الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Summary In cancer patients, chemotherapy-induced peripheral neuropathy (CIPN) is the most
devastating side effect. CIPN is caused by damage to or degeneration of peripheral nerve fibres
(autonomic, sensory ,motor). It is predominantly a sensory phenomenon, occurs in 20–85% of
cancer patients, and usually starts in the fingers, toes, and spreads proximally in a glove and
stock distribution. It has been shown that platinum-based drugs, ixabepilone, thalidomide, and
taxanes as well as its analogues are the most neurotoxic classes of anticancer drugs. Taxanes
chemo protocol is used in breast cancer patients and the incidence of Taxanes induced
peripheral neuropathy (TIPN) ranges from 11.0% to more than 80% of participants in the form
of neuropathic symptoms that persisted from one to three years following treatment.
Chemotherapy-induced peripheral neuropathy can remain for months to years after
chemotherapy has been completed, posing significant issues for cancer survivors as a leading
source of persistent pain with a severe impact on function and quality of life. CIPN can also
limit patients’ therapeutic options, resulting in reduced chemotherapeutic dose or
discontinuance of chemotherapy, which may reduce treatment efficacy and impact overall
survival.
As part of adequate management, it is critical to detect CIPN in breast cancer patients
early. Nerve conduction study (NCS) provide objective information regarding peripheral
neuromuscular disorders, including confirmation and assessment of the severity of peripheral
neuromuscular disorders. In addition to being used in locating lesions in sensory pathways, it
also provides objective information as an extension of the clinical examination by measuring
sensory nerve action potentials.
Several drugs are used for management of CIPN, Historically, Lidocaine was used to
manage chronic neuropathic pain due to its ability to block sodium channels in neuronal cell
membranes, which may play a role in both inflammatory and neuropathic pain pathogenesis
and maintenance. As a result of its anti-inflammatory properties, lidocaine inhibits neutrophil
accumulation at the site of injury and reduces the release of inflammatory mediators. Lidocaine
has also been demonstrated to have anti-hyperalgesic effects on the peripheral and central
nervous systems. Consequently, we considered the possibility of intravenous lidocaine
preventing chronic pain development. Research findings have shown that Duloxetine, a
serotonin (5-HT) and norepinephrine (NE) dual reuptake inhibitor (SNRI), is effective in
treating neuropathy-related pain. This is because 5-HT and NE are the primary
neurotransmitters that inhibit input to the spinal dorsal horn neurons, thus reducing the
transmission of painful peripheral stimuli.
Aim of the study
A study was conducted in order to determine whether intravenous (IV) lidocaine or oral
duloxetine had a more significant effect on the onset, severity, and duration of TIPN in patients
with breast cancer, as well as to evaluate patients’ quality of life and determine the degree of
cell-mediated immunity.
Summary, Conclusion and Recommendations
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The most important findings of this study
There was early detection of neuropathic pain in week 5 in control group. After
completion of TT, 75 % of participants got DN4≥4 in GC in comparison to 20% and 25% of
participants in GL and GD, respectively (p <0.001).
Mild neuropathic pain (30-40) was significantly reported by more participants in control
group, in comparison to lidocaine and duloxetine group at week 6 and 7 weeks and throughout
the last 3weeks of TT. Moderate NP (41-70 points) was reported by 25% of participants, in GC,
in comparison to no participants in the other groups (p<0.001). The global pain intensity,
unpleasant and most of neuropathic pain items (except cold and dull pain which not reported
by any patients in the studied group) were significantly more intense in control group, in
comparison to lidocaine and duloxetine in the last 3 weeks of TT (p<0.05).
NCS showed higher % of participants 55% got mild axonal neuropathy in comparison to
20 and 25 % had mild neuropath in lidocaine and duloxetine groups , respectively in addition
to 25% got moderate neuropathy in CG in comparison to 5% with the other two groups The
difference between the three studied groups regarding Taxane neuropathy was statistically
significant (p=0.002)
QLQ-CIPN categories showed that, 70% of women in the control group reported quite
bit neuropathic pain compared to 5% in lidocaine group and 10% in duloxetine group after 8
weeks of TT. 80 % of women in the control group reported quite bit neuropathic pain compared
to 15% in lidocaine group and 20% in duloxetine group after 12 weeks of TT. This difference
was statistically significant (p<0.001).
The median LDH was not statistically significant differences between the three studied
groups before stating Taxane Therapy(p= 0.182). Also, after completion TT protocol the
median LDH index was not statistically significant in the three studied groups(p= 0.666).