Cryotherapy for Prevention of Taxane-Induced Peripheral Neuropathy: A Meta-Analysis.

Junting Jia,Raghav Sundar,Aishwarya Bandla,Zhiying Hao,Yimeng Guo

doi:10.3389/fonc.2021.781812

Abstract

PurposeTaxanes are widely used in gynecological cancer therapy, however, taxane-induced peripheral neuropathy (TIPN) limits chemotherapy dose and reduces patients’ quality of life. As a safe and convenient intervention, cryotherapy has been recommended as a promising intervention in the recent clinical guidelines for the prevention of TIPN. Although there are a considerable number of studies which explored the use of cryotherapy in preventing chemotherapy-induced peripheral neuropathy (CIPN), there is insufficient large-scale clinical evidence. We performed a meta-analysis on the current available evidence to examine whether cryotherapy can prevent TIPN in cancer patients receiving taxanes.MethodsWe searched databases including PubMed, Embase, and Cochrane from inception to August 3, 2021 for eligible trials. Clinical trials that examined the efficacy of cryotherapy for prevention of TIPN were included. The primary outcome was the incidence of TIPN, and secondary outcomes were incidence of taxane dose reduction and changes in nerve conduction studies. The meta-analysis software (RevMan 5.3) was used to analyze the data.ResultsWe analyzed 2250 patients from 9 trials. Assessments using the Common Terminology Criteria for Adverse Events (CTCAE) score showed that cryotherapy could significantly reduce the incidence of motor and sensory neuropathy of grade≥2 (sensory: RR 0.65, 95%CI 0.56 to 0.75, p<0.00001; motor: RR 0.18, 95% CI [0.03, 0.94], p=0.04). When evaluated using the Patient Neuropathy Questionnaire (PNQ), cryotherapy demonstrated significant reduction in the incidence of sensory neuropathy (RR 0.11, 95% CI 0.04 to 0.31], p<0.0001), but did not show significant reduction in the incidence of motor neuropathy (RR 0.46, 95% CI 0.11 to 1.88, p=0.28). Cryotherapy was associated with reduced incidences of taxane dose reduction due to TIPN (RR 0.48, 95% CI [0.24, 0.95], p=0.04) and had potential to preserve motor nerves.ConclusionsCryotherapy is likely to prevent TIPN in patients receiving taxanes. High quality and sufficient amount of evidence is warranted.

Highlights

Taxanes are extensively used as first-line chemotherapy agents in the treatment of many types of cancer including breast, ovarian, prostate, gastric, head-and-neck cancers, and non-small cell lung cancer
Assessments using the Common Terminology Criteria for Adverse Events (CTCAE) score showed that cryotherapy could significantly reduce the incidence of motor and sensory neuropathy of grade≥2
When evaluated using the Patient Neuropathy Questionnaire (PNQ), cryotherapy demonstrated significant reduction in the incidence of sensory neuropathy (RR 0.11, 95% confidence interval (CI) 0.04 to 0.31], p

Summary

Introduction

Taxanes are extensively used as first-line chemotherapy agents in the treatment of many types of cancer including breast, ovarian, prostate, gastric, head-and-neck cancers, and non-small cell lung cancer. As one of the most common non-hematologic adverse effects, taxane-induced peripheral neuropathy (TIPN) has very high incidence ranging from 11 to 87% and severely impairs patients’ quality of life. TIPN primarily alters sensation in the extremities, with numbness, tingling, or pain in the fingertips and toes. It presents as motor nerve impairments with significant weakness in the limbs, which may put patients at high risks of falling, or trouble sensing tiny objects [1, 2]. There are no agents recommended for prevention of chemotherapy induced peripheral neuropathy (CIPN) in the clinical practice guidelines from the American Society of Clinical Oncology and the European Society for Medical Oncology [4, 5]. Due to the lesser adverse effects, nonpharmacological interventions such as exercise, yoga, acupuncture and cryotherapy are being investigated for their role in prevention of CIPN in clinical trials, some resulting in reduced CIPN incidence to a certain extent [1]

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