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Design and Participants: This prospective multicenter German trial determined whether sensorimotor training (SMT) and whole-body vibration (WBV) training reduce symptoms and decrease onset of CIPN. Patients undergoing oxaliplatin or vinca alkaloid treatment were followed over 5 years. Intervention groups performed supervised SMT or WBV training sessions (15-30 min) twice per week, concomitant to medical therapy. The primary endpoint, CIPN incidence, and all qualitative secondary endpoints were evaluated by Fisher’s test in each stratum separately and by the Mantel-Haenszel (MH) test across strata.
Results: Patients (n=55 SMT, n=53 WBV, n=50 treatment as usual [TAU]) were aged mean 49 years (SD=18-82) and were 59% male. Incidence was lower in both interventions vs TAU: SMT (30%; 95% CI=18%-42%) and WBV (41%; 28%-55%) vs TAU (71%; 58%-83%); P=.002 intention-to-treat MH test. Patients receiving vinca alkaloids and performing SMT benefited most. Results were more pronounced in per-protocol analysis (>75% participation in intervention) (SMT [29%; 17%-41%] and WBV [38%; 24%-51%] vs TAU [73%; 62%-86%]). SMT improvements were also found vs TAU for balance control bipedal with eyes open, bipedal with eyes closed, monopedal, vibration sensitivity (33% vs 50%; MH), sense of touch (0% vs 8.0%; MH), and leg strength (1.8% vs 12%; MH) (all P<.05). SMT reported less pain and burning sensation than WBV or TAU. In SMT, fewer dose reductions vs TAU and WBV were observed (32% vs 56% and 54%; P=.04). Furthermore, lower mortality in SMT reached significance vs TAU (1.9%; 0.0-5.7% vs 17%; 5.6-29%; P=.04).
Commentary: CIPN is a common complication (70%-90%) of oxaliplatin or vinca alkaloids chemotherapies and can potentially compromise quality of life and survival due to dose reduction. American Society of Clinical Oncology guidelines highlight the limited benefits of treating CIPN with pharmacological interventions,4 despite their high costs and side effects. Although the SMT/WBV training sessions used were supervised by sports therapists, the authors note the exercises were simple, low intensity and low cost, and could easily be done in all phases of oncologic care as well as at home—though further studies are needed. Of note, only individuals starting first-line chemotherapy were included, so it remains uncertain if patients receiving subsequent courses of chemotherapy would report similar benefits from SMT/WBV. Study strengths include electrophysiological assessments of neural function along with patient-reported outcomes.
Bottom Line: Neuromuscular SMT for CIPN due to first-line oxaliplatin or vinca alkaloid treatment significantly improved vibration sensitivity, balance, pain, and lower leg strength.
Reviewer: Jason K. Bowman, MD FACEP FAAEM, Ben Taub Hospital and Baylor St. Luke’s Medical College, Baylor College of Medicine, Houston, TX
References:
1. Cavaletti G, Marmiroli P. Management of oxaliplatin-induced peripheral sensory neuropathy. Cancers (Basel). 2020;12(6):12. doi:10.3390/cancers12061370.
2. Laforgia M, Laface C, Calabrò C, et al. Peripheral neuropathy under oncologic therapies: a literature review on pathogenetic mechanisms. Int J Mol Sci. 2021;22(4):22. doi:10.3390/ijms22041980.
3. Lee KT, Bulls HW, Hoogland AI, James BW, Colon-Echevarria CB, Jim HSL. Chemotherapy-induced peripheral neuropathy (CIPN): a narrative review and proposed theoretical model. Cancers. 2024;16(14):2571.
4. Loprinzi CL, Pacchetti C, Bleeker J, et al. Prevention and management of chemotherapy induced peripheral neuropathy in survivors of adult cancers: ASCO guideline update. J Cain Once. 2020;38(28):3325-3348.
Source: Streckmann F, Elter T, Lehmann HC, et al. Preventive effect of neuromuscular training on chemotherapy-induced neuropathy: a randomized clinical trial. JAMA Intern Med. 2024;184(9):1046-1053. doi:10.1001/jamainternmed.2024.2354.
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