Breast cancer

CIPN leads to reduced dose of chemo in early breast cancer

As well as its impact on quality of life, chemotherapy-induced peripheral neuropathy (CIPN) is associated with breast cancer patients receiving significantly lower dose intensity of chemo.

A retrospective chart review of 348 early breast cancer patients who received weekly paclitaxel between 2010 and 2020 at Austin Health found 80.2% experienced taxane-induced peripheral neuropathy (TIPN) of any grade during treatment.

Most patients who developed TIPN had Grade 1 (52.0%), 25.3% had Grade 2 and 2.9% had Grade 3.

While most patients experienced resolution of their symptoms over time, 22.4% of patients available at one-year follow-up had persisting TIPN.

The study, published in the Asia-Pacific Journal of Clinical Oncology, said patients who developed TIPN received significantly reduced relative dose intensity than those who did not develop TIPN (p<0.0005).

“Median and mean dose intensities were 100% and 90.8% for patients with no TIPN versus 86% and 82% for all-grade TIPN patients.

The study found the relative dose intensity decreased with increasing TIPN severity.

“Median and mean dose intensities were: 100% and 89.7%, grade one; 66.7% and 67.9%, grade two; and 72.2% and 65.5%, grade three TIPN.”

“With increasing severity of TIPN, there was an increasing frequency of dose reduction such that 15.9% of non-TIPN, 32.0% of grade one, 46.6% of grade two, and 50.0% of grade three TIPN subgroups received dose reductions, which were statistically significant (p < .0005).”

“Despite numerous ways to dose-modify in response to TIPN, dose reductions and premature cessations were the primary methods in the studied cohort, potentially raising the role of defined protocols in this single institution study,” the study said.

Neoadjuvant treatment (p = 0.038) and body surface area (p = 0.035) were independently associated with the development of TIPN during treatment.

Older age (median 57.4 v 50.9 years) and pre-treatment diabetes were the only observed risk factors associated with TIPN at one-year follow-up.

Only 7.9% of patients with TIPN received any treatment for their neuropathy.

“This highlights the profound issue of lacking effective therapeutics for TIPN patients,” the study said.

“TIPN will continue to be a significant management concern in curative intent breast cancer therapy,” the study concluded.

“Future prospective studies will be vital to validate associated risk factors and explore therapeutic options, with a focus on assessment of TIPN at long-term follow-up.”

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