Gadoxetic acid-enhanced magnetic resonance imaging predicts early nab-paclitaxel-induced peripheral neuropathy during pancreatic cancer treatment: A pilot study

Nab-paclitaxel (nab-PTX) is transported by organic anion-transporting polypeptide (OATP)1B1 and OATP1B3. Chemotherapy-induced peripheral neuropathy (CIPN) is a representative adverse event associated with gemcitabine plus nab-PTX (GnP) in patients with pancreatic cancer. Gadoxetic acid is also transported by OATP1B1 and OATP1B3. We aimed to assess whether the enhancement effect of gadoxetic acid-enhanced magnetic resonance (MR) imaging could predict the development of CIPN for GnP. This study evaluated 27 patients with pancreatic cancer who underwent gadoxetic acid-enhanced MR imaging prior to GnP treatment. The contrast enhancement index (CEI), a measure of liver enhancement on hepato-biliary images, was measured. Plasma concentrations of paclitaxel at 0.5, 6, and 24 h after first administration were also determined in 13 patients. Sixteen of the twenty-seven patients (59.3 %) developed ≥ grade 1 CIPN during the first 8 weeks. We found a negative relationship between the CEI and area under the plasma concentration curve of PTX (r = -0.729, p = 0.003). In multivariate analysis, a CEI <1.84 and concomitant diabetes mellitus were independent predictors of CIPN development (hazard ratio, 5.37, p = 0.027; hazard ratio, 3.68, p = 0.012, respectively). Gadoxetic acid-enhanced MR imaging could be useful in predicting the development of CIPN during GnP therapy.