Abstract
BackgroundPaclitaxel induced peripheral neuropathy (PIPN) is a major debilitating side effect of paclitaxel in patients with breast cancer with no fully known mechanisms. The aim of the study was to find out the possible risk factors for PIPN.MethodsEligible patients with node positive breast cancer undergoing chemotherapy with paclitaxel were assessed. They belonged to an initial randomized controlled trial in which the effectiveness of omega-3 fatty acids in preventing and reducing severity of PIPN was evaluated (protocol ID: NCT01049295). Reduced total neuropathy score (r-TNS) was used for measuring PIPN. All analyses were performed adjusting for intervention effect. The association between age, BMI, BSA, pathological grade, molecular biomarkers and PIPN was evaluated.ResultsFifty-seven patients with breast cancer were investigated. Age was significantly associated with risk of PIPN (RR:1.50, P value = .024). Body mass index and BSA had significant association with severity of PIPN (B:1.28, P = .025; and B: 3.88, P = .010 respectively). Also, BSA showed a significant association with the risk of PIPN (RR: 2.28, P = .035; B: 3.88, P = .035). Incidence and severity of PIPN were much more pronounced in progesterone receptor positive (PR+) patients (RR:1.88, P = .015 and B:1.54, P = .012). Multivariate analysis showed that age and the status of PR+ were independent risk factor for incidence and the status of PR+ was the only independent risk factor for severity of PIPN.ConclusionAge, BSA and the status of PR+, should be considered as the risk factors for PIPN before commencement of chemotherapy with paclitaxel in patients with breast cancer. Older patients, those with greater BSA and PR+ patients may need closer follow up and more medical attention due to greater incidence and severity of PIPN.
Highlights
Paclitaxel induced peripheral neuropathy (PIPN) is a major debilitating side effect of paclitaxel in patients with breast cancer with no fully known mechanisms
Patients The results of the current study were obtained from a randomized double-blind placebo controlled trial, in which we studied the prophylactic effect of n-3 polyunsaturated fatty acids on incidence and severity of PIPN in female patients with a node positive breast cancer undergoing chemotherapy with 4 courses of 175 mg/ m2paclitaxel,(protocol ID: NCT01049295) [4]
Age, body surface area (BSA) and progesterone receptor status were associated with PIPN while in multivariate analysis, age and Progesterone receptor (PR) status were remained as the independent risk factors for the incidence of PIPN and PR+ status was the only predictor of PIPN severity
Summary
Paclitaxel induced peripheral neuropathy (PIPN) is a major debilitating side effect of paclitaxel in patients with breast cancer with no fully known mechanisms. The aim of the study was to find out the possible risk factors for PIPN. Paclitaxel induced peripheral neuropathy (PIPN), is the main dose-limiting and long lasting side effect of paclitaxel, with no fully understood mechanisms. Microtubules aggregation in axons and Schwan cells maybe underlying the sensory axonal peripheral neuropathy due to paclitaxel, while motor and autonomic nervous system are less affected [1,2,3]. Body mass index (BMI), and body surface area (BSA) pathological grade and molecular biomarkers may Ghoreishi et al BMC Cancer (2018) 18:958 tailored to the individual patients based on their characteristics
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