Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting adverse reaction in cancer patients treated with several cytotoxic anticancer agents including paclitaxel. Duloxetine, an antidepressant known as a serotonin-noradrenalin reuptake inhibitor, is the only agent that has moderate evidence for the use to treat painful CIPN. The present retrospective cohort study aimed to analyze risk factors for paclitaxel-induced peripheral neuropathy (PIPN), and investigate ongoing prescription drug use for PIPN in Japan. Female breast and gynecologic cancer patients who underwent paclitaxel-based chemotherapy at a single center in Japan between January 2016 and December 2019 were enrolled in this study. Patients' information obtained from electronic medical records were statistically analyzed to test possible risk factors on PIPN diagnosis. Patients' age, total paclitaxel dose, the history of female hormone-related diseases, hypertension and body mass index (BMI), but not additional platinum agents, were significantly associated with increased PIPN diagnosis. Drugs prescribed for PIPN included duloxetine, pregabalin, mecobalamin and Goshajinkigan, a polyherbal medicine, regardless of poor evidence for their effectiveness against CIPN, and were greatly different between breast and gynecologic cancer patients diagnosed with PIPN at the departments of Surgery and Gynecology, respectively. Thus, older age, greater total paclitaxel dose, the history of estrogen-related diseases, hypertension and BMI are considered risk factors for PIPN in paclitaxel-based chemotherapy of female cancer patients. It appears an urgent need to establish a guideline of evidence-based pharmacotherapy for PIPN.
Highlights
Our retrospective cohort study showed that older age and increased total paclitaxel dose were associated with increases in peripheral neuropathy (PIPN) diagnosis in female breast and gynecologic cancer patients, in agreement with the previous reports [16, 29,30,31]
In paclitaxel-treated female breast and gynecologic cancer patients, older age and increased total paclitaxel dose were significantly associated with the incidence of PIPN, and the history of female hormone-related disease, hypertension and body mass index (BMI) had significant impact on PIPN development
Additional administration of platinum agents had no significant impact on PIPN diagnosis
Summary
Cancer chemotherapy with anti-cancer drugs, such as taxanes, platinum-containing agents, vinca alkaloids and proteasome-inhibiting agents including bortezomib, often causes. The moderate usefulness of duloxetine for treatment of CIPN in cancer patients treated with various cytotoxic chemotherapeutics including paclitaxel has been supported by clinical trials in Japan [19, 20]. Apart from opioids and non-steroidal anti-inflammatory drugs (NSAIDs) that are often used to treat cancer pain, vitamin B12, pregabalin and Goshajinkigan, a Chinese polyherbal medicine, in addition to duloxetine, are commonly prescribed for treatment of CIPN in Japan [21], there is poor evidence for their effectiveness against CIPN [17, 22,23,24]. We retrospectively analyzed the association of various factors including older age, cumulative dose of paclitaxel and addition of platinum agents with PIPN diagnosis in female breast or gynecologic cancer survivors who underwent paclitaxel-based chemotherapy at Kindai University Hospital in Osakasayama city, Japan, and examined current trends in prescription drug use to treat PIPN
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