4. Discussion
SWOG, breast cancer, Taxane-induced CIPN, neuropathy, CIPN, taxane-induced CIPN, neurotoxic, diabetes
NEUROPATHY, BREAST CANCER, ADVERSE EVENT, REGRESSION, DIABETES
In this ancillary analysis of a previous randomized trial investigating the preventive effect of cryotherapy on weekly paclitaxel-induced CIPN in breast cancer patients, cryotherapy resulted in substantially lower incidence of early CIPN and a numerical decrease in the incidence of persistent CIPN at more than 1 year after treatment completion when compared to control. Age ≥ 65 year was a substantial predictive factor for persistent CIPN in multivariate logistic regression analysis.In early breast cancer patients administered with adjuvant taxane-based chemotherapy, CIPN is a common and prolonged adverse event that can complicate quality of life and increase the risk of falls or functional impairment. Taxane-induced CIPN is commonly recognized during chemotherapy, however, recent studies have reported the presence of persistent CIPN after treatment completion. In a randomized trial of acetyl-L-carnitine for the prevention of taxane-induced CIPN (SWOG S0715), FACT-NTX scores on the placebo and experimental arm stayed decreased during weeks 12, 24, 36, 52, and 104.Risk factors of CIPN occurrence include chemotherapy regimen, age, comorbidities, and preexisting neuropathy. Taxane-containing regimen is well established neurotoxic chemotherapy and paclitaxel is more neurotoxic than docetaxel. Regarding patient factors, age and history of diabetes are risk factors for CIPN.Previous clinical trials assessed the preventive effects of cryotherapy, compression therapy and exercise on CIPN during chemotherapy, but few reported the prevention effect of persistent CIPN with long-term follow-up. In our study, cryotherapy resulted in not only statistically lower incidence of early CIPN but also a numerically lower incidence of persistent CIPN when compared with the control group. It is possible that preventing CIPN during chemotherapy is linked to a lower incidence of persistent CIPN. A retrospective study found that having severe CIPN was a significant risk factor for CIPN duration.