Prevalence Of Chemotherapy-induced Peripheral Neuropathy Research Articles

Prevalence of Chemotherapy-Induced Peripheral Neuropathy Among Cancer Patients and Its Effects on Quality of Life: A Survey Study

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of cancer treatment, leading to nerve damage and impairing patients' quality of life.Objective: To evaluate the prevalence of CIPN among cancer patients and its effects on their quality of life.Methods: A cross-sectional study was conducted at Allied Hospital, Pinum Cancer Hospital, and Aziz Fatima Hospital in Faisalabad, Pakistan. The study included 54 cancer patients (20 males, 34 females) aged 13-71 years, undergoing chemotherapy for at least six months. Patients were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Chemotherapy Induced Peripheral Neuropathy 20-item scale (EORTC-QLQ-CIPN20) and the Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS). Data were analyzed using SPSS version 25, with descriptive statistics and chi-square tests performed to evaluate associations.Results: CIPN was prevalent in 90.7% of patients, with mild (59.3%), moderate (27.8%), and severe (3.7%) neuropathy levels. Neuropathy was significantly correlated with reduced quality of life (p = 0.663).Conclusion: CIPN is highly prevalent among cancer patients and significantly affects their quality of life. Early detection and management are crucial to mitigate these effects.

Cropsi study: Efficacy and safety of cryotherapy and cryocompression in the prevention of chemotherapy-induced peripheral neuropathy in patients with breast and gynecological cancer–A prospective, randomized trial

ObjectiveThis study aimed to demonstrate the superiority of cryocompression over cryotherapy alone in the prevention of chemotherapy-induced peripheral neuropathy (CIPN) grade 2 or above. MethodsThis prospective randomized study was conducted between May 2020 and January 2023 in Innsbruck. Eligible patients had a diagnosis of gynecological cancer and received a minimum of 3 cycles of taxane-based CT (neoadjuvant, adjuvant or palliative therapy). Patients were randomized 1:1 to receive either cryotherapy or cryocompression on their upper extremities during chemotherapy (CT). We performed temperature measurements, two QoL questionnaires and neurological tests during CT and at follow-up 3 and 6–9 months after the completion of CT. CIPN was assessed using the CTCAE score. ResultsOf 200 patients recruited, both groups showed a lower prevalence of CIPN in this study compared to recent literature. In the group receiving cryotherapy, the prevalence of grade 1 CIPN was 30.1 %, and that of grade 2 CIPN or above was 13.7 %; in the group treated with cryocompression, the prevalence of grade 1 CIPN was 32.8 %, and that of grade 2 or above CIPN was 17.2 %. We found a significant reduction in temperature in the cryotherapy and cryocompression groups. Regarding the two QOL questionnaires as well as the neurological tests no significant differences were found between the two groups. ConclusionOur study suggests that cryotherapy as well as cryocompression is a safe and effective way to cool patients’ extremities to lower the prevalence of CIPN. Cryocompression was not more effective than cryotherapy alone in the prevention of CIPN.

A prospective observational study to assess peripheral neuropathy in patients receiving weekly paclitaxel chemotherapy

Background: Peripheral neuropathies are disorders of peripheral nerve cells and fibres. Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of anticancer treatment, and it can affect the patient's long-term survival. The prevalence of CIPN is around 38%. Peripheral neurotoxicity (PN) is a side effect of paclitaxel that can lead to treatment discontinuation. The intensity and severity of neuropathy is more with patients receiving weekly paclitaxel chemotherapy. Methods: 60 patients of CA breast receiving weekly paclitaxel monotherapy who fulfilled inclusion and exclusion criteria were enrolled in the study. Clinical examination and grading of neuropathy was done according to NCI-CTCAE version 4.0. All patient had undergone nerve-conduction studies at baseline and 3 months after baseline. Results: 50% of patients, developed signs symptoms of peripheral neuropathy, out of which tingling sensation was the most common symptom (40%). The incidence of grade 1 peripheral neuropathy at 3 and 6 months were 35%, and 31.66%, while grade 2 neuropathy was noted in 18.33%, and 14.75% of patients, respectively. There was a significant difference in the SNAP value between baseline and 3 months for right ulnar nerve, right and left sural nerve and CMAP for right median nerve, right ulnar nerve, right and left tibial nerves which suggests development of neuropathy during 3 months of paclitaxel chemotherapy. Conclusions: This study provides information on the incidence and severity of peripheral neuropathy in patients receiving weekly paclitaxel chemotherapy, which can help physician in further management.

Impact of exercise on chemotherapy-induced peripheral neuropathy (CIPN) in survivors with post-treatment primary breast cancer.

12077 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of neurotoxic chemotherapy with limited treatment options. We examined the association between exercise and CIPN symptoms in patients with post-treatment primary breast cancer. Methods: Using a retrospective design, patients completing a standardized survey assessing exercise exposure, neuropathy symptoms, and pain in a tertiary cancer center survivorship clinic were included. Exercise was assessed using a standardized questionnaire quantified in standardized metabolic equivalent tasks (MET-h/wk). Chi-square tests, Mann-Whitney U-tests, Kendall’s rank correlations, and multivariable logistic regressions adjusting for important clinical covariates examined the relationship between exercise and CIPN and whether this differed as a function of chemotherapy regimen (taxane vs. non-taxane based therapy). Results: A total of 5,444 patients with primary breast cancer previously treated with adjuvant chemotherapy (median age 62 years (IQR: 55, 71); median of 4.7 years post chemotherapy completion (IQR: 3.3, 7.6)) were identified. The overall prevalence of CIPN was 34% (95% CI: 33%, 36%); 33% (95% CI: 31%, 34%) for non-taxane and 37% (95% CI: 35%, 39%) for taxane based chemotherapy. The prevalence of CIPN was 28% (95% CI: 26%, 30%) among exercisers (≥5 days of moderate or ≥3 days of strenuous exercise per week) and 38% (95% CI: 37%, 40%) among non-exercisers (difference 11%; 95% CI: 8%, 13%; p < 0.001). Associations appeared dose-dependent. CIPN prevalence was 42% for < 6 MET-h/wk, 33% for 6-20.24 MET-h/wk and 29% for > 20.25 MET-h/wk (p-value < 0.001). Exercise was associated with reduced prevalence of all individual CIPN symptoms (numbness and tingling, pain, interference in daily living). Higher exercise was associated with lower CIPN regardless of chemotherapy regimen. Conclusions: CIPN is persistent several years following chemotherapy cessation in patients with breast cancer but significantly reduced by exercise in a dose-dependent manner.

Soluble epoxide hydrolase inhibition alleviates chemotherapy induced neuropathic pain.

Chemotherapy induced peripheral neuropathy (CIPN) is a particularly pernicious form of neuropathy and the associated pain is the primary dose-limiting factor of life-prolonging chemotherapy treatment. The prevalence of CIPN is high and can last long after treatment has been stopped. Currently, late in the COVID-19 pandemic, there are still increased psychological pressures on cancer patients as well as additional challenges in providing analgesia for them. These include the risks of nonsteroidal anti-inflammatory drug (NSAID) analgesics potentially masking early infection symptoms and the immunosuppression of steroidal and opiate based approaches. Even without these concerns, CIPN is often inadequately treated with few therapies that offer significant pain relief. The experiments we report use soluble epoxide hydrolase inhibitors (sEHI) which relieved this intractable pain in preclinical models. Doses of EC5026, an IND candidate intended to treat neuropathic pain, elicited dose dependent analgesic responses in multiple models including platinum-based, taxane, and vinca alkaloid-based CIPN pain in Sprague Dawley rats. At the same time as a class, the sEHI are known to result in fewer debilitating side effects of other analgesics, likely due to their novel mechanism of action. Overall, the observed dose-dependent analgesia in both male and female rats across multiple models of chemotherapy induced neuropathic pain holds promise as a useful tool when translated to the clinic.

Prevention and therapy of chemotherapy-induced peripheral neuropathy: a review of recent findings.

Chemotherapy-induced peripheral neuropathy is one of the most frequent dose-limiting side effects, observed in patients receiving antineoplastic agents, persisting for up to two years after completing treatment, greatly affecting both the course of chemotherapy and patients' quality of life. Approximately 20 to 85% of patients treated with neurotoxic chemotherapy will develop peripheral neuropathy and there is considerable variability in its severity among patients. The main symptoms are numbness, paresthesia, and burning pain in a "glove and stocking" distribution. The prevalence of chemotherapy-induced peripheral neuropathy will likely increase as cancer survival rates continue to improve. Currently, there are only a few therapeutic options available for the prevention or successful therapy because the mechanisms of chemotherapy-induced peripheral neuropathy remain unclear. A better understanding of the risk factors and underlying mechanisms of chemotherapy-induced peripheral neuropathy is needed to develop effective preventive and therapeutic strategies.

Ovariectomy Reduces Anti-inflammatory CD4+ T Cells in the Dorsal Root Ganglion of NaïVe and Paclitaxel-treated Female Mice

Chemotherapeutic agents are often a life-saving cancer treatment, but the development of chemotherapy-induced peripheral neuropathy (CIPN) is a major dose-limiting toxicity. The prevalence of CIPN is greater than 68%, with post-menopausal women and patients taking anti-estrogens and aromatase inhibitors having increased risk. T cell deficient male and female mice have prolonged paclitaxel (PTX)-induced mechanical hypersensitivity. Sex-specific hormones can alter the T cell response contributing to differential susceptibilities to disease. As a result of estrogen, females have more CD4+ T cells in blood and tissues, but it is unknown if this is true in the DRG. To have a better understanding of the role of CD4+ T cells in mouse DRG, we characterized pro- and anti-inflammatory CD4+ T cells in naive and PTX-treated male, female, and ovariectomized (OVX) mice. We used multi-color flow cytometry to determine pro- and anti-inflammatory CD4+ T cell subsets in the DRG of naive and PTX-treated male, female, and OVX mice. Findings show that CD4+ T cells are present in the DRG of naive and PTX-treated male and female mice. Female mice had a greater frequency of CD4+ T cells in the DRG than OVX and male mice. Although the frequencies of cytokine-producing CD4+ T cells in the DRG differ between male and female, the majority of CD4+ T cells were anti-inflammatory cells that increased after PTX administration. PTX induced a robust increase in FoxP3, IL-10, and IL-4 producing CD4+ T cells in the DRG of female mice, but not in OVX or male mice. Our data demonstrate that CD4+ T cells in the DRG of estrogen-competent female mice secrete anti-inflammatory cytokines (IL-10 and IL-4), which are known to reduce CIPN. These findings support a model in which estrogen promotes anti-inflammatory CD4+ T cells in female DRG to suppress peripheral neuropathy. Grant support from National Institutes of Health NIGMS P20GM103643.

Chemotherapy-Induced Peripheral Neuropathy: Epidemiology, Pathomechanisms and Treatment.

PurposeThis review provides an update on the current clinical, epidemiological and pathophysiological evidence alongside the diagnostic, prevention and treatment approach to chemotherapy-induced peripheral neuropathy (CIPN).FindingsThe incidence of cancer and long-term survival after treatment is increasing. CIPN affects sensory, motor and autonomic nerves and is one of the most common adverse events caused by chemotherapeutic agents, which in severe cases leads to dose reduction or treatment cessation, with increased mortality. The primary classes of chemotherapeutic agents associated with CIPN are platinum-based drugs, taxanes, vinca alkaloids, bortezomib and thalidomide. Platinum agents are the most neurotoxic, with oxaliplatin causing the highest prevalence of CIPN. CIPN can progress from acute to chronic, may deteriorate even after treatment cessation (a phenomenon known as coasting) or only partially attenuate. Different chemotherapeutic agents share both similarities and key differences in pathophysiology and clinical presentation. The diagnosis of CIPN relies heavily on identifying symptoms, with limited objective diagnostic approaches targeting the class of affected nerve fibres. Studies have consistently failed to identify at-risk cohorts, and there are no proven strategies or interventions to prevent or limit the development of CIPN. Furthermore, multiple treatments developed to relieve symptoms and to modify the underlying disease in CIPN have failed.ImplicationsThe increasing prevalence of CIPN demands an objective approach to identify at-risk patients in order to prevent or limit progression and effectively alleviate the symptoms associated with CIPN. An evidence base for novel targets and both pharmacological and non-pharmacological treatments is beginning to emerge and has been recognised recently in publications by the American Society of Clinical Oncology and analgesic trial design expert groups such as ACTTION.

Systematic review of long-term chemotherapy-induced peripheral neuropathy (CIPN) following adjuvant oxaliplatin for colorectal cancer.

Chemotherapy-induced peripheral neuropathy (CIPN) is the most common dose-limiting side effect of oxaliplatin. It often persists and can adversely affect quality of life of colorectal cancer (CRC) survivors. This systematic review explored the proportions of patients with persistent CIPN and the reporting methods used. MEDLINE, EMBASE, Web of Science and CINAHL were searched up to March 2021 for publications reporting CIPN outcomes following adjuvant oxaliplatin-containing chemotherapy at prespecified timepoints in participants with CRC. Secondary outcomes assessed the tools used to measure CIPN. Two authors reviewed full text publications for eligibility, data extraction and appraisal. Meta-analysis was performed where Common Terminology Criteria for Adverse Events (any grade) was reported at the most frequent timepoints. From 7895 citations identified, 27 studies met the eligibility criteria: six were randomised control trials, and 21 were non-randomised studies. Pooled prevalence of CIPN at 6, 12, 24 and 36months after chemotherapy were 58%, 45%, 32% and 24% respectively. The average prevalence of CIPN decreased by 26% per year after chemotherapy (pooled RR = 0.74; 95% CI 0.72-0.75). Across all studies, ten separate tools were used as the primary measure of CIPN. Quality appraisal identified open-label design and inadequate reporting of participants lost to follow-up as the main methodological limitations. Our summary of reported rates of persistent CIPN indicates substantial long-term toxicity affecting CRC survivors, and will help clinicians estimate CIPN risk and its change over time. The heterogeneity of CIPN measures identified in the review highlights the need for a standardised CIPN assessment.

Genetic variants predictive of chemotherapy-induced peripheral neuropathy symptoms in gynecologic cancer survivors

<h3>Objectives:</h3> Identifying gynecologic cancer patients at higher risk of chemotherapy-induced peripheral neuropathy (CIPN), a common and debilitating side effect of cancer treatment, could inform treatment decision-making and quality of life discussions. We sought to identify genetic variants associated with the prevalence of CIPN among gynecologic cancer survivors, and to determine if these variants added predictive power to a model including demographic and clinical factors. <h3>Methods:</h3> Patients were recruited from an academic gynecologic-oncology practice into a prospective cohort study. Participants included in this analysis provided a voluntary DNA saliva sample and self-reported CIPN symptoms (FACT/GOG-Ntx) along with other emotional, social and physical health items. Clinical and treatment data were abstracted from medical records. Genotyping of 23 single nucleotide polymorphisms (SNPs) in 15 genes identified in the literature as being related to platinum or taxane-induced neuropathy in other cancer populations was performed using iPLEX Gold method. The analyses were restricted to White females (97% of the cohort) and those who received chemotherapy. Risk allele carrier frequencies of individuals with and without high CIPN symptoms (FACT/GOG-Ntx score >9.5, median) were compared using logistic regression adjusting for age; odds ratios (OR) and 95% confidence intervals (CIs) are reported. We generated receiver operating characteristic (ROC) curves to examine the predictive ability of the identified significant SNPs along with known clinical risk factors (age, diabetes, body mass index (BMI), Charlson Comorbidity Index (CCI), previous cancer diagnosis) with regards to CIPN symptomatology. <h3>Results:</h3> A total of 108 individuals who provided a saliva sample with sufficient DNA for analysis received chemotherapy and were included in the analysis. Mean age was 62.8±10.5 years; 40.4% had obesity and 9% had diabetes. Most were diagnosed with ovarian cancer (58%) or uterine cancer (30%), and were not actively receiving treatment (76%). Having at least one risk allele in two SNPs was significantly associated with high CIPN symptomology: rs3753753 in <i>GPX7,</i> 2.65 (1.18, 5.92) and rs139887 in <i>SOX10,</i> 2.55 (1.14, 5.72). Further, including these SNPs in the predictive model improved the ROC curve area under the curve (AUC) over the demographic and clinical characteristics alone (AUC: 0.75 vs. 0.66, p=0.04; Figure 1). <h3>Conclusions:</h3> Genetic and clinical characteristics are predictive of higher CIPN symptomatology in gynecologic cancer survivors and combining these factors resulted in superior predictive power. Prospective validation of these results and assessment of their clinical utility are warranted.

Prevalence and predictors of peripheral neuropathy after chemotherapy: Outcomes from the Detroit Research on Cancer Survivorship (ROCS) cohort.

12069 Background: Increased life expectancy for cancer survivors following advances in treatment has led to a greater likelihood of developing long-term complications. Among them is chemotherapy-induced peripheral neuropathy (CIPN), which adversely impacts the functional capacity of survivors. We assessed prevalence and predictors of CIPN in a cohort of African-American (AA) cancer survivors. Methods: The study population included 633 breast, colorectal, prostate and lung cancer survivors who received chemotherapy and participated in the Detroit Research on Cancer Survivorship (ROCS) study. Presence of CIPN was based on self-reported pain, numbness or tingling in the hands or feet, occurring either for the first time or worsening after chemotherapy. If participants reported continued CIPN at the time of survey, their symptoms were reported as persistent. CIPN severity was self-reported as mild, moderate or severe. Logistic regression analysis was used to evaluate socio-demographic and clinical factors (including 12 common comorbid conditions) associated with CIPN prevalence, persistence and severity. Results: Overall, 67% of the cohort reported CIPN at a mean time of 25.3 months (range 2-74 months) after cancer diagnosis, and 51% reported persistent CIPN. The distribution of CIPN severity consisted of 32.2% with mild, 30.8% with moderate, and 36.9% with moderate to severe symptoms. Diagnosis of primary breast (OR 3.99, 95% CI 1.52-10.46) or colorectal cancers (OR 5.24, 95% CI 2.17-12.69) conferred greater CIPN prevalence relative to a diagnosis of prostate cancer. The presence of each additional comorbid condition among those outlined in the survey also conferred a 20% greater prevalence of CIPN (OR 1.2, 95% CI 1.03-1.39). Similar trends were seen among those who reported persistent CIPN. Using age &gt; 65 at diagnosis as the reference group, age &lt; 50 (OR 2.64, 95% CI 1.43-4.88) and age 51-64 (OR 1.96, 95% CI 1.14-3.35) resulted in an increased risk of moderate or severe compared to mild CIPN. Conclusions: In the Detroit ROCS cohort, CIPN was reported in two-thirds of cancer survivors receiving chemotherapy. Out of them, more than one-third reported moderate to severe symptoms, more commonly seen among those age &lt; 65. Consideration of CIPN as a prominent long-term complication of cancer treatment should play a role in treatment decisions and development of new chemotherapy regimens.

Chemotherapy-induced peripheral neuropathy after modern treatment of Hodgkin’s lymphoma; symptom burden and quality of life

Background Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting side effect of Hodgkin’s lymphoma (HL) treatment. We aimed to describe the prevalence of CIPN associated symptoms in long-term HL survivors compared to controls, and determine associated factors, including impact on health-related quality of life (HRQoL). Material and methods A questionnaire, including EORTC QLQ-CIPN-20 for CIPN related symptoms and SF-36 for HRQoL, was completed by 303 HL survivors at a median of 16 years after diagnosis. CIPN results were compared to a normative population (n = 606). CIPN associated factors were identified by linear regression analysis. Results Total CIPN score and subscores were significantly higher in HL survivors compared to controls. In multivariate analysis of HL survivors, a number of comorbidities (p < 0.001) and female gender (p = 0.05) were significantly associated with more CIPN. No association with disease or treatment factors was found. In a multivariate analysis including survivors and controls, the number of comorbidities (p < 0.001) and caseness (p < 0.001) were significantly associated with more CIPN. In HL survivors higher CIPN score was associated with reduced HRQoL (p < 0.001). Conclusion HL survivors more than a decade after treatment report higher neuropathy-related symptom burden than controls, with a negative impact on HRQoL. Symptoms may be related to factors other than neurotoxic chemotherapy.

Prevalence of Chemotherapy-Induced Peripheral Neuropathy in Multiple Myeloma Patients and its Impact on Quality of Life: A Single Center Cross-Sectional Study.

Bortezomib is a pivotal drug for the management of multiple myeloma. However, bortezomib is a neurotoxic anticancer drug responsible for chemotherapy-induced peripheral neuropathy (CIPN). CIPN is associated with psychological distress and a decrease of health-related quality of life (HRQoL), but little is known regarding bortezomib-related CIPN. This single center, cross-sectional study assessed the prevalence and severity of sensory/motor CIPN, neuropathic pain and ongoing pain medications, anxiety, depression, and HRQoL, in multiple myeloma patients after the end of bortezomib treatment. Paper questionnaires were sent to patients to record the scores of sensory and motor CIPNs (QLQ-CIPN20), neuropathic pain (visual analogue scale and DN4 interview), anxiety and depression (HADS), the scores of HRQoL (QLQ-C30 and QLQ-MY20) and ongoing pain medications. Oncological data were recorded using chemotherapy prescription software and patient medical records. The prevalence of sensory CIPN was 26.9% (95% CI 16.7; 39.1) among the 67 patients analyzed and for a mean time of 2.9 ± 2.8 years since the last bortezomib administration. The proportion of sensory CIPN was higher among patients treated by intravenous and subcutaneous routes than intravenous or subcutaneous routes (p = 0.003). QLQ-CIPN20 motor scores were higher for patients with a sensory CIPN than those without (p < 0.001) and were correlated with the duration of treatment and the cumulative dose of bortezomib (coefficient: 0.31 and 0.24, p = 0.01 and 0.0475, respectively), but not sensory scores. Neuropathic pain was screened in 44.4% of patients with sensory CIPN and 66.7% of them had ongoing pain medications, but none were treated with duloxetine (recommended drug). Multivariable analysis revealed that thalidomide treatment (odds-ratio: 6.7, 95% CI 1.3; 35.5, p = 0.03) and both routes of bortezomib administration (odds-ratio: 13.4, 95% CI 1.3; 139.1, p = 0.03) were associated with sensory CIPN. Sensory and motor CIPNs were associated with anxiety, depression, and deterioration of HRQoL. Sensory CIPN was identified in a quarter of patients after bortezomib treatment and associated with psychological distress that was far from being treated optimally. There is a need to improve the management of patients with CIPN, which may include better training of oncologists regarding its diagnosis and pharmacological treatment.

337P A prospective study about the quality of life and chemotherapy-induced peripheral neuropathy

Chemotherapy-induced peripheral neuropathy (CIPN) is a common complication of chemotherapy (CT) (19% to 85% of cases, depending on the type of CT). This complication can further affect patients' quality of life (QOL). The aim of our work was to assess the quality of life (QOL) of patients according to the occurrence or not of an CIPN during anti-cancer treatment. This is a prospective study performed on patients with known neurotoxic CT (Oxaliplatin, Cisplatin, Taxanes, Vinorelbine and Vincristine). The survey was carried out over a period of one month (September 2019) on patients treated at the department of medical oncology in Sfax. We used the WHO classification as well as the DN4 score to diagnose and characterize CIPN. We used the EORTC QLQ-C30 questionnaire to assess the QOL according to the presence or not of an CIPN. We analyzed 5 areas of QOL in our patients physical functioning, daily functioning, social functioning, pain, insomnia and overall health. Seventy-three patients were included in the study with 46 women (63%) and 27 men (37%). The average age was 51.8 years [13-80 years]. The cancers mainly reported in our series were: colorectal cancers (26%), breast cancers (24.6%), nasopharyngeal cancers (15%), ovarian carcinomas (11%) and eso-gastric cancers (6.8 %). The disease was metastatic in 43 cases (58.9%). The most widely used CT drugs were Taxanes (28 cases: 38.35%) and Oxaliplatin (22 cases: 30.14%). Thirty-eight patients had CIPN (52.1%). The CIPN was classified according to the WHO classification as grades 1 and 2 in 63.2% and 36.8% of the cases, respectively. The DN4 Score was ≥ 4 in 31 cases. We found a statistically significant change in patients' QOL in the areas of physical functioning (p <0.0001), daily functioning (p = 0.007), social functioning (p = 0.021), pain (p = 0.024) and overall health (p = 0.013) in case of CIPN. In our study, the prevalence of CIPN was 51.1%. This CIPN significantly impacted the QOL in the areas of physical functioning, daily functioning, social functioning, pain and overall health. This is consistent with data from the literature.

Chemotherapy-induced peripheral neuropathy in newly diagnosed breast cancer survivors treated with taxane: a prospective longitudinal study.

This study aimed to prospectively explore severity and prevalence of chemotherapy-induced peripheral neuropathy (CIPN) and examine the correlation between clinician-assessed (objective) and patient-reported (subjective) CIPN in breast cancer survivors receiving taxane. This was a prospective, longitudinal study. Purposive sampling was adapted to enroll women newly diagnosed with breast cancer and about to receive taxane. The CIPN was assessed after breast cancer diagnosed and before chemotherapy (T1), before cycle 1 to 4 taxane infusion (T2 to T5), and after chemotherapy completion (T6 to T8). Total Neuropathy Score-clinical version (TNSc), Identification Pain Questionnaire (ID pain), Functional Assessment of Cancer Therapy-Taxane subscale (FACT-Tax), and Peripheral Neuropathy Scale (PNS) were utilized for measuring CIPN. Descriptive statistics, Pearson correlation coefficient, and generalized estimating equation were used to analyze data. A total of 88 participants were included. Both clinician-assessed and patient-reported CIPN gradually increased between T1 and T6 and mildly decreased at T7 and T8. Fifty-five participants (62.5%) experienced CIPN at T8. Weak-to-moderate correlations between subjective and objective CIPN were found at T6 to T8 (r = 0.272-0.533, p < 0.05). The change of TNSc, FACT-Tax, and PNS were significant over time. However, the significant change of neuropathic pain was only found at T6. The change of CIPN prevalence and severity were significant over time in survivors newly diagnosed with breast cancer. Specifically, the severest and highest CIPN was detected at chemotherapy completion. Survivors remained suffering from CIPN 3 months after chemotherapy completion. Besides, mild to moderate correlations between clinician-assessed and patient-reported CIPN were identified.

Long-Term Prevalence of Sensory Chemotherapy-Induced Peripheral Neuropathy for 5 Years after Adjuvant FOLFOX Chemotherapy to Treat Colorectal Cancer: A Multicenter Cross-Sectional Study.

(1) Background: Oxaliplatin is among the most neurotoxic anticancer drugs. Little data are available on the long-term prevalence and consequences of chemotherapy-induced peripheral neuropathy (CIPN), even though the third largest population of cancer survivors is made up of survivors of colorectal cancer. (2) Methods: A multicenter, cross-sectional study was conducted in 16 French centers to assess the prevalence of CIPN, as well as its consequences (neuropathic pain, anxiety, depression, and quality of life) in cancer survivors during the 5 years after the end of adjuvant oxaliplatin chemotherapy. (3) Results: Out of 406 patients, the prevalence of CIPN was 31.3% (95% confidence interval: 26.8–36.0). Little improvement in CIPN was found over the 5 years, and 36.5% of patients with CIPN also had neuropathic pain. CIPN was associated with anxiety, depression, and deterioration of quality of life. None of the patients with CIPN were treated with duloxetine (recommendation from American Society of Clinical Oncology), and only 3.2%, 1.6%, and 1.6% were treated with pregabalin, gabapentin, and amitriptyline, respectively. (4) Conclusions: Five years after the end of chemotherapy, a quarter of patients suffered from CIPN. The present study showed marked psychological distress and uncovered a failure in management in these patients.

Abstract P1-17-06: Long-term incidence of taxane induced peripheral neuropathy in early breast cancer patients, a real world, single centre experience exploring effects on health related quality of life

Abstract Background: Addition of taxanes to adjuvant chemotherapy provides survival benefit in patients with early breast cancer (EBC). Intensifying adjuvant regimens with taxanes leads to increased toxicity, including higher rates of sensory peripheral neuropathy (sPN). Prevalence of chemotherapy induced peripheral neuropathy (CIPN) in trials varies with reported rates of 15 - 30%. Up to 15% of patients report persistent CIPN 1-3 years post treatment with associated adverse impact on quality of life (QOL). There is limited data reporting rates of CIPN and QOL beyond 3 years. We assessed rates of persistent sPN in real world patients with EBC treated with adjuvant taxanes and its effect on QOL. Methods: Patients who received adjuvant taxane for EBC at a metropolitan health service in the preceding 10 years were identified from hospital records and invited to participate. Data was collected at a single time point using the EORTC Quality of Life (QLQ30) and Chemotherapy-Induced Peripheral Neuropathy (CIPN20) questionnaires. Demographic, co-morbid and treatment details were collected from medical records. Raw scores were linearly transformed to a 0 to 100 scale with higher scores indicating higher functioning, QOL and levels of symptomatology. Prevalence was determined using a binary model of no or any sPN and cases grouped into no/mild or moderate/severe for further analysis. Groupwise comparisons were performed with parametric and non-parametric tests. Analysis of covariance was used to fit models incorporating comorbid factors such as diabetes with time point of assessment as the covariate. Results: 176 of 250 questionnaires were returned, a response rate of 71%. Median age was 59 (range 30-88 years) with 52% of respondents receiving paclitaxel vs 47% docetaxel containing regimens. Median time from completion of taxane was 30 months (range 6-120 months). 11 patients (6%) had known diabetes and 50 (26%) had at least one other known risk factor for neuropathy. The prevalence of CIPN across all time points was 74.4%, much higher than seen in historical trials. Table 1: Incidence of sensory neuropathy (all grades) by time from chemotherapyTime bracket (months)N= (176)PN (%)No PN (%)6-246352 (82.5)11 (17.5)25-486347 (74.6)16 (25.4)49-1205032 (64%)18 (36%) QOL scores were lower in patients with moderate/severe sPN, with a median global QOL scaled score of 50 vs 75 in patient with no/mild sPN (p = 0.0062). Increasing sPN score was associated with lower QOL score controlling for time from chemotherapy (standardised beta co-efficient -0.28). In an analysis of covariance, diabetes was the only significant comorbid factor associated with higher sPN scores. In the final model incorporating diabetes, miscellaneous other sPN risk factors and time from chemotherapy, diabetes was associated with increased sPN scores with a small effect size (p = 0.03). Paclitaxel was associated with higher sPN scores than docetaxel (p 0.0001) with significant interaction of paclitaxel with diabetes independent of other sPN risk factors and time from chemotherapy (p = 0.02). Paclitaxel was associated with higher sPN scores in diabetic patients (adjusted mean score in diabetic patients 46.7 v 20.9 in non-diabetic receiving paclitaxel, p = 0.001). Conclusion: CIPN is significantly more prevalent in this real world cohort than reported in historic data, with persistent sPN having a negative correlation with QOL out to 10 years. Higher rates of paclitaxel-associated sPN in diabetic patients could inform decision making on adjuvant chemotherapy. Citation Format: Elizabeth F Blackley, Megan G Kesper, Peter Savas, Bianca Devitt. Long-term incidence of taxane induced peripheral neuropathy in early breast cancer patients, a real world, single centre experience exploring effects on health related quality of life [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-17-06.

Peripheral Neuropathy and Hypovitaminosis D Are Associated in Multiple Myeloma Patients

Introduction New strategies in the treatment of multiple myeloma (MM) have improved response rates, progression-free survival and overall survival (OS). Despite the advances in treatment, patients frequently experience adverse events such as chemotherapy-induced peripheral neuropathy (CIPN). CIPN decreases quality of life, and requires dose adjustment, delay or premature termination of treatment, resulting in a negative influence on time to progression and survival. In addition, several studies have found that up to 54% of MM patients have peripheral neuropathy (PN) at diagnosis. A possible mechanism of vitamin D deficiency and PN was found in animal trials, where an increase of nerve growth factor was observed in diabetic rats after supplementation of vitamin D. Furthermore, correction of hypovitaminosis D through vitamin D supplementation was found to reduce PN in patients with DM type 2. Objectives The primary objective of this study was to determine the correlation between the 25-hydroxyvitamin D serum levels and PN in patients with smoldering or symptomatic MM. Secondary objectives were to gain insight into the number of patients with inadequate 25-hydroxyvitamin D serum levels (&lt; 75 nmol/L); to evaluate the influence of different vitamin D levels on the severity of CIPN; to determine the correspondence of the ICPNQ results and patients' records; and to search for differences in prevalence of CIPN for each drug. Methods In this multicentre study, performed in the Medical Center Leeuwarden and Deventer Hospital in the Netherlands, smoldering and symptomatic MM patients were included in the study, regardless of stage or previous treatment. Patients had to be older than 18 years, and able to give informed consent. Blood samples were collected to determine vitamin D levels, and hypovitaminosis D was defined as a 25-hydroxyvitamin D level (vitamin D) below 75 nmol/L. The Indication for Common Toxicity Criteria (CTC) Grading Peripheral Neuropathy Questionnaire (ICPNQ), a validated questionnaire to distinguish different PN grades in MM patients, was used to determine the severity of PN. Visual Analog Scale (VAS) scores were used to grade the intensity of PN. Results We included 120 MM patients with a median age of 68 years (min-max; 48-84), and 57,5% were male. The median vitamin D level was 49.5 nmol/L (min-max; 10-138), and 84% had a serum 25-hydroxyvitamin D level &lt;75 nmol/L. The percentage of patients with PN grade 1 or higher was 69%. In the medical records, absence or presence of PN was mentioned in 40% of the patients by clinicians. The percentage of patients with PN categorized in the vitamin D groups &lt;25, 25-49.9, 50-74.9, and ≥75 nmol/L, was 88, 72, 54, and 79%, respectively. However, patients in the vitamin D group ≥75 nmol/L were diagnosed with MM for a shorter period of time, and received more intensive treatment. A trend was found between lower vitamin D levels (grouped &lt;25, 25-49.9, 50-74.9, and ≥75 nmol/L) and higher incidence of PN (p = 0.036). Conclusions PN and hypovitaminosis D are common in MM patients, and low vitamin D levels are possibly associated with the occurrence of PN. In addition, more attention for PN is needed, as PN is underreported by clinicians. Further research is necessary to clarify the relationship between vitamin D and PN, and whether vitamin D supplementation could positively influence PN in MM patients. Disclosures No relevant conflicts of interest to declare.

Management of Peripheral Neuropathy Induced by Chemotherapy.

Chemotherapy-induced peripheral neuropathy (CIPN) is considered a severe side effect of therapeutic agents with limited treatment options. The incidence of CIPN in cancer patients is approximately 3-7% in cytostatic monotherapy and as high as 38% in cases of polychemotherapy. The prevalence of CIPN was found to be 68% within the first month of chemotherapy treatment. In some cases, CIPN can resolve, partially or completely, after completion of the treatment; in other cases, it can remain for a long time and affect the patient's quality of life. The aim of this study is to present up-to-date data regarding available treatment options for the management of CIPN. The up-to-date guidelines of ESMO (European Society for Medical Oncology), ASCO (American Society of Clinical Oncology), ONS (Oncology Nursing Society), NCI (National Cancer Institute), and NCCN (National Comprehensive Cancer Network) were reviewed and included in the manuscript. The use of tricyclic antidepressant (TCA), selective serotonin norepinephrine reuptake inhibitor (SSNRI), pregabalin, and gabapentin are recommended as first-line treatment. Other treatment options were offered as second and third lines of treatment (lidocaine patches, capsaicin high-concentration patches, tramadol, and strong opioids, respectively); however, lower significance was demonstrated. Inconclusive results were found in the use of cannabinoids, drug combinations, antiepileptics, antidepressants, and topical drugs. TCA, other antidepressants, and opioids could be recommended as treatment. Yet, we could not recommend an ideal therapeutic agent for the prevention or treatment of CIPN. Therefore, CIPN continues to be a challenge to clinicians and our patients.

Prevalence of peripheral neuropathy associated with chemotherapy in four oncology centers of Colombia.

Chemotherapy-induced peripheral neuropathy is a common adverse reaction in a variety of medications frequently used for a great number of cancer treatments. This condition consists of mainly sensory-type symptoms, motor components and autonomic changes. Reported prevalence ranges from 30-68%, after the completion of chemotherapy in non-Latin American people with different populations and socioeconomic levels. To determine the prevalence of chemotherapy-induced peripheral neuropathy in a Colombian population. A real-world evidence cross-sectional retrospective study was performed in all patients from oncological clinical centers in Colombia, which received pharmacological therapy for any cancer between January 2015 and December 2016, with taxanes (paclitaxel, docetaxel), alkylators (oxaliplatin), proteasome inhibitors (bortezomib), and epothilone B analogs (ixabepilone). A total of 1,551 patients in four cities were included, and 11,280 doses were applied; predominantly females (n = 1,094; 70.5%), with a mean age of 57 ± 13 years old. Paclitaxel was the most commonly prescribed drug (n = 788; 50.8%). Chemotherapy-induced peripheral neuropathy was developed in 48.9% of paclitaxel, 58.5% of oxaliplatin, 50.5% of docetaxel, 43.7% of bortezomib and 95.2% of ixabepilone patients. Thirty-three patients were treated with two of these medications simultaneously. Chemotherapy-induced peripheral neuropathy is a frequent adverse reaction to daily cancer therapy in Colombian patients managed with taxanes, alkylators, proteasome inhibitors, and epothilone B analogs. Hence, it is necessary to establish more successful diagnostic methods and incorporate validated scales in the routine evaluation of all patients receiving these medications in our environment.