Relation between auditory difficulties and bortezomib-induced peripheral neuropathy in multiple myeloma: a single-center cross-sectional study

[Ototoxicity of systemic treatments for malignant tumours, principles of diagnostic and management]

The incidence of ototoxicity in cancer patients is difficult to quantify due to confounding factors such as age, multi-medication, noise exposure and the frequent absence of pre-treatment hearing assessment. Around 40% of cancer survivors report a decline in hearing since their treatment, suggesting that ototoxicity associated with cancer treatment is underestimated. Our understanding of the pathophysiological mechanisms of systemic ototoxicity is essentially based on that of cisplatin. The recent discovery of auditory neuropathies and hidden hearing loss could explain why other anticancer drugs are potentially involved in this toxicity. We describe ways of diagnosing damage to auditory function that should enable such damage to be identified in the future. Strategies for mitigating ototoxicity include, in the case of cisplatin, discussing the indication with the patient, modulating the dose, being vigilant about other ototoxic agents and setting up a network with otologists. Prosthetic solutions, such as hearing aids and cochlear implants, should be considered for early rehabilitation of hearing function in order to reduce their impact on survival and quality of life.

Efficacy of donepezil for the treatment of oxaliplatin-induced peripheral neuropathy: DONEPEZOX, a protocol of a proof of concept, randomised, triple-blinded and multicentre trial

BACKGROUND

The use of oxaliplatin in digestive tract cancers could induce severe peripheral neuropathy (OIPN) decreasing the quality of life of patients and survivors. There is currently, no univocal treatment for these peripheral neuropathies. Donepezil, a reversible inhibitor of cholinesterase, used to treat Alzheimer's disease and dementia, is reported to have a good safety profile in humans, and preclinical data have provided initial evidence of its effectiveness in diminishing neuropathic symptoms and related comorbidities in OIPN animal models.

METHODS

The DONEPEZOX trial will be a proof-of-concept, randomised, triple-blinded, and multicentre study. It will be the first clinical trial evaluating the efficacy and safety of donepezil for the management of OIPN. Adult cancer survivors with OIPN that report sensory neuropathy according to QLQ-CIPN20 sensory score (equivalence of a grade ≥ 2), at least 6 months after the end of an oxaliplatin-based chemotherapy will be included. Eighty patients will be randomly assigned to receive either donepezil or placebo over 16 weeks of treatment. The primary endpoint will be the rate of responders (neuropathic grade decreases according to the QLQ-CIPN20 sensory score) in the donepezil arm. The severity of OIPN will be assessed by the QLQ-CIPN20 sensory scale before and after 16 weeks of treatment. The comparison versus the placebo arm will be a secondary objective. The other secondary endpoints will be tolerance to donepezil, the severity and features of OIPN in each arm before and after treatment, related-comorbidities and quality of life. Fleming's one-stage design will be used for sample size estimation. This design yields a type I error rate of 0.0417 and power of 91% for a responder rate of at least 30% in donepezil arm. A total of 80 randomized patients is planned.

DISCUSSION

This study will allow, in the case of positive results, to initiate a phase 3 randomized and placebo-controlled (primary endpoint) clinical study to assess the therapeutic interest of donepezil to treat OIPN.

TRIAL REGISTRATION

NCT05254639 , clincialtrials.gov, Registered 24 February 2022.