The oxaliplatin agent of Folfirinox is neurotoxic to peripheral nerves of the hands, feet and throat. Close to a decade ago, someone with an understanding of anatomy and physiology proposed cold therapy which causes constriction of capillary beds temporarily preventing the oxaliplatin from coming into contact with peripheral nerves when most concentrated as it is being infused. By causing constriction of blood flow during the 90 minutes of the infusion, the nerves are protected. The cold mitts and booties are then removed and the diluted oxaliplatin circulates and is active and toxic to tumor cells for several days post infusion.

When I heard of pushback from a physician or an N.P., it was clearly obvious they had no familiarity of the technique and poor understanding of the physiologic response to cold. This was usually health care workers in smaller hospitals that don’t have expertise in treating pancreatic cancer. Sadly a technique that has shown benefit in helping as much as 50% was denied them. The larger centers are more amenable in letting patients use the technique and there is even a large clinical study at a major pancreas center in the US. When cold therapy is used from the start, it leads to a better patient experience of tolerability and the patient able to get the full number of cycles with oxaliplatin to derive maximum benefit.

NEUROPATHY PREVENTION WHEN TAKING FOLFIRINOX/ICING

Feature story on cold therapy
https://letswinpc.org/disease-management/ice-prevent-neuropathy/
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https://www.uspharmacist.com/article/ice-chips-prevent-hyperalgesia-with-oxaliplatin
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7810270/
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https://learn.colontown.org/topic/managing-neuropathy-and-cold-sensitivity/
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https://ascopubs.org/doi/abs/10.1200/JCO.2020.38.15_suppl.e16140
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https://paltown.org/icing/
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https://letswinpc.org/research/more-research-needed-for-neuropathy/
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https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-cold-cap-therapy-can-reduce-hair-loss-caused-by-chemotherapy/
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Link to booties and mitts for cold therapy. https://a.co/d/ipJy8Hq
Two sets of booties/mitts are necessary for the cold to last through the infusion cycle.
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Article from Iris Oncology: https://www.breastcancer.org/research-news/hand-cooling-compression-nearly-halve-risk-of-neuropathy-from-chemotherapy
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Article on exercise in lessening CIPN
https://pubmed.ncbi.nlm.nih.gov/38559210/