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Journal of Drug Delivery and Therapeutics

Open Access to Pharmaceutical and Medical Research

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Open Access Full Text Article                                                           Research Article

Enhancing QOL in Cancer Patients: An Observational Study on the Incidence and Severity of Platinum-Induced Peripheral Neuropathy at a Single Cancer Centre in Chennai

Bhavadharani R ¹, Sapthami Ramya V G ¹, Bhavadharini K ¹, Dr. Shailaja Krishnamoorthy ², Dr. Ram Prabu M P ³, Dr. Emmanuel C ⁴

¹ Pharm D, C. L. Baid Metha College of Pharmacy, Thoraipakkam, Chennai - 600097.

² MPharm, PhD., Professor and Head of Department of Pharmacy Practice, C. L. Baid Metha College of Pharmacy, Thoraipakkam, Chennai - 600097.

³ MBBS, MD, DM, Head of Medical Oncology, Gleneagles Health City Chennai (GHCC), Perumbakkam, Chennai - 600100

⁴ M.Phil, PhD, Director of Academics and Research, Gleneagles Health City Chennai (GHCC), Perumbakkam, Chennai - 600100

 

 

INTRODUCTION

The cancer burden is rising relentlessly both globally and in India, making the battle against it seem far from over. In India, the incidence of cancer cases was projected to increase from 1.46 million in 2022 to 1.57 million by 2025, with lung cancer and breast cancer remaining the most common sites of cancer incidence in males and females, respectively.¹ Cancer treatment involves various approaches, including surgery, immunotherapy, hormone therapy, radiotherapy, chemotherapy, and RNA-based therapies. Though chemotherapy is effective, it often falls short of eradicating the cancer cells and is accompanied by many side effects, significantly affecting the quality of life of cancer patients.²

Chemotherapy-induced peripheral neuropathy (CIPN) is a serious and often persistent adverse effect of certain chemotherapeutic agents, acting as a major dose-limiting factor in many first-line treatments and affecting 20–50% of patients at standard doses and nearly all at higher doses.³ It can lead to longer infusion times, dose reductions, or early termination of chemotherapy, negatively impacting treatment efficacy and patient survival.⁴ CIPN primarily manifests as sensory, motor, and autonomic deficits, with sensory symptoms—such as numbness, tingling, and pain—being the most common, typically starting in the hands and feet. Motor symptoms, like weakness and balance issues, are less frequent but can progress to paralysis, while autonomic symptoms are rare.⁵

Platinum-based chemotherapy agents like oxaliplatin, carboplatin, and cisplatin are known to cause CIPN, and the incidence and severity of neurotoxicity may vary among different platinum drugs.⁶ However, once neurotoxicity develops, the clinical presentation is generally similar for all three drugs, with only minor pattern differences.⁷ Most of the existing literature indicates that, among the three agents, cisplatin and oxaliplatin exhibit a greater neurotoxic potential compared with carboplatin. This difference in neurotoxicity is attributed to the reactivity of each specific platinum drug, particularly the liability of leaving groups as they interact with various biomolecules, which determines the severity of the toxicity.⁸ 

Numerous studies have examined the incidence of peripheral neuropathy associated with specific chemotherapeutic classes, such as taxanes.⁹ Others have focused on the overall incidence of peripheral neuropathy across specific chemotherapy regimens, and some have studied any one specific platinum drug.^10,11 However, despite the breadth of existing research on different classes of chemotherapy, there remains a notable lack of comprehensive data specifically addressing the incidence and severity of peripheral neuropathy associated exclusively with platinum-based regimens, and to identify which is most strongly associated with its development. Identifying this is crucial for developing new interventions or making early interventions aimed at improving the quality of life, particularly for cancer patients receiving a platinum-based regimen in India.

Our primary objective is to compare platinum-based regimens to evaluate the incidence and severity of peripheral neuropathy associated with each, aiming to identify regimens with higher neurotoxic potential. Additionally, as a secondary objective, we aim to address population heterogeneity by considering specific risk factors that may influence the incidence and severity of peripheral neuropathy, ensuring a more accurate and comprehensive analysis. These findings are expected to provide insights for improving prevention and management strategies in India.

METHODS AND MATERIALS

A prospective observational study was conducted at the Department of Medical Oncology, Gleneagles Health City Chennai (GHCC), India, over the period of six months, from September 2024 to February 2025. Ethical approval was obtained from the respective Institutional Ethics Committee (Approval ID: [BMHR/2024/0090]), and the study adhered to the Strengthening of the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for reporting observational research.

Study population

The study included 78 participants (aged ≥18 years) with a confirmed diagnosis of any origin of cancer who were prescribed platinum-based chemotherapy. While some degree of heterogeneity was expected due to the inclusion of participants with comorbidities such as diabetes mellitus, hypothyroidism, infections, autoimmune diseases, and lifestyle-related factors like smoking and alcohol use, these were not excluded. This approach was adopted to reflect real-world clinical scenarios, as such conditions are common among cancer patients and may influence the incidence and severity of peripheral neuropathy (PN). Participants who did not meet the inclusion criteria, had incomplete medical records, or did not provide informed consent were excluded from the study. The participant enrolment process had been summarised in Figure 1.

 

 

Figure 1

                 

 

Sample size and sampling

Based on expert opinion, assuming an outcome proportion of 20% in the study group, the sample size was calculated with a 95% confidence level, a 5% margin of error, and a 10% anticipated loss to follow-up. Using standard sample size estimation formulas for observational studies, the initial estimate was calculated to be 71 participants. After adjusting for the 10% loss to follow-up, the final sample size was determined to be 78. The sample size was determined based on a priori power analysis to ensure adequate statistical power. The study employed a stratified sampling method to ensure the representation of participants from key subgroups, namely: cisplatin, carboplatin, and oxaliplatin, with each group consisting of 26 participants. 

Data collection and assessment 

After obtaining informed consent, baseline data, including sociodemographic characteristics, clinical history, and chemotherapy details, were collected using a structured data collection form. The form was designed based on previous studies and literature to capture key information such as age, gender, BMI (Body Mass Index), ethnicity, social history, cancer diagnosis, stage, comorbidities, chemotherapy regimen, number of cycles, treatment plan, and the grade of PN. Neuropathy was assessed at baseline using the National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE) criteria. Participants were monitored throughout their chemotherapy regimen, with data collected on cycles completed, dose adjustments, and any additional treatments. Neuropathy assessments were repeated at each follow-up visit to track to identify PN and changes in severity.

Ethical considerations

The study protocol was approved by the Institutional Ethics Committee (Approval ID: [BMHR/2024/0090]). Written informed consent was obtained from all participants prior to enrolment.

Data analysis

Data analysis was performed using IBM SPSS Statistics version 23. Continuous variables were summarised as mean, standard deviation (SD), median, and range, while categorical data were presented as frequencies and percentages. The chi-square test or Fisher's exact test was applied to categorical variables, and binary logistic regression was used for continuous variables. Post hoc analysis, with standardised residuals > +2 or < -2, identified significant groups.

For neuropathy severity, the chi-square test or Fisher's exact test was employed for categorical variables and ordinal regression was used for continuous exposure variables. A p-value of <0.05 was considered statistically significant.

RESULTS

A total of 78 patients who received platinum-based chemotherapy were observed and followed up for six months to assess the incidence and severity of peripheral neuropathy (PN). An incidence of 18% of participants reported symptoms consistent with peripheral neuropathy, and the severity of these symptoms was assessed. In addition to estimating incidence and severity, the study aimed to explore potential risk factors associated with peripheral neuropathy.

Participants were nearly equally distributed by gender, with a mean age of 56.38 ± 13.66 years. The association between gender and age with the development of peripheral neuropathy was assessed to explore any relation between them, which was insignificant.  The mean BMI was 24.96 ± 4.62 kg/m², with most patients falling within normal or underweight. Due to cancer-related muscle loss, the presence of obesity was minimal in the study, allowing the study to primarily focus on other risk factors. Similarly, smoking and alcohol consumption history were evaluated with peripheral neuropathy. The study included only non-smokers and former smokers, as well as non-alcoholic and former alcoholic participants, enabling an analysis of past exposures and their potential influence on peripheral neuropathy. Although the study aimed to investigate ethnicity and family history as additional risk factors, all participants belonged to a single ethnic background (non-Chinese Asian), and none reported a family history of peripheral neuropathy. The sociodemographic, clinical, and treatment characteristics of the patients are summarised in Table I and Table II.

 

 

TABLE I- CHARACTERISTICS OF STUDY PARTICIPANTS
Socio-Demographic Characteristics of Study Participants
Variables		Categories		Frequency n(%) N=78
Gender		Male		32(41)
		Female		46(59)
Ethnicity		Non-Chinese Asian		78(100)
		Chinese		-
		Caucasian		-
Age in years, Mean ± SD				56.38 ±13.66
BMI, Mean ± SD				24.96 ± 4.62
Family history of PN		Yes		-
		No		78(100)
Smoking		Non-Smoker		74(94.9)
		Ex-Smoker		4(5.1)
		Smoker		-
Alcohol consumption		Alcoholic		-
		Non-Alcoholic		74(94.9)
		Ex-Alcoholic		4(5.1)
Clinical Characteristics of Study Participants
Co-Morbidities		Diabetes mellitus		26(56.5)
		Hypothyroidism		10(21.7)
		Infection		4(8.7)
		Autoimmune disease		2(4.3)
		DM + Hypothyroidism + Infection		4(8.7)
Stages of cancer		Stage 1		8(10.3)
		Stage 2		20(25.6)
		Stage 3		22(28.2)
		Stage 4		28(35.9)
TABLE II - CHEMOTHERAPY REGIMEN AND TREATMENT CHARACTERISTICS
Variables	Categories				Frequency n (%) N=78
Regimens	Nab-Paclitaxel + Carboplatin (Nab- PC)				4(5.1)
	Paclitaxel + Carboplatin (PC)				12(15.4)
	Gemcitabine + Carboplatin (GemCarbo)				3(3.8)
	Docetaxel + Carboplatin + Trastuzumab (DCH)				5(6.4)
	Pemetrexed + Carboplatin				2(2.6)
	Capecitabine + Oxaliplatin (CAPOX)				14(17.9)
	5-Fluorouracil + Leucovorin + Oxaliplatin + Docetaxel (FLOT)				5(6.4)
	5-Fluorouracil + Leucovorin + Oxaliplatin + Irinotecan  (FOLFIRINOX)				4(5.1)
	Oxaliplatin				3(3.8)
	Gemcitabine + Cisplatin (GC)				4(5.1)
	Cisplatin				15(19.2)
	Bleomycin + Etoposide + Cisplatin  (BEP)				4(5.1)
	Doxorubicin + Cisplatin				2(2.6)
	Paclitaxel + Ifosfamide + Cisplatin     (TIP)				1(1.3)
Platinum drugs	Carboplatin				26(33.33)
	Oxaliplatin				26(33.33)
	Cisplatin				26(33.33)
Other Neurotoxic  Drugs in the Study Regimen	Nab-Paclitaxel				5(6.5)
	Paclitaxel				13(16.9)
	Docetaxel				8(10.4)
	Drugs considered non-neurotoxic a				51(66.2)
Duration of chemotherapy	<1 months				7(9)
	<3 months				28(35.9)
	<6 months				43(55.1)
Neuroprotective agents	Mylin Plus				17(22.1)
	Pregabalin				4(5.2)
	Renerve plus				3(3.9)
	Mylin Plus + Pregabalin				9(11.7)
	Mylin Plus + Renerve Plus				1(1.3)
aIt includes Gemcitabine, Docetaxel, Trastuzumab, Pemetrexed, Capecitabine, 5-Fluorouracil, Leucovorin, Irinotecan, Bleomycin, Etoposide, Doxorubicin, Ifosfamide

 

 

The primary objective of the study was to assess the incidence of peripheral neuropathy (PN) in relation to different platinum-based chemotherapy agents. A statistically significant association was observed between platinum drugs and PN (Fisher’s Exact test, p = 0.032). Post hoc analysis using standardised residuals indicated a higher-than-expected incidence of PN with carboplatin (residual = +2.1).

A significant association was also found between the primary site of cancer and PN incidence (Fisher’s Exact test, p = 0.03). Post hoc analysis showed elevated standardised residuals for endometrial cancer (+3.3) and ovarian cancer (+2.4), suggesting these sites were major contributors to the observed association. The association between chemotherapy regimens and PN was significant (Fisher’s Exact test, p = 0.049), with the paclitaxel + carboplatin regimen contributing most prominently in post hoc analysis. Additionally, a significant relationship was identified between neurotoxic agents in the regimen and PN (Fisher’s Exact test, p = 0.001). Among these, paclitaxel showed the highest standardised residual, indicating a strong association with the occurrence of PN. Additionally, a statistically significant association was observed between comorbidities and the incidence of peripheral neuropathy (Fisher’s Exact test, p < 0.05). However, post hoc analysis did not identify any specific comorbidity as significantly contributing to this association. The statistical results have been summarised in Table III.

 

 

TABLE III - STATISTICAL ANALYSIS OF INCIDENCE OF PERIPHERAL NEUROPATHY
Factor	Univariate regression				Multivariate regression
	OR	95% CI	p-value	OR	95% CI	p-value
Platinum Drugs, Carboplatin (All other groups)a	6.353	(1.216, 33.191)	0.032*	0.033	(0.002, 10.369)	0.023*
Gender, Male (Female)	1.944	(0.551, 6.857)	0.301	4.637	(0.968, 22.207)	0.055
Age	0.965	(0.919, 1.014)	0.160	0.949	(0.9, 1.0)	0.52
BMI	1.067	(0.926, 1.228)	0.371	1.135	(0.960, 1.342)	0.139
Smoking, Smoker (All other groups)a	1.564	(0.151, 16.254)	0.708	0.177	(0.009, 3.569)	0.259
Alcohol consumption, Alcoholic (All other groups)a	0.639	(0.062, 6.644)	0.716	0.348	(0.020, 6.072)	0.470
Primary site of cancer, Ovary (All Other Groups)a	2.561	(1.896, 2.759)	0.03*	5.741	(0.567, 58.093)	0.139
Stage of Cancer, Stage 4 (All Other Groups)a	0.567	(0.132, 2.426)	0.444	0.104	(0.006, 1.652)	0.109
Comorbidities, Diabetes mellitus (All other groups)a	16.5	(1.353, 201.29)	0.017*	0.060	(0.003, 1.403)	0.08
Regimen, PC (All other groups)a	0.924	(0.846, 0.956)	0.049*	0.078	(0.008, 1.596)	0.09
Cumulative Dose - Carboplatin	0.996	(0.994, 0.999)	0.009	0.999	(0.998, 1.0)	0.123
Cumulative Dose - Oxaliplatin	1.003	(0.995, 1.011)	0.476	1.0	(0.998, 1.002)	0.787
Cumulative Dose - Cisplatin	1.017	(0.989, 1.045)	0.244	0.999	(0.998, 1.001)	0.748
Other Neurotoxic Drugs in the Study Regimen, Paclitaxel (All other groups)a	2.874	(1.585, 5.210)	0.001*	2.448	(2.154, 4.925)	0.048*
Duration of chemotherapy, Less than 1 month (All other groups)a	0.558	(0.202, 1.538)	0.259	0.033	(0.006, 10.376)	0.246
Neuroprotective agents, Mylin Plus (All other groups)a	0.486	(0.189, 2.125)	0.411	0.126	(0.086, 0.569)	0.579
*p-value of <0.05 considered significant a Reference variable groups are indicated in parentheses. The phrase 'all other groups' refers to the combined reference group, where multiple categories are merged into a single group for comparison against the case group.

 

 

While platinum drugs and several clinical factors were significantly associated with the incidence of PN, no statistically significant relationship was found with the severity of neuropathy. Severity was assessed using the National Cancer Institute’s Common Terminology Criteria for Adverse Events (NCI-CTCAE v5.0), but no significant differences were observed across drug types, regimens, or other variables (p > 0.05). Though not significant, the patients receiving oxaliplatin and cisplatin showed only grade 1 and grade 2, while patients receiving carboplatin showed severity of all grades, and details are presented in Table IV. 

 

 

 

 

This suggests that while certain agents and factors increase the likelihood of developing PN, they may not influence the grade or clinical severity of symptoms as per NCI-CTCAE classification.

DISCUSSION

In our study, the incidence of peripheral neuropathy (PN) was found to be 18%, demonstrating both clinical relevance and statistical significance. Compared to previous studies, the incidence observed in our study was lower.¹² Our findings also revealed significant variation in the incidence of peripheral neuropathy among different platinum-based drugs. Notably, carboplatin showed a higher association with PN compared to oxaliplatin and cisplatin. This finding contrasts with earlier reports, such as the study by Feng G et al., which identified oxaliplatin as the primary contributor to PN.¹³ Following a closer analysis, this discrepancy may not be solely due to carboplatin itself, but rather to the combination of drugs used in the chemotherapy regimens. Many regimens in our study included multiple anti-cancer drugs, some of which are known to be neurotoxic, making it important to consider the contribution of each component. When the individual associations of other neurotoxic agents in the regimen with PN were examined, paclitaxel was found to have a stronger association with increased incidence of PN compared to other drugs. This is consistent with existing literature, including studies by Sun S et al., which highlight the substantial neurotoxicity associated with paclitaxel alone.¹⁴

Further evaluation revealed that the paclitaxel-carboplatin (PC) regimen, in particular, was significantly associated with both the incidence and severity of PN which was similar in reporting of the study by Guastalla JP et al.¹⁵ These findings suggest that the higher neuropathy rates observed with the PC regimen may be due to a combined or additive neurotoxic effect of both paclitaxel and carboplatin, rather than carboplatin alone. This may explain why carboplatin was more significantly associated with neuropathy in our study.

Moreover, the frequent use of the paclitaxel + carboplatin regimen, especially in gynaecological cancers, may therefore explain the higher incidence of PN noted in patients with endometrial and ovarian cancer in our study.¹⁶ While comorbid conditions as a group were found to be associated with PN, no single comorbidity appeared to significantly influence the outcome individually, suggesting a more complex interplay of general health status and treatment response.

In our study, the severity of PN, as assessed by NCI-CTCAE grading, did not differ significantly among the platinum agents, treatment regimens, or other variables analyzed. Though insignificant, our study revealed a higher number of mild cases (Grades 1 and 2) of peripheral neuropathy. This result is consistent with the study conducted by Ashok V. Kalidindi et al., which also reported that most cases of peripheral neuropathy were of mild severity.¹⁷

The predominance of mild severity could be due to the shorter period of our study. The absence of long-term follow-up is a crucial limitation, particularly given that peripheral neuropathy is often a long-term side effect of chemotherapy. The study's six-month follow-up period was insufficient to capture the full scope of the long-term effects of chemotherapy on peripheral neuropathy. The study’s findings are also limited by its single-centre design, as the research was carried out at only one clinical site. 

Overall, our study highlights the increased risk of PN with combination regimens containing carboplatin and paclitaxel, especially in patients with ovarian and endometrial cancers. These findings underline the importance of careful monitoring and early preventive measures in cancer patients. 

CONCLUSION

The study explored and analysed both the incidence and severity of peripheral neuropathy (PN) in patients receiving platinum-based chemotherapy. It was concluded that in the study population, the paclitaxel + carboplatin (PC) regimen was significantly associated with an increased incidence of PN, particularly in female patients with ovarian and endometrial cancers. These findings underscore the importance of implementing tailored neuroprotective strategies from the start of the chemotherapy cycle, particularly when prescribing the paclitaxel and carboplatin (PC) regimen. Early initiation of neuroprotective measures, coupled with vigilant monitoring of high-risk patients, can help mitigate the development of peripheral neuropathy. Additionally, establishing a stewardship framework to systematically document symptoms and facilitate timely interventions will further enhance patient outcomes and quality of life during and after chemotherapy.

Financial Support and Sponsorship: No financial support or sponsorship was received for the conduct of this study.

Conflict of Interest: The authors declare no conflicts of interest.

Acknowledgement: The authors have no acknowledgements to declare. Work is attributed to the Department of Medical Oncology, Gleneagles Health City Chennai (GHCC), Perumbakkam, Chennai – 600100

REFERENCES

1. Sathishkumar K, Chaturvedi M, Das P, Stephen S, Mathur P. Cancer incidence estimates for 2022 & projection for 2025: Result from National Cancer Registry Programme, India. Indian J Med Res. 2022 Oct-Nov;156(4&5):598-607. PMCid:PMC10231735 https://doi.org/10.4103/ijmr.ijmr_1821_22 PMid:36510887 

2. Behranvand N, Nasri F, Zolfaghari Emameh R, et al. Chemotherapy: a double-edged sword in cancer treatment. Cancer immunology, immunotherapy. 2022 Mar;71(3):507-26. https://doi.org/10.1007/s00262-021-03013-3 PMid:34355266

3. Bae EH, Greenwald MK, Schwartz AG. Chemotherapy-induced peripheral neuropathy: mechanisms and therapeutic avenues. Neurotherapeutics. 2021 Oct 1;18(4):2384-96. https://doi.org/10.1007/s13311-021-01142-2 PMid:34676514 PMCid:PMC8804039

4.     Burgess J, Ferdousi M, Gosal D, et al. Chemotherapy-induced peripheral neuropathy: epidemiology, pathomechanisms and treatment. Oncology and therapy. 2021 Dec 1:1-66.

5. Starobova H, Vetter I. Pathophysiology of chemotherapy-induced peripheral neuropathy. Frontiers in molecular neuroscience. 2017 May 31;10:174. https://doi.org/10.3389/fnmol.2017.00174 PMid:28620280

6. Brozou V, Vadalouca A, Zis P. Pain in platin-induced neuropathies: a systematic review and meta-analysis. Pain and Therapy. 2018 Jun;7:105-19. https://doi.org/10.1007/s40122-017-0092-3 PMid:29196945 PMCid:PMC5993684

7. Calls A, Carozzi V, Navarro X, Monza L, Bruna J. Pathogenesis of platinum-induced peripheral neurotoxicity: Insights from preclinical studies. Experimental Neurology. 2020 Mar 1;325:113141. https://doi.org/10.1016/j.expneurol.2019.113141 PMid:31865195

8. Hu X, Jiang Z, Teng L, Yang H, Hong D, Zheng D, Zhao Q. Platinum-induced peripheral neuropathy (PIPN): ROS-related mechanism, therapeutic agents, and nanosystems. Frontiers in Molecular Biosciences. 2021 Nov 24;8:770808. https://doi.org/10.3389/fmolb.2021.770808 PMid:34901160 PMCid:PMC8652200

9. Song SJ, Min J, Suh SY, et al. Incidence of taxane-induced peripheral neuropathy receiving treatment and prescription patterns in patients with breast cancer. Support Care Cancer. 2017 Jul;25(7):2241-2248. https://doi.org/10.1007/s00520-017-3631-x PMid:28204996

10. Pourghasemian M, Mehr AD, Molaei M, Habibzadeh A. Outcome of FOLFOX and modified DCF chemotherapy regimen in patients with advanced gastric adenocarcinoma. Asian Pacific Journal of Cancer Prevention: APJCP. 2020 Aug;21(8):2337. https://doi.org/10.31557/APJCP.2020.21.8.2337 PMid:32856863 PMCid:PMC7771915

11. Mohammed S, Othieno-Abinya NA, Amayo E, et al. Prevalence and predictors of Cisplatin-induced peripheral neuropathy at the kenyatta national hospital. Journal of global oncology. 2019 Sep;5:1-6. https://doi.org/10.1200/JGO.19.00097 PMid:31479343 PMCid:PMC6733204

12. Shah A, Hoffman EM, Mauermann ML, Loprinzi CL, Windebank AJ, Klein CJ, Staff NP. Incidence and disease burden of chemotherapy-induced peripheral neuropathy in a population-based cohort. Journal of Neurology, Neurosurgery & Psychiatry. 2018 Jun 1;89(6):636-41. https://doi.org/10.1136/jnnp-2017-317215 PMid:29439162 PMCid:PMC5970026

13. Feng G, Zhou X, Chen J, Li D, Chen L. Platinum drugs-related safety profile: the latest five-year analysis from FDA adverse event reporting system data. Frontiers in oncology. 2023 Jan 11;12:1012093. https://doi.org/10.3389/fonc.2022.1012093 PMid:36713566 PMCid:PMC9875054

14. Sun S, Tang L, Zhang J, et al. Cisplatin improves antitumor activity of weekly nab-paclitaxel in patients with metastatic breast cancer. International journal of nanomedicine. 2014 Mar 19:1443-52. https://doi.org/10.2147/IJN.S58275 PMid:24672237 PMCid:PMC3964033

15. Guastalla JP, Pujade-Lauraine E, Weber B, Cure H, Orfeuvre H, Mousseau M, Vincent P, Dieras V, Tubiana-Mathieu N, Jacquin JP, Mignot L. Efficacy and safety of the paclitaxel and carboplatin combination in patients with previously treated advanced ovarian carcinoma: a multicenter GINECO (Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens) phase II study. Annals of oncology. 1998 Jan 1;9(1):37-43. https://doi.org/10.1023/A:1008211909585 PMid:9541681

16. Markman M, Kennedy A, Webster K, Kulp B, Peterson G, Belinson J. Neurotoxicity associated with a regimen of carboplatin (AUC 5-6) and paclitaxel (175 mg/m2 over 3 h) employed in the treatment of gynecologic malignancies. Journal of cancer research and clinical oncology. 2001 Jan;127(1):55-8. PMCid:PMC12165049 https://doi.org/10.1007/s004320000157 PMid:11206272 

17. Kalidindi AV, Dubashi B, Jayanthi M, Shewade DG. Efficacy and safety of capecitabine and oxaliplatin (CAPOX) treatment in colorectal cancer: An observational study from a tertiary cancer center in South India. Indian Journal of Cancer. 2022 Jan 1;59(1):73-9. https://doi.org/10.4103/ijc.IJC_618_19 PMid:33402602