Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting toxicity of paclitaxel. Though no pharmacological agents have been identified to prevent CIPN, cryotherapy with frozen gloves and socks may reduce the risk of developing CIPN and thereby increase the likelihood of patients completing the planned dose of paclitaxel.
Patients and methods
Among women with early-stage breast cancer who received at least one cycle of paclitaxel, 119 were included in the 2016 cohort who received cryotherapy when they developed symptoms of CIPN, and 96 patients in the 2017 cohort who received prophylactic cryotherapy. From electronic patient records, data were abstracted on dates and doses of adjuvant paclitaxel, dose reductions, cycle delays, symptoms of CIPN, and whether and when frozen gloves and socks were used. The outcome was the proportion of patients completing the planned 720 mg/m2 of paclitaxel cumulated over nine cycles. The hazard ratio (HR) of a dose-limiting event due to CIPN was estimated in a Cox proportional hazards model.
In the 2016 cohort, cryotherapy was needed due to symptoms of CIPN in 54 (45%) patients. Significantly, more patients, 77% in the 2017 cohort, completed the planned dose of 720 mg/m² compared with 64% in the 2016 cohort, p = 0.017. The HR of a dose reduction or cessation due to CIPN, adjusted for age and HER-2 status, was 0.50 (95% confidence interval 0.30–0.84), p = 0.009, for the 2017 cohort compared with the 2016 cohort.
The results of this study suggest that prophylactic cryotherapy may reduce the risk of a dose-limiting event due to CIPN and increase the proportion of patients completing the planned dose of paclitaxel in adjuvant treatment of early-stage breast cancer. Despite this, CIPN remains to be an important dose-limiting toxicity of paclitaxel.
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All patients received oral as well as written information about the project and signed a permission to abstract their electronic patient record. The project was approved by the Danish Data Protection Agency, but approval from the Scientific Ethical Committee for the Region of South Denmark was not needed.
While there are no pharmacological agents known to prevent chemotherapy-induced peripheral neuropathy (CIPN), this study demonstrates that cryotherapy with frozen gloves and socks has the potential to reduce the risk of a dose-limiting event due to CIPN among breast cancer patients receiving weekly paclitaxel in the adjuvant or neo-adjuvant setting. By using cryotherapy from the first cycle of paclitaxel, more patients can complete the planned dose intensity. However, CIPN still remains to be an important dose-limiting toxicity of paclitaxel.
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Rosenbaek, F., Holm, H.S., Hjelmborg, J.v.B. et al. Effect of cryotherapy on dose of adjuvant paclitaxel in early-stage breast cancer. Support Care Cancer 28, 3763–3769 (2020). https://doi.org/10.1007/s00520-019-05196-z
- Breast cancer