Does coasting occur with both paclitaxel and oxaliplatin (chemotherapy medications)?

Coasting Phenomenon in Paclitaxel and Oxaliplatin-Induced Neuropathy

Coasting occurs primarily with oxaliplatin, not with paclitaxel. While both medications cause chemotherapy-induced peripheral neuropathy (CIPN), they have distinct clinical trajectories and recovery patterns.

Oxaliplatin-Induced Neuropathy and Coasting

• Oxaliplatin-induced neuropathy is characterized by a unique "coasting" phenomenon, where neuropathic symptoms continue to develop and progress for an additional 2-6 months after treatment cessation 1
• After completion of oxaliplatin therapy, neuropathy typically worsens for 2-3 months before beginning to improve 1
• This coasting phenomenon is reported to be partially reversible in approximately 80% of patients and completely resolves in about 40% at 6-8 months after treatment cessation 1

Paclitaxel-Induced Neuropathy Pattern

• In contrast to oxaliplatin, paclitaxel-induced neuropathy tends to improve immediately after chemotherapy cessation 2
• Paclitaxel neuropathy symptoms resolve more between doses during treatment, unlike oxaliplatin symptoms which accumulate 1
• After completion of chemotherapy treatments, paclitaxel neuropathy improves over the ensuing several months without the worsening period seen with oxaliplatin 1

Differences in Symptom Distribution and Presentation

• Paclitaxel-induced chronic neuropathy symptoms are more prominent in the lower extremities than upper extremities during treatment 1
• Oxaliplatin-induced symptoms are more severe in the upper extremities than in the lower extremities during treatment 1
• Both drugs cause primarily sensory neuropathy with numbness, tingling, and pain in a stocking-glove distribution 1, 3

Acute vs. Chronic Neuropathy

• Both drugs cause acute neuropathy syndromes that peak around day 3 after administration 2
• Paclitaxel acute symptoms remain similar in intensity with each cycle and largely resolve between cycles 2
• Oxaliplatin acute symptoms are about half as severe in the first cycle compared to later cycles and do not resolve completely between cycles 2
• Acute neurotoxicity appears to predict the severity of chronic neuropathy for both drugs, more prominently with oxaliplatin 2

Pathophysiological Differences

• Different mechanisms underlie paclitaxel and oxaliplatin-induced neuropathy 4
• Paclitaxel might directly affect somatosensory neurons while oxaliplatin primarily targets dividing cells and immune cells 4
• Both drugs affect mitochondrial function in peripheral nerves, which may contribute to the development of neuropathy 5

Clinical Implications

• Knowledge of these differences is important for patient education and management expectations 1
• For patients with established painful CIPN from either drug, duloxetine is the only agent with appropriate evidence to support its use, though the benefit is limited 1
• Clinicians should assess the appropriateness of dose delaying, dose reduction, or stopping chemotherapy in patients who develop intolerable neuropathy and/or functional impairment 1

Understanding the distinct patterns of neuropathy, particularly the presence of coasting with oxaliplatin but not paclitaxel, is crucial for proper patient management and symptom control during and after chemotherapy.