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Sensory peripheral neuropathy after taxane treatment is not uncommon

Conference
SABCS 2019

Peripheral neuropathy post-taxane chemotherapy has been shown to be significantly more prevalent in a real-world cohort than in historical trials, according to the results of a single center study. Symptoms and subsequent decrease in quality of life (QoL) persisted well beyond a typical follow-up period. As rates of chemotherapy-induced peripheral neuropathy and the effect on QoL are important when counselling and consenting patients for treatment and when considering survivorship, higher rates of paclitaxel-associated sensory peripheral neuropathy in diabetic patients may assist decision-making on adjuvant chemotherapy regimens.

Until recently, limited data was available beyond 3 years on sensory peripheral neuropathy and its effects on QoL in a non-clinical trial population. Blackley et al. aimed to assess the rates of persistent neuropathy in patients with early breast cancer who were treated with adjuvant taxanes and its effect on QoL [1]. This was done by identifying patients from hospital medical records who had received adjuvant taxane-containing regimens for early breast cancer over a 10-year period from 2007-2017 and inviting them to participate. Data was collected at a single time point using the EORTC Quality of Life (QLQ30) and Chemotherapy-Induced Peripheral Neuropathy (CIPN20) questionnaires.

It was found that QoL scores were lower in patients with moderate or severe sensory peripheral neuropathy: median global QoL scaled score was 50 versus 75 in patients with no or mild sensory peripheral neuropathy (P=0.0062). Increasing sensory peripheral neuropathy score was associated with lower QoL score controlling for time from chemotherapy. The severity of sensory peripheral neuropathy decreased over time, which suggests there may be recovery in some patients beyond 2 years. However, it was pointed out that this analysis was limited by small patient numbers and did not reach statistical significance.

The researchers also found that diabetes mellitus was the only significant comorbid factor associated with higher sensory peripheral neuropathy scores (P=0.03) and that paclitaxel was associated with higher rates of sensory peripheral neuropathy than docetaxel (adjusted mean scaled score in diabetic patients was 46.7 vs 20.9; P=0.001). Also, the interaction of paclitaxel with diabetes mellitus was significant, independent of other sensory peripheral neuropathy risk factors and time from chemotherapy (P=0.02). Early cessation of chemotherapy did not predict for late onset or persistent sensory peripheral neuropathy, although this was a very small retrospectively identified subgroup.

1. Blackley EF, et al. P1-17-06. SABCS 2019.



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