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Incapacitating autonomic neuropathy precipitated by taxol
S M Jerian1, G A Sarosy, C J Link
1Medicine Branch, National Cancer Institute, Bethesda, Maryland 20892.
Gynecologic Oncology
|November 1, 1993
Summary
Taxol chemotherapy can cause objective autonomic neuropathy, leading to severe orthostatic hypotension in patients. This condition, characterized by abnormal autonomic function tests, improved with fludrocortisone treatment.
Area of Science:
- Oncology
- Neurology
- Pharmacology
Background:
- Taxol (paclitaxel) is a significant chemotherapy agent for breast and ovarian cancers.
- Its toxicity profile is still being defined with evolving dosing and scheduling.
- Autonomic neuropathy is a potential, though not well-documented, side effect.
Observation:
- Two patients, with and without diabetes, developed severe orthostatic hypotension after Taxol infusion.
- Symptoms of autonomic dysfunction were absent before Taxol therapy.
- Other causes of orthostatic hypotension were excluded.
Findings:
- This study presents the first evidence of Taxol-induced quantifiable, objective autonomic neuropathy.
- Abnormal results were observed in multiple noninvasive autonomic function tests (tilt test, Valsalva ratio, heart rate variability, hand grip test).
- Patients showed marked improvement in orthostatic hypotension with fludrocortisone treatment.
Implications:
- Taxol-induced autonomic neuropathy is a clinically relevant toxicity.
- Noninvasive autonomic testing should be considered in patients on Taxol experiencing weakness and orthostasis.
- Understanding and monitoring this neuropathy can improve patient management and treatment outcomes.