Neuropathy In Breast Cancer Patients Research Articles

Relation between Vitamin D Level and Severity of Paclitaxel-Induced Peripheral Neuropathy in Breast Cancer Patients

Relation between Vitamin D Level and Severity of Paclitaxel-Induced Peripheral Neuropathy in Breast Cancer Patients

Comparative Study of the Effects of Duloxetine and Venlafaxine on Acute Symptomatic Taxane-induced Neuropathy in Breast Cancer Patients: A Randomized Clinical Trial.

Chemotherapeutic agents have the potential to induce neurotoxicity, resulting in a range of symptoms, including mild paresthesia, neuropathic pain, pronounced ataxia, and significant impairment. Taxane-induced neuropathy (TIN) is a prevalent adverse effect and a significant constraint of Taxane-based chemotherapy protocols in treating breast cancer. In this current study, we aim to compare the effects of Venlafaxine and Duloxetine in taxane-induced Neuropathy as well as the quality of life, Depression, and Anxiety in Breast cancer Patients. The present study investigated breast cancer patients who experienced acute neuropathic pain after receiving paclitaxel treatment, a chemotherapeutic agent. The participants were allocated randomly into two groups, one receiving Venlafaxine and the other receiving Duloxetine. The participants underwent assessments for anxiety, depression, pain, neuropathy, quality of life, and neuropathic pain through the administration of questionnaires at the commencement of the study and after ten weeks following the intervention. Both groups exhibited decreased neuropathic pain, with the venlafaxine group significantly reducing McGill's pain score. Although, the result is not suggestive of a difference between venlafaxine and duloxetine impact on any variables scores. Duloxetine and Venlafaxine effectively treat neuropathic symptoms such as paraesthesia, tingling, and itching. Venlafaxine is also beneficial for relieving pain associated with neuropathy.This trial was retrospectively registered on 1.1.2023 at irct.ir (trial registration ID: IRCT20220115053723N1). URL: https://www.irct.ir/trial/62540/pdf.

Efficacy of metformin in prevention of paclitaxel-induced peripheral neuropathy in breast cancer patients: a randomized controlled trial.

Background: Paclitaxel-induced peripheral neuropathy (PN) is a serious clinical problem with no approved drug for prevention. This study aimed to examine the neuroprotective effect of metformin against paclitaxel-induced PN in breast cancer patients. Methods: Patients with confirmed breast cancer diagnosis who were planned to receive paclitaxel were randomized to receive either metformin or placebo. Both groups received the standard chemotherapy protocol for breast cancer. Patients started metformin/placebo 1week before paclitaxel initiation and continued study interventions thereafter for nine consecutive weeks. The primary outcome was the incidence of development of grade two or more paclitaxel-induced sensory PN. The PN was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE). Patients' quality of life (QoL) was assessed by the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACTGOG-Ntx) subscale. Pain severity was measured by the Brief Pain Inventory Short Form (BPI-SF). Serum levels of nerve growth factor (NGF) and neurotensin (NT) were measured at baseline and at the end paclitaxel treatment. Results: A total of 73 patients (36 in the metformin arm and 37 in the control arm) were evaluated. The cumulative incidence of development of grade two or more PN was significantly lower in the metformin arm (14 (38.9%) than the control arm (28 (75.7%); p = 0.001). At the end of paclitaxel treatment, patients' QoL was significantly better in the metformin arm [median (IQR) FACTGOG-Ntx subscale of (24.0 (20.5-26.5)] compared to the control arm (21.0 (18.0-24.0); p = 0.003). The metformin arm showed lower "average" and "worst" pain scores than those detected in the control arm. At the end of the paclitaxel treatment, there was a significant difference in the median serum NGF levels between the two arms, favoring metformin (p < 0.05), while NT serum levels were deemed comparable between the two study arms (p = 0.09). Conclusion: The use of metformin in breast cancer patients offered a marked protection against paclitaxel-induced PN, which translated to better patient QoL. Clinical Trial Registration: https://classic.clinicaltrials.gov/ct2/show/NCT05351021, identifier NCT05351021.

The motivation of breast cancer patients to participate in a national randomized control trial

PurposeClinical trials are essential for development of better cancer care. Therefore, patient willingness to participate in these trials is important. The aim of this study was to assess motivation and thoughts of breast cancer patients concerning participation in a clinical trial.MethodsTwenty-one patients participated in two semi-structed interviews about participating in a clinical trial testing the efficacy of cryotherapy for the prevention of chemotherapy-induced peripheral neuropathy in breast cancer patients treated with paclitaxel. The interviews took place before and after the intervention and were coded and categorized following the steps in Braun & Clarke’s thematic analysis to identify motivational factors and experiential themes.ResultsFour overarching themes were identified: (1) reasons to participate in the trial, (2) personal resources, (3) safety, and (4) experience of the randomization. The most frequent reason for participating in the trial was to support research and help others, but many also participated hoping to receive the intervention treatment. The study showed that a surplus of personal resources played an important role when the patients decided to participate in the trial. Differences were found between patients belonging to the intervention and the control group in relation to these themes. Finally, both groups experienced the extra examinations received during the trial as an additional source of safety.ConclusionThis qualitative study found different factors influencing the experience of participating in a clinical trial, e.g., intervention-status, personal resources, and safety. This knowledge can be valuable when planning future clinical trials involving breast cancer patients.

A meta-analysis studying the utility of cryotherapy in the prevention of peripheral neuropathy in breast cancer patients receiving paclitaxel and nab-paclitaxel.

12025 Background: Debilitating Peripheral Neuropathy (PN) caused by paclitaxel adversely impacts the quality of life in Breast Cancer (BC) patients. Cryotherapy using cooling devices during taxane infusion is a non-invasive strategy to prevent PN, but its efficacy has not been established. We hope to answer this question through our meta-analysis. Methods: A systematic search with keywords and controlled vocabulary encompassing BC, antineoplastics, and paclitaxel was conducted in PubMed, CINHAL, Embase, Scopus, Web of Science Collections, and CENTRAL. All databases were searched on March 7, 2022. There were no search restrictions on date, language, status, or outcomes. 405 records were identified, and duplicates were removed using EndNote 20. The remaining 372 records were imported into Covidence, and the titles and abstracts were screened independently by 2 reviewers. 22 out of 63 full texts were relevant to our question of which 14 [12 Randomized control studies and 2 retrospective studies] were included for the meta-analysis using R package meta. Only studies that analyzed cryotherapy use in BC patients who received paclitaxel or nab-paclitaxel were included. Relative risk (RR) derived from random effects model with Mantel-Haenszel method was used to compare the occurrence of PN between cryotherapy vs placebo groups. Results: Pooled incidence of Common Terminology Criteria for Adverse Events (CTCAE) grade ≥ 2 PN was 24.85% (81/326) in the cryotherapy arm and 42.35% (72/170) in the placebo arm. Overall RR for CTCAE grade ≥ 2 PN with cryotherapy compared to placebo was 0.45 [0.27,0.77, p = 0.0031]. RR for sensory PN was 0.19 [0.05,0.66, p = 0.009] and for motor PN was 0.18 [0.03,0.99, p = 0.0491]. RR for Patient Neurotoxicity Questionnaire (PNQ) score ≥ D which connotes severe neuropathy was 0.24 [0.09,0.62, p = 0.0035]. Cold intolerance was the predominant adverse effect at 15% (37/247). Fingernail paronychia and skin irritation were reported at 0.8% (2/247) each. 5.1% (15/294) stopped cryotherapy use prior to completion. However, this number was driven by a single study (10/16 patients stopped using cryotherapy due to cold intolerance) and 7/11 studies had no discontinuations. Visual inspection of our funnel plots revealed no publication bias. Conclusions: Use of cryotherapy decreased the occurrence of CTCAE grade ≥ 2 PN by 55% in BC patients getting paclitaxel or nab-paclitaxel. Occurrence of both sensory and motor PN were lower. Cold intolerance was the most frequently reported issue with its use but lead to relatively low discontinuation rates in most studies. Given the lack of any severe adverse effect, cryotherapy use must be encouraged for patients receiving paclitaxel and nab-paclitaxel. Further studies are needed establish a standardized way of applying cryotherapy in terms of the device to use, timing and other logistical factors.

Abstract P4-04-01: Safety and efficacy of cryotherapy in the prevention and treatment of chemotherapy-induced peripheral neuropathy in breast cancer patients

Abstract Introduction Chemotherapy-induced peripheral neuropathy (CIPN) is a serious clinical problem that can be caused by some cytotoxic agents used in breast cancer (BC) treatment, most commonly seen following taxane-based therapy[1,2]. Several strategies have been studied for CIPN prevention and treatment, but, still, there is no standard recommendation, options are limited and results unsatisfactory [1]. Cryotherapy is a technique that consists of reducing the blood flow in a certain area of the body by cold temperatures, in order to limit the cytotoxic reach. A few studies have been conducted to analyze the safety and efficacy of this strategy in CIPN prevention and treatment, and results are controversial [3,4,5]. More data is needed to clarify cryotherapy role in this clinical context. Methods This is a retrospective analysis of 40 BC patients treated at a single Brazilian institution between December 2019 and June 2022, aiming at efficacy and safety of cryotherapy in the prevention and treatment of CIPN. Cryotherapy was administered by the Hilotherm Clinic Chemo HT02 device (Hilotherm GmbH - Oberwil bei Zug, Switzerland [6]). The procedure consisted of patients using glove and sock-like devices on hands and feet throughout the chemotherapy infusion. The devices were pre-cooled to 10oC and then put on patients 30 minutes before starting, till one hour after the end of chemotherapy infusion. A questionnaire, as proposed by Leonard et al [7], was administered to patients every cycle to assess the development and severity of CIPN symptoms. Statistical analyses were performed by using a Cox regression model. Results Of the 40 patients analysed, 33 (83.5%) underwent a taxane-based regimen. The median number of cryotherapy sessions was three (ranging from 1 to 12), and, when excluded patients who underwent only one session of cryotherapy, the median was 4 (range 2 to 12). 75% of the 40 patients underwent cryotherapy in all chemotherapy sessions, or were still receiving chemo with cryotherapy by the time of our analysis. 80% of those who left treatment did so after the first session (HR 40.44 (CI95: 8.34 – 196.1; p&amp;lt; 0.0001). CIPN was stable or better than the baseline status for 26 (87%) of the 30 patients that underwent more than 1 session of cryotherapy; only 1 (25%) of the four patients who developed CIPN worse than the baseline status had grade 2 symptoms. Conclusion Cryotherapy is a safe and tolerable strategy that can be used during chemotherapy for breast cancer. Our data suggests that this is an efficient approach to prevent and treat CIPN, but the retrospective nature of the study and the small sample size must be considered when interpreting the results. Finally, strategies must be developed to further improve adherence and tolerability, and prospective randomized trials are needed to confirm the efficacy of cryotherapy in this context. 1. Loprinzi et al. Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update. J Clin Oncol 38:3325-3348. 2020 2. Rivera et al. Chemotherapy-Associated Peripheral Neuropathy in Patients With Early-Stage Breast Cancer: A Systematic Review. JNCI J Natl Cancer Inst, 2018, Vol. 110, No. 2 3. Rosenbaek et al. Effect of cryotherapy on dose of adjuvant paclitaxel in early-stage breast cancer. Supportive Care in Cancer (2020) 28:3763–3769 4. Ruddy et al. Randomized controlled trial of cryotherapy to prevent paclitaxel-induced peripheral neuropathy (RU221511I); an ACCRU trial. The Breast Volume 48, December 2019 5. Shigematsu et al. Cryotherapy for the prevention of weekly paclitaxel-induced peripheral adverse events in breast cancer patients. Support Care Cancer. 2020 6. https://www.hilotherm.com/en/about-hilotherm/ accessed on July 15 2022 at 23:03 7. Leonard et al. Survey of oxaliplatin-associated neurotoxicity using an interview-based questionnaire in patients with metastatic colorectal cancer. BMC Cancer 2005, 5:116 Citation Format: Rafael B. Costa, Angélica Nogueira-Rodrigues, Claynner Paccely Oliveira Bessa, Rafaela Cristina Adalberto Menezes, Fernanda Coelho de Miranda Jorge Oliveira, Matheus Costa e Silva, Flávia Rocha Paes, Bruno L. Ferrari. Safety and efficacy of cryotherapy in the prevention and treatment of chemotherapy-induced peripheral neuropathy in breast cancer patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-04-01.

Mitigation of paclitaxel-induced peripheral neuropathy in breast cancer patients using limb-cooling apparatus: a study protocol for a randomized controlled trial.

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most common adverse events that can significantly impair the quality of life of patients. Although limb cooling may be beneficial for preventing CIPN, logistical challenges exist in ensuring consistent efficacy and safety. The purpose of this randomized controlled trial is to validate whether limb cooling with strict temperature control can reduce CIPN in patients with breast cancer receiving weekly paclitaxel as a perioperative treatment. This study is a multicenter, double-blinded, randomized controlled trial. We plan to enroll patients with breast cancer who are scheduled to receive 12 weekly doses of paclitaxel (60 min 80 mg/m2 intravenous infusion) as perioperative chemotherapy. Patients will be randomly divided into the intervention or control groups and undergo limb cooling therapy maintained at a constant temperature of 13°C and 25°C, respectively. The primary endpoint is the proportion of patients who report Patient Neurotoxicity Questionnaire (PNQ) ≥ D in their limbs by the end of the study treatment or at the time of discontinuation. The results of this trial will contribute to the establishment of new evidence for limb cooling therapy in the mitigation of CIPN and present a safe and stable cooling device that may be suitable for use in the clinic. https://jrct.niph.go.jp/en-latest-detail/jRCT2032210115, identifier jRCT2032210115.

Comprehensive Assessment of the Effectiveness of the Use of Alpha-lipoic Acid and Ipidacrine Hydrochloride for the Prevention of Paclitaxel-indused Peripheral Neuropathy in Breast Cancer Patients

Abstract. Almost 97% of women undergoing chemotherapy with paclitaxel for breast cancer suffer from symptoms of peripheral neuropathy, the severity of which directly depends on the single, cumulative dose and duration of infusion of the agent. Neurological manifestations of paclitaxel-induced peripheral neuropathy, such as bilateral numbness, neuropathic pain and paresthesias in the distal parts of the limbs, often lead to the need to reduce doses, up to the refusal of taxanes, which negatively affects the immediate and long-term results of treatment. Despite numerous scientific studies, there are no known means for prevention of chemotherapy-induced peripheral neuropathy. Of the more than 20 drugs studied so far for the prevention of chemotherapy-induced peripheral neuropathy, none has shown sustained and systemic clinically significant results.&#x0D; The aim of the study: to assess the effectiveness of the combination of alpha-lipoic acid and acetylcholinesterase inhibitor ipidacrine hydrochloride for the prevention of paclitaxel-induced peripheral neuropathy in breast cancer patients.&#x0D; Materials and methods of the study: a comprehensive assessment of clinical (survey regarding subjective symptoms and quality of life, neurological examination), neurophysiological (electroneuromyography) and morphological indices of paclitaxel-induced peripheral neuropathy in breast cancer patients who received polychemotherapy in neoadjuvant, adjuvant or palliative settings carried out according to the schemes of AT (paclitaxel, doxorubicin) or ET (paclitaxel, epirubicin) regimens with or without preventive treatment of neuropathy, has been performed.&#x0D; Results of the study. The use of the studied scheme for the prevention of paclitaxel-induced peripheral neuropathy led to a significant improvement in neurological manifestations, neurophysiological and morphometric parameters of peripheral nerves, as well as quality of life and the severity of subjective symptoms and their impact on daily life activities in comparison with patients who received chemotherapy without treatment for the prevention of neuropathy.&#x0D; Conclusions. The combination of alpha-lipoic acid and the acetylcholinesterase inhibitor - ipidacrine hydrochloride, could be recommended for prophylaxis of paclitaxel-induced peripheral neuropathy.&#x0D; Key words: breast cancer, chemotherapy, polyneuropathy, prevention, questionnaires, electroneuromyography, morphometric analysis.

An Evaluation of the Efficacy of Compression Therapy Using Sleeves and Stockings to Prevent Docetaxel-induced Peripheral Neuropathy in Breast Cancer Patients.

Taxanes are key drugs for patients with breast cancer. A major adverse effect of taxanes is peripheral neuropathy (PN). To investigate the ability of compression therapy using sleeves and stockings to prevent PN due to the taxane docetaxel, we conducted a single-center historical control trial. Patients receiving docetaxel at 75 mg/m2 every 3 weeks for 4 cycles as first-line chemotherapy for breast cancer were eligible. PN was evaluated using the common terminology criteria for adverse events version 4.0. The primary endpoint was the incidence of allgrade PN until 3 weeks after the fourth docetaxel administration. We evaluated 26 patients in the intervention group and compared their data to those collected retrospectively from 52 patients treated with docetaxel without compression. Neither the incidence of all-grade PN until 3 weeks after the fourth docetaxel administration (63.5% in the control group vs. 76.9% in the intervention group, p=0.31) nor that of PN grade ≥ 2 (13.5% vs. 15.4%, p=0.99) differed between the groups. In this study, the efficacy of compression therapy using sleeves and stockings to prevent PN induced by docetaxel was not demonstrated. Further clinical studies including medications or intervention are needed to reduce the incidence and severity of PN induced by chemotherapy.

The Effect of Supportive Educational Intervention on Perceived Stress and Severity of Chemotherapy-Related Neuropathy in Breast Cancer Patients

Background: The nature of breast cancer (BC) and its treatment is such that it leads to physical and psychological complications. Objectives: The present study aimed to determine the effect of supportive educational intervention on the perceived stress and severity of chemotherapy-related neuropathy in BC patients. Methods: This quasi-experimental study was carried out on 60 women suffering from BC in Zahedan, Iran, in 2020. The patients were selected using the convenience sampling method and randomly assigned into two groups of intervention and control. The patients in the intervention group received four 45-minute sessions about the common problems of BC on a weekly and individual basis. The control group received only routine ward care. Data collection tools were the Perceived Stress Scale (PSS) developed by Cohen and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale. Data were collected before the intervention and six weeks after the intervention. Data analysis was performed using SPSS 22 software. Results: The results of independent t-test showed that the mean and standard deviation of perceived stress score in the intervention group decreased from 56.8 ± 5.92 to 50.36 ± 3.89 (P &lt; 0.001), and in the control group decreased from 55.6 ± 3.65 to 54.8 ± 3.53 (P = 0.258). The mean and standard deviation of neuropathy severity score in the intervention group decreased from 12.90 ± 1.66 to 8.43 ± 2.16 (P &lt; 0.001), and in the control group increased from 12.56 ± 2.28 to 13.03 ± 1.93 (P = 0.276). The independent t-test showed that after implementing the supportive educational intervention, there was a significant difference between the two groups in terms of mean and standard deviation of neuropathy severity score (P &lt; 0.001). Conclusions: According to our results, supportive educational intervention reduced the perceived stress and severity of neuropathy. Thus, it is necessary to include these supportive interventions in educational and care programs to improve patients’ psychological status and reduce stress and neuropathy.

Docetaxel Chemotherapy Induced Peripheral Neuropathy in Breast cancer Patients and its Amelioration by Vitamin E

Background: Chemotherapy is used to treat different types of cancer. Its use is associated with neurotoxicity, the most common of them is peripheral neuropathy. Taxanes are recognized to cause peripheral neuropathy of which Docetaxel is studied. Aim: To evaluate the neurotoxicity of Docetaxel and assess the protective effect of vitamin E in breast cancer patients. Methods: In a prospective placebo controlled randomized study, 60 women with breast cancer were selected. Patients had surgery and planned for chemotherapy administration. Chemotherapy protocol used is TAC that includes Docetaxel, Doxorubicin and Cyclophosphamide given every 21 days. They are assessed for neuropathy clinically and by nerve conduction study at the baseline and after completion of chemotherapy. They are divided into 2 groups each composed of 30 patients. The 1st group is given Vitamin E and the second group is given placebo. Results: showed that the incidence of neuropathy is the same in both groups, but it was less severe in Vitamin E treated group compared to the placebo group. Conclusion: vitamin E ameliorates the severity of peripheral neuropathy and can be used for this purpose. Recommendation: We recommend large multicenter studies to be done and using other agents that possibly prevent or ameliorate Docetaxel induced neuropathy in the future.

Lithium and preventing chemotherapy-induced peripheral neuropathy in breast cancer patients: a placebo-controlled randomized clinical trial

BackgroundChemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of some chemotherapy regimens. Lithium has been suggested for CIPN in some animal studies. We aimed to study lithium’s preventive effect on CIPN in breast cancer patients treated with taxanes and platinum-based medications.MethodA double-blind placebo-controlled randomized clinical trial (RCT) was implemented on 36 breast cancer patients in two equal-size groups by block randomization. Participants in both groups consumed daily tablets, either placebo or lithium (300 mg), for 5 days in each course of chemotherapy. The tablets were prescribed 1 day before the start of chemotherapy. The electromyography (EMG) and nerve-conduction-velocity (NCV) tests were achieved before the first chemotherapy, 3 and 9 months after the treatment. The changes and signs or symptoms of CIPN, such as numbness, tingling, freezing, sensitivity to touch, muscle weakness, fibrillation, and knee and elbow reflex disorders, were recorded by examination. The trend of outcome changes was compared between two groups during the 9 months of study.ResultsIn both groups, neurologic signs and symptoms were exacerbated during the first 3 months and improved up to the ninth month of study. Results showed significant changes of all EMG-NCV variables during the 9 months of research in each group (P < 0.001), but the interaction of time and group effect was not significant in none of those indices. All symptoms changed significantly over the study time (P < 0.001) without significant statistical difference between the two groups (P=0.352). No side effect was found during the study.ConclusionThe study showed that 300 mg lithium prescription once daily for 5 days might not effectively prevent CIPN in breast cancer patients. Evaluation of lithium effect on CIPN on different cancers in future studies is suggested.Trial registrationIranian Registry of Clinical Trials IRCT20160813029327N10. Registration date: May 16, 2018.

Diagnostic tools should be used for the diagnosis of chemotherapy induced peripheral neuropathy in breast cancer patients receiving taxanes.

BackgroundThough the incidence, characteristics, and pathogenesis of chemotherapy induced peripheral neuropathy (CIPN) by taxane based chemotherapy were extensively studied, diagnostic guidelines extent only recently.AimTo observationally investigate whether specific tests can be used to predict and monitor CIPN severity.MethodsFourteen female breast cancer patients receiving paclitaxel or docetaxel were evaluated using the McGill Pain Questionnaire (MPQ), National Cancer Institute Common Toxicity Criteria (NCI‐CTC) grading, clinical total neuropathy score (TNSc), quantitative sensory testing (QST) of pressure pain threshold (PPT), and numeric rating scale (NRS) scores and stocking and glove distribution testing (SGDT), at the start (T0), midst (T1), and end (T2) of their treatment and after 3 months (T3).ResultsAt T3, patients scored NCI‐CTC neuropathy grade 1 (14.3%), 2 (64.3%), and 3 (14.3%) respectively. Fifty percentage scored at least grade 1 at T0, with complaints not caused by CIPN. Pain, if present, was denominated “tingling” and “cold” in the MPQ. Median TNSc score increased from T0 (2.43) to T1 (4.71) to T2 (5.50) to T3 (5.57), as did pinprick and cold sensation disturbances in SGDT. PPT and associated NRS remained unchanged. TNSc and SGDT at T1 could not predict the NCI‐CTC grade at T3.ConclusionNCI‐CTC, TNSc, and stocking and glove distribution testing can be used in the early diagnosis and monitoring of CIPN, with false‐positive findings at baseline. Final NCI‐CTC grades could not be predicted.

151P The impact of limb hypothermia on the incidence and severity of paclitaxel induced peripheral neuropathy in breast cancer patients

Chemotherapy induced peripheral neuropathy (CIPN) is a common side effect of many chemotherapy drugs and has a profound impact on quality of life. CIPN due to paclitaxel is a common dose-limiting toxicity which can adversely affect treatment results by forcing dose reduction and sometimes premature treatment discontinuation.

Chemotherapy Induced Peripheral Neuropathy in Breast Cancer Patients

Chemotherapy Induced Peripheral Neuropathy in Breast Cancer Patients

Factors predicting chemotherapy induced peripheral neuropathy in breast cancer patients receiving neurotoxic chemotherapy

Factors predicting chemotherapy induced peripheral neuropathy in breast cancer patients receiving neurotoxic chemotherapy

Docetaxel-Induced Peripheral Neuropathy in Breast Cancer Patients Treated with Adjuvant or Neo-Adjuvant Chemotherapy

Background: Docetaxel-induced peripheral neuropathy (PN) is typically manifested as sensory and motor neuropathy. This study aimed to investigate the incidence, duration, and risk factors of sensory and motor PN and their impact on health-related quality of life (HRQOL) among breast cancer (BC) patients during the first year since starting docetaxel-based chemotherapy. Methods: We reported a secondary analysis of longitudinal data on docetaxel-induced PN and HRQOL among 127 BC patients. Results: Cumulative incidence rates of motor and sensory PN were 31.5 and 21.3%, while the median durations of motor and sensory PN were 6 and 13 weeks. A consistently significant risk factor for both PNs was a cumulative docetaxel dose of >300 mg/m². A significant interaction between sensory PN and time was found for physical and social functioning, while a significant motor PN and time interaction effect was identified for physical functioning only. Conclusions: Motor PN was more common than sensory PN in BC patients treated with docetaxel. Both types of PN had a significant impact on physical functioning.

Nerve conduction, circulating osteopontin and taxane-induced neuropathy in breast cancer patients

Chemotherapy-induced peripheral neuropathy (CIPN) is a disabling complication related to taxanes. Underlying mechanisms are not completely understood and no specific treatment exists. We investigated the role of nerve conduction studies (NCS) and of serum osteopontin (OPN) measurement as a means to stratify the risk of developing taxane-induced neuropathy (TIN). We enrolled 50women with breast cancer treated with taxanes (docetaxel or paclitaxel) in a 3-month prospective study. They were evaluated before chemotherapy (time-point T0) and followed up at 1 (T1) and 3 (T2) months with clinical examinations/scales, quality of life (QoL) questionnaires, NCS, and serum OPN dosages. A reduction of sural and superficial peroneal sensory action potentials was seen at T1, with a progression at T2 (P<0.001). In contrast, a significant impact of neuropathic symptoms on QoL only occurred at T2 (P<0.01). OPN levels at T0 inversely correlated to axonal loss in the sural nerve (T0-T2, P<0.01). OPN levels at T0 were lower in the intermediate and poor outcome patient subgroups, compared to the good outcome subgroup, as specifically defined (P<0.05). Lower limb NCS changes occurred earlier than the detrimental effects of TIN on patients' QoL. Low serum OPN levels before chemotherapy may represent a novel biomarker of TIN risk.

Unveiling the real-world outcomes of breast cancer (BC) patients with taxanes-induced neuropathy using a digital patient-powered network (PPN).

e18248 Background: Taxanes-induced neuropathy is common in BC patients receiving taxanes, forcing dose reductions and treatment delays and posing serious challenges for the long-term patient QoL. Discovering neuropathy predictors in patients could guide better treatment decisions, improved QoL and reduce healthcare costs. Belong digital PPN is a social network for cancer patients and caregivers that supports disease management. In this study we used our artificial intelligence (AI) engine to classify the prevalence, characteristics and taxanes-induced neuropathy status of BC patients. Methods: We analyzed real-world patient-reported outcomes provided voluntarily and anonymously from users on the Belong PPN. Data from BC patients reporting treatment with taxanes was extracted and additional analysis segmented the data to those who experienced neuropathy and those who did not. Further validation of the data was performed by our research team to assure accuracy. Results: We evaluated 169 BC cancer patients from the US treated with taxanes. In the cohort 72% were Paclitaxel-treated and 28% Docetaxel-treated at various disease stages: 68% at early stage BC (0-2) and 32% at the advanced/metastatic stages (3-4). 83% of Paclitaxel-treated patients and 67% of Docetaxel-treated patients reported experiencing neuropathy in the Belong platform. These real-world reports indicated significantly higher incidence of taxane-induced neuropathy in comparison to literature summarizing data from clinical trials, suggesting neuropathy incidence of 27% for paclitaxel and 16% for docetaxel (grades 2-4). Conclusions: Real-world patient-reported outcomes from the Belong PPN captured the prevalence of taxanes-induced neuropathy in BC patients and correlated it to the specific drug in use. Evidence for higher incidence of taxanes-induced neuropathy may lead to lower patient QoL and higher healthcare costs and should stimulate better treatment decisions. Further exploration of the gap between controlled clinical studies and real-world evidence is urgently needed to understand the true patient outcomes and optimize healthcare accordingly.

Abstract P4-16-11: A modest proposal for classical massage on chemotherapy-induced peripheral neuropathy in breast cancer patients receiving adjuvant paclitaxel: A randomized controlled trial using electromyography

Abstract Background: Oncology professionals face challenges to find out a complete solution in prevention or alleviation of chemotherapy induced peripheral neuropathy (CIPN). Current pharmacological treatments used for CIPN have limited effects and pose major side effects. At this point, management of CIPN by a multidisciplinary team approach is very crucial. Therefore, this randomized controlled study aimed to examine the effect of classical massage on CIPN using objective and subjective measurements in breast cancer patients receiving adjuvant paclitaxel. Method:The study was conducted at Dr. Abdurrahman Yurtaslan Ankara Training and Research Hospital in Turkey between July 2017 and June 2018. The study was approved by a local ethical committee. Eligible patients with breast cancer included those who (a) were 18 years and older; (b) had no documented diagnosis of CIPN; (c) had receiving the first cycle of adjuvant paclitaxel. Exclusion criteria were (a) history of severe psychiatric disorder; (b) history of peripheral neuropathy due to any cause; (c) had lesion on hands or feet; (d) had bleeding or coagulation disorders. Simple randomization method was utilized to allocate patients to an intervention group (n=18) and a control group (n=19). Patients in the intervention group (IG) received totally 12 sessions classical massage, on the days of chemotherapy cycles. The duration of each massage was 30 min, with 20 min for the feet and 10 min for the hands. The CG received only routine care. After completion of paclitaxel regimen no intervention was applied to neither the IG nor the CG, and patients were followed at week 16. Subjective measurement tools included the Self-Leeds Assessment of Neuropathic Symptoms and Sign (S-LANSS); and the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy (EORTC QLQ-CIPN20). Electromyography (EMG) was applied as an objective measurement at baseline and week 12 for all patients by the same neurologist. The data were collected at five time points including baseline (T1), week 4 (T2) week 8 (T3), week 12 (T4) and week 16 (T5). To analyze data repeated measures ANOVA and Mann Whitney U tests were used. Results: The S-LANSS scores were significantly lower in the IG when compared the CG (p&amp;lt;.05). Motor sub-dimension scores of EORTC QLQ-CIPN20 were significantly lower in favor of the IG compared to the CG. As for sensorial and autonomic sub-dimensions of the EORTC QLQ CIPN20 showed no significant difference. Regarding EMG outcomes, compound muscle action potentials of ulnar nerve and posterior tibial nerve in the IG were significantly higher than the CG at week 12. Conclusion: In this study, classical massage initiated concurrently with adjuvant paclitaxel regimen decreased neuropathic pain severity and prevented motor axonal neuropathy in the IG when compared to the CG. Accordingly, classical massage had promising effects on prevention and alleviation of CIPN. Based on the results, classical massage can be recommended as a preventive complementary option for breast cancer patients receiving adjuvant paclitaxel. Citation Format: Demirci U, Izgu N, Gok Metin Z, Karadas C, Ozdemir L, Çetin N. A modest proposal for classical massage on chemotherapy-induced peripheral neuropathy in breast cancer patients receiving adjuvant paclitaxel: A randomized controlled trial using electromyography [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-16-11.