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Factors Associated With Chemotherapy-Induced Peripheral Neuropathy in Older Patients

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Key Points

  • A history of diabetes and increasing age were associated with an increased risk of peripheral neuropathy in older patients receiving taxane therapy.
  • A history of autoimmune disease was associated with a lower risk of peripheral neuropathy in these patients.
  • The investigators concluded that patients with diabetic complications may choose to avoid paclitaxel or taxane plus platinum combination therapies if other efficacious options exist.

In an analysis of the linked Southwest Oncology Group–Medicare databases reported by Hershman et al in the Journal of Clinical Oncology, an increased risk of peripheral neuropathy in older patients receiving taxane therapy was associated with increasing age and a history of diabetes in addition to drug-related factors.

Study Details

The study included data from 1,401 patients aged ≥ 65 years who received taxane therapy in 23 phase II or III studies from 1999 to 2011. Potential associations of grade 2 to 4 peripheral neuropathy risk were assessed for diabetes, hypothyroidism, hypercholesterolemia, hypertension, varicella zoster infection, peripheral vascular disease, and autoimmune diseases.

Risk Factors

An increased risk of grade 2 to 4 neuropathy was found for treatment with paclitaxel vs docetaxel (25% vs 12%, odds ratio [OR] = 2.20, P < .001) and for use of a taxane with a platinum agent (OR = 1.68, P = .004). Risk of neuropathy increased by 4% for each 1 year increase in age (P = .006). Risk of neuropathy was greater in patients with diabetes (22% vs 16%, OR = 1.67, P = .001) and with diabetes with complications (25% vs 16%, OR = 2.13, P = .002) vs those without diabetes. Patients with autoimmune disease (eg, Sjögren’s syndrome, lupus, rheumatoid arthritis) were at reduced risk of neuropathy (11% vs 18%, OR = 0.49, P = .06). None of the other conditions assessed was significantly associated with neuropathy risk.

The investigators concluded: “We found that in addition to drug-related factors, age and history of diabetes were independent predictors of the development of chemotherapy-induced peripheral neuropathy. Interestingly, we also observed that a history of autoimmune disease was associated with reduced odds of neuropathy. Patients with diabetic complications may choose to avoid paclitaxel or taxane plus platinum combination therapies if other efficacious options exist.”

Dawn L. Hershman, MD, of Columbia University Medical Center, New York, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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