Predictors of chemotherapy-induced peripheral neuropathy among breast cancer patients treated with taxanes.

Abstract

90 Background: Breast cancer is one of the most common types of cancer. Taxanes are used to treat both early and metastatic breast cancer. Chemotherapy-induced peripheral neuropathy (CIPN) is its most common dose-limiting side effect that is debilitating and that could alter the treatment outcomes. This study aims to assess the predictors in the development and severity of CIPN. Methods: A retrospective review of 229 breast cancer patients was done to identify if age, BMI, race, smoking history, alcohol use, diabetes, chronic kidney disease (CKD), estrogen (ER), progesterone receptor (PR) and HER2 status, type and dose of taxane were predictors in the development and severity of CIPN. Patients who had incomplete data and baseline neuropathy were excluded from the study. Severity of peripheral neuropathy was graded from 1 to 4. Pearson Chi-square and T-test were done to determine the presence of statistical difference in the development and severity of CIPN among the above predictors. Odds ratio was computed using logistic regression analysis. Results: Among the 229 patients in this study, 158 (69%) developed neuropathy, 90 (57%) of whom had grade 1 neuropathy. Majority of the subjects in this study were African American (75.1%). Age, BMI, race, smoking, alcohol use, CKD and diabetes did not show any statistical significance as predictors of development and severity of CIPN (p > 0.05). Patients with ER+/PR- and ER+/PR+ had lower odds of developing neuropathy with OR 0.36 (p = 0.006) and 0.44 (p = 0.026) respectively. HER2 positivity was associated with higher chances of neuropathy (OR 2.11, p = 0.028). Paclitaxel was associated with higher chances of neuropathy compared to docetaxel (OR 2.89, p = 0.02). Dose of paclitaxel did not show any difference in the occurrence of CIPN. Those treated with paclitaxel had more severe neuropathy (p = 0.04). Conclusions: Positive ER and PR receptors have lower chances of developing CIPN. HER2 positivity is a predictor in the development of neuropathy. Paclitaxel is more neurotoxic than docetaxel. Age, race, BMI, smoking, alcohol use, diabetes and CKD were not predictors in the development and severity of CIPN.