Utility of Vibration Perception Thresholds as a Biomarker of Chemotherapy-Induced Peripheral Neuropathy: A Systematic...

Chemotherapy-induced peripheral neuropathy (CIPN) is a common, debilitating, and treatment-limiting adverse effect of many agents used for cancer treatment. There is currently no gold-standard diagnostic criterion nor a widely accepted method for accurate and early identification of CIPN. Vibration perception threshold (VPT), which reflects large-fibre nerve function, has been proposed as a potential biomarker for CIPN.

A systematic review and meta-analysis was pre-registered and conducted by searching PubMed, EMBASE, Scopus, CENTRAL, and Web of Science databases from inception to November 2024. The primary outcome was the change in VPT following neurotoxic chemotherapy compared to the baseline/control group. PROSPERO CRD42024584611.

Thirty-one studies involving 1635 participants were included in the final analysis. There was a moderate-to-large increase of VPT following chemotherapy in both the hands (pooled SMD = 0.75, 95% CI [0.52, 0.97]) and feet (SMD = 0.69 95% CI [0.50, 0.88]). Heterogeneity of effects was larger in the hands (I² = 77.10%) than the feet (I² = 69.10%). Meta-regression showed that combination treatment with taxane and platinum agents produced a greater increase in VPT than either alone. Few studies (n = 5) investigated VPT changes specifically in patients diagnosed with CIPN limiting the ability to assess its utility as a biomarker.

This study demonstrates consistent increases in VPT (loss of sensitivity) following chemotherapy. Future studies should incorporate clear CIPN diagnostic criteria, comparative analyses between patients with and without CIPN, and longitudinal testing to determine the utility of VPT as an early biomarker of neurotoxicity.

This review demonstrates that vibration perception threshold (VPT) consistently worsens following chemotherapy, with moderate pooled effect sizes. Comparable changes were observed in both the hands and feet, and combination therapy with taxane and platinum agents was associated with greater deterioration in vibration perception measured in the hand. Together, they support VPT as a promising objective measure that can contribute to the assessment of peripheral neurotoxicity, with hand-based testing potentially offering a practical and sensitive site for assessment.