament is thought to be a biomarker of vincristine induced peripheral neuropathy because it [is induced by] the axonal breakdown that is triggered by neuropathy.”

The trial is ongoing, and McNally’s team is still in the process of data analysis; however, she is optimistic that it will help garner some goof baseline data for this patient population.

“Hopefully, we’ll get some good baseline data for the next study and will be able to [take a closer look] at neuropathy causing medication or chemotherapy medications in lymphoma,” she concluded. “Then we can [focus more] on interventions.”

Reference

McNally G, Manring C, Gault C, et al. Evaluating vincristine induced peripheral neuropathy outcomes in patients with lymphoma. Presented at: 47th Annual Oncology Nursing Society Congress; April 27-May 1, 2022, Anaheim, CA. Abstract P344.