ONS 2018: Peripheral Neuropathy Is More Severe With Paclitaxel Than With Docetaxel in Patients With Breast Cancer
May 17, 2018—Washington, DC—Peripheral neuropathy could be more severe with paclitaxel than with docetaxel in patients with breast cancer.
This finding from a secondary data analysis was reported at the presented at the Oncology Nursing Society 43rd Annual Congress, from May 17 – 20.
Ya-Ning Chan, MS, of National Yang-Ming University, Taipei, Taiwan, explained that taxanes are among the most common cytotoxic drugs used in breast cancer treatment.
Peripheral neuropathy associated with taxanes may influence patients’ functional status and quality of life. Studies have focused, however, on peripheral neuropathy induced by paclitaxel, which is much more severe than that induced by docetaxel.
Data on comparison of the incidence and severity of peripheral neuropathy between the two drugs are limited.1
Ms. Chan and colleagues objectively compared differences in incidence and severity of taxane-induced peripheral neuropathy between paclitaxel and docetaxel in women with breast cancer.
A secondary data analysis assessed at least one cycle of taxane treatment in two teaching hospitals in Taiwan. Overall, 64 women with breast cancer (n = 32 in each group) having taxane-induced peripheral neuropathy were included.
Taxane-induced peripheral neuropathy was assessed using the Total Neuropathy Score-clinical version. The main symptoms of taxane-induced peripheral neuropathy in the paclitaxel group were vibration sensitivity (78.1%), pin sensitivity (65.6%), and motor symptoms (65.6%).
Autonomic symptoms (65.6%) and pin sensitivity (62.5%) were most common in the docetaxel group.
Participants in the paclitaxel group experienced a significantly higher incidence of motor symptoms (x2 = 9.035, P < .01); vibration sensitivity (x2 = 7.943, P < .01); strength (x2 = 4.016, P < .05); and deep tendon reflex (x2= 5.189, p < .05) than those in docetaxel group.
The severity of vibration sensitivity, and pin sensitivity was higher in paclitaxel and docetaxel groups, respectively. Also, overall severity of taxane-induced peripheral neuropathy (t = 3.449, P < .01); motor symptoms (t = 2.536, P < .05); vibration sensitivity (t = 4.146, P < .001); strength (t = 2.211, P < .05) ;and deep tendon reflex (t = 2.274, P < .05) was significantly more in the paclitaxel group than the docetaxel group.
Patients with paclitaxel suffered from sensory, motor, and autonomic symptoms. Motor symptoms were rare in the docetaxel group.
Moreover, severity of sensory symptoms was more than that of motor or autonomic.
Ms. Chan concluded that these results may help clinical staff to understand taxane-induced peripheral neuropathy in paclitaxel- and docetaxel-treated patients. Additionally, risks of taxane-induced peripheral neuropathy, such as burns or falling, could be managed better in patients receiving a taxane.
Ms. Chan suggested that future studies with a longitudinal design and larger sample size are needed to confirm the findings of this preliminary study.
In a related study, Mei Ying Jue, BSN, RN, OCN, of Houston Methodist Hospital, Texas, explained that research on chemotherapy-induced peripheral neuropathy focuses primarily on treating symptoms.
Little evidence supports preventative measures. Ms. Jue and colleagues evaluated inducing hypothermia to reduce the incidence of peripheral neuropathy. Inducing hypothermia using cold caps to scalp has been associated with reduction in alopecia in patients receiving chemotherapy2 and the study by Ms. Jue evaluated whether same principle could be applied to reduce peripheral neuropathy.
Ms. Jue’s team compared the incidence and severity of peripheral neuropathy and quality of life in patients with breast cancer who receive 12 weekly doses of paclitaxel and cold therapy to their hands and feet versus standard of care in a randomized, controlled manner.
"If the cold cap could minimize hair loss,” Ms. Jue told Elsevier’s PracticeUpdate, “we thought that cold therapy to hands and feet might minimize neuropathy and provide some relief to our patients."
Key exclusion criteria included a history of peripheral neuropathy, diabetes, hand and foot conditions, and use of medications such as vitamin B12, glutamine, certain antidepressants, anticonvulsants, and opioids.
Patients who received cold therapy wore chilled Elasto-Gel hypothermia mitts and slippers 15 minutes prior to the start of and throughout the 1-h infusion.
They were assessed at each weekly treatment session for peripheral neuropathy using the National Cancer Institute Common Toxicity Criteria for Adverse Events v4.0. The patient also completed the Functional Assessment of Cancer Therapy - Taxane questionnaire.
Data was collected at weeks 1, 4, 8, and 12, and at 1 month after completion of treatment for 31 of 48 participants.
Preliminary findings suggested a significant treatment (P = .005) and time (P < .001) effect on peripheral motor neuropathy.
Patients receiving standard of care developed neuropathy earlier than those who received cold therapy. No significant differences due to treatment were observed between groups in Functional Assessment of Cancer Therapy - Taxane questionnaire.
Ms. Jue concluded that applying cold therapy during infusion may minimize underlying nerve damage by limiting delivery of paclitaxel to distal small capillaries.
This intervention, she believes, may improve both outcomes and drug delivery. Initial findings indicate a positive outcome however a further analysis will be performed at study completion.
References:
- Tofthagen C, McAllister RD, Visovsky C. Peripheral neuropathy caused by Paclitaxel and docetaxel: an evaluation and comparison of symptoms. J Adv Pract Oncol. 2013; 4 (4): 204-15.
- Rugo HS, Voigt J. Scalp Hypothermia for Preventing Alopecia During Chemotherapy. A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin Breast Cancer. 2018 Feb; 18(1): 19-28.
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