Researchers have found that patients who have breast cancer who undergo treatment with taxanes show a pattern of clinically meaningful, persistent sensory and motor symptoms associated with chemotherapy-induced peripheral neuropathy, according to new findings presented by Trivedi et al at the 2023 ASCO Annual Meeting (Abstract 12003). The results of the study also demonstrated that patients may experience more severe symptoms after receiving treatment with paclitaxel than with docetaxel.
Background
Chemotherapy-induced peripheral neuropathy—nerve pain, tingling, or numbness in the hands or feet—is a common side effect of certain cancer treatments, including the taxanes paclitaxel and docetaxel. Paclitaxel and docetaxel are standard treatments for early-stage breast cancer. Both can lead to chemotherapy-induced peripheral neuropathy, but differences in symptoms caused by the two drugs have not been well described previously.
Currently, factors such as a patient’s age, preexisting neuropathy, and previous paclitaxel exposure are considered to be strong predictors of the condition. The larger goal of the new study was to develop a risk prediction model to help physicians individualize patient care using common clinical factors.
“These results from [the study] are highly relevant because taxanes such as paclitaxel and docetaxel are integral to our treatment of breast cancer. Peripheral neuropathy [as a result of] these drugs is familiar but poorly understood. Importantly, neuropathy symptoms were assessed not only by clinicians but also from the patient’s perspective using the CIPN20 questionnaire,” explained senior study author Michael J. Fisch, MD MPH, FACP, FAAHPM, FASCO, Clinical Professor of General Oncology in the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, Senior National Medical Director in the Department of Oncology and Genetics at AIM Specialty Health, and Co-Chair of the Southwest Oncology Group (SWOG) Symptom Control and Quality of Life Committee.
Study Methods and Results
In the new prospective, observational cohort SWOG S1714 study, researchers enrolled 1,336 patients with either breast cancer, non–small cell lung cancer, or ovarian/fallopian tube cancer who were undergoing treatment with paclitaxel or docetaxel. The researchers then developed a predictive model of chemotherapy-induced peripheral neuropathy in the 1,103 patients with had breast cancer who participated in the study.
The researchers evaluated the patients for symptoms of peripheral neuropathy using the National Cancer Institute’s (NCI) Common Terminology Criteria for Adverse Events system prior to treatment and again after 4, 8, 12, 24, 52, 104, and 156 weeks from enrollment. The patients also underwent neurosensory testing and functional testing.
Additionally, the patients were asked to complete their own self-assessments using the EORTC QLQ-CIPN20 (CIPN20) questionnaire—which scores symptoms overall on a 100-point scale, with higher scores indicating worse symptoms. Previous studies have found that patients with chemotherapy-induced peripheral neuropathy may experience a 7 to 10-point increase in their sensory subscale scores on the questionnaire. The new study defined a sensory subscale score increase of 8 points or more as a clinically meaningful worsening of the symptom.
After 24 weeks of follow-up, the researchers discovered that the patients experienced clinically meaningful and persistent sensory and motor symptoms. Over 40% of those who were treated with paclitaxel or docetaxel experienced clinically meaningful increases in their CIPN20 sensory subscores at follow-up. At nearly every time point throughout the 24 weeks, patients treated with paclitaxel had more sensory neuropathy than patients treated with docetaxel.
Conclusions
At multiple time points, the researchers collected blood samples from all of the patients involved in the study and are currently analyzing a range of biomarkers to identify additional predictors of chemotherapy-induced peripheral neuropathy. The researchers also plan to assess the effects of dosing frequency and dosing modifications on symptoms of the condition.
“There is a need to better understand [chemotherapy-induced peripheral neuropathy], as it has the potential to impact patient outcomes and quality of life,” emphasized lead study author Meghna S. Trivedi, MD, MS, Assistant Professor of Medicine at the Co-Leader of the Hereditary Breast and Ovarian Cancer Program at the Herbert Irving Comprehensive Cancer Center at Columbia University. “[The new study] was designed to collect the data and specimens to allow us to better characterize [chemotherapy-induced peripheral neuropathy] so that we can not only individualize cancer treatment strategies but also identify novel interventions for the prevention and treatment of [the condition],” she concluded.
Disclosure: The research in this study was supported by the NCI, led by SWOG, and conducted by the National Institutes of Health (NIH)–funded Community Oncology Research Program. Additional funding was provided by grants from the NIH and NCI, and in part by The Hope Foundation for Cancer Research. For full disclosures of the study authors, visit meetings.asco.org.
