Oxaliplatin can cause numbness, tingling, and pain in the hands and feet, with consequences for mobility, work, and quality of life. Researchers commonly assess these effects through patient questionnaires and clinical examinations. Although questionnaires capture patients'experiences, responses can be influenced by expectations, while detailed neurological testing can be difficult to incorporate into busy clinics and large trials. Neurofilament light chain, a structural protein in nerve fibers, enters the bloodstream following nerve injury and has emerged as a potential biomarker. However, further validation is needed to establish how reliably it reflects oxaliplatin-related neurotoxicity and whether it can measure responses to preventive interventions.
A study (DOI: 10.48130/ejcc-0026-0012) published in European Journal of Cancer Care on 24 August 2026 by Ellen M. Lavoie Smith's team, University of Alabama at Birmingham School of Nursing, reports preliminary evidence that sNfL tracks worsening neuropathy and correlates with established assessments after treatment.
Investigators conducted a prospective, longitudinal pilot study involving adults with stage II–III colorectal cancer scheduled to receive oxaliplatin-containing adjuvant chemotherapy. Participants were recruited at Birmingham's O'Neal Comprehensive Cancer Center and had no preexisting peripheral neurotoxicity or previous neurotoxic chemotherapy exposure. Assessments took place before treatment, midway through chemotherapy, at treatment completion, and three months after the final oxaliplatin dose. Trained research nurses used the Total Neuropathy Score–Nurse, which combines symptoms with neurological examination findings, and the six-item CIPN6 questionnaire, which assesses sensory symptoms. At each assessment, researchers also collected five milliliters of blood, separated and froze the serum, and measured sNfL using an enzyme-linked immunosorbent assay. Statistical analyses examined changes over time and associations among the measures, accounting for age, sex, race, and cumulative oxaliplatin dose. The participants had an average age of approximately 55 years; 19 were men. Mean sNfL concentrations rose from 23.8 picograms per milliliter before chemotherapy to 46.7 at treatment completion and 61.1 three months later. Mean nurse-assessed neuropathy scores increased from 0.5 to 2.6 and then 2.9, while mean CIPN6 scores rose from 6.6 to 11.7 and then 12.4. All three measures changed significantly over time, showing continued worsening after chemotherapy ended—a phenomenon known as “coasting.” At three months, sNfL showed moderate correlations with nurse-assessed neuropathy scores (r = 0.51) and patient-reported symptoms (r = 0.58). Adjusted analyses also supported associations between the biomarker and both neuropathy assessments. Together, these results indicate that rising blood concentrations reflected worsening neurotoxicity across different measurement approaches. Follow-up data availability varied by assessment, however, and the small observational study did not test a preventive intervention or establish whether early biomarker changes could predict later neuropathy.
The study supports further evaluation of sNfL as a monitoring measure alongside patient reports and clinical assessments. Larger, multisite studies must establish meaningful thresholds, standardize testing, and determine whether concentrations fall when an intervention reduces neurotoxicity. Faster testing methods would also be needed before results could guide chemotherapy decisions during routine visits. For now, the marker offers a promising research tool, with additional validation required before it could serve as the sole outcome measure in clinical trials.
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References
DOI
10.48130/ejcc-0026-0012
Original Source URL
https://doi.org/10.48130/ejcc-0026-0012
Funding information
This work is supported by funding from the University of Alabama at Birmingham Impact Funding Grant (Smith PI).
About European Journal of Cancer Care
European Journal of Cancer Care (e-ISSN 1365-2354) is an open-access, peer-reviewed journal dedicated to publishing original research on multiprofessional cancer care. The journal provides a forum for multiprofessional and service-user dialogue, and the reporting of original research or rigorous reviews within the field of cancer care both in Europe and internationally.