BMI, Lifestyle Factors and Taxane-Induced Neuropathy in Breast Cancer Patients: The Pathways Study

Greenlee, Heather; Hershman, Dawn L.; Shi, Zaixing; Kwan, Marilyn L.; Ergas, Isaac J.; Roh, Janise M.; Kushi, Lawrence H.

doi:10.1093/jnci/djw206

Cited by 100 publications

(96 citation statements)

References 39 publications

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“…The association between every 2‐week paclitaxel administration and the development of neuropathy is more difficult to explain but is perhaps related to paclitaxel pharmacokinetics and, as a result, to perhaps greater nerve exposure to peak doses of drug. These previously reported, non‐age‐based associations serve to validate the lack of age‐related findings reported here .…”

Section: Discussionsupporting

confidence: 87%

Age and the Risk of Paclitaxel-Induced Neuropathy in Women with Early-Stage Breast Cancer (Alliance A151411): Results from 1,881 Patients from Cancer and Leukemia Group B (CALGB) 40101

et al. 2018

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Section: Discussionsupporting

confidence: 87%

Age and the Risk of Paclitaxel-Induced Neuropathy in Women with Early-Stage Breast Cancer (Alliance A151411): Results from 1,881 Patients from Cancer and Leukemia Group B (CALGB) 40101

et al. 2018

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“…Obesity has been associated with higher odds of peripheral neuropathy, a common side effect of oxaliplatin, in colon and breast cancer. 19, 35, 36 Greater vulnerability to neuropathy and lower dosing (obese patients in our study had lower drug mg/cm 2 muscle) are also potential explanations for the non-significant association of low muscle with dose reductions on oxailplatin. However, since low muscle was associated with early discontinuation and treatment delay regardless of the drug examined, another possibility is that the type of toxicity experienced determines the outcome: peripheral neuropathy on oxaliplatin could lead to early discontinuation and treatment delay but less often to dose reduction, whereas diarrhea, nausea, and neutropenia on 5-fluorouracil might lead to all three outcomes.…”

Section: Discussionmentioning

confidence: 67%

Muscle mass at the time of diagnosis of nonmetastatic colon cancer and early discontinuation of chemotherapy, delays, and dose reductions on adjuvant FOLFOX: The C‐SCANS study

Feliciano

Lee

Prado

et al. 2017

Cancer

105

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Background For many chemotherapy regimens dosed on body surface area (BSA), patients are dose-reduced, delayed, or discontinue treatment, reducing survival. Consideration of body composition may be useful in individualizing chemotherapy dosing, but few studies examine the association of body composition with chemotherapy tolerance in colon cancer. Methods We identified non-metastatic colon cancer patients diagnosed from 2006–2011 at Kaiser Permanente who received FOLFOX as initial adjuvant chemotherapy (n=533). We quantified patients’ muscle mass using clinically-acquired computed tomography (CT) scans and quantified chemotherapy doses, treatment dates, and related toxicities using the electronic medical record. In logistic regression models adjusting for age, sex, and stage, we examined associations of muscle tertiles with early discontinuation (<6 cycles), treatment delay (≥3 days off-schedule ≥3 times), and/or dose reduction (relative dose intensity≤0.70, based on planned treatment). Results Average age at diagnosis was 58.7 years, body surface area (BSA) was 1.9 m2, and body mass index was 28.7 kg/m2. Compared to the highest sex-specific tertile of muscle, patients in the lowest tertile were more likely to experience toxicities had twice the risk of adverse outcomes on FOLFOX: odds ratios (OR) and 95% Confidence Intervals (95%CI) were OR=2.34 (95%CI: 1.04, 5.24; p-trend=0.03) for early discontinuation, OR=2.24 (95%CI: 1.37, 3.66; p-trend=0.002) for treatment delay and OR=2.28 (95%CI: 1.19, 4.36; p-trend=0.01) for dose reduction. Conclusions Lower muscle mass is associated with greater toxicity and poor chemotherapy adherence on FOLFOX. Many chemotherapy drugs are dosed on BSA: treatment may be better individualized if muscle mass is considered.

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“…These data are clinically important for highlighting the differential risk and time course of CIPN claims by type of chemotherapy agent(s). Prior research has largely relied on clinically assessed CIPN, which is heterogeneous in severity, and it may not always account for comorbid conditions or lifestyle factors that modulate the risk of CIPN . Although the current study likely offers a more conservative estimate of CIPN (because of the greater severity required to obtain a claim), the primary goal was to estimate the differential risk of CIPN by chemotherapy agent, which should be independent of the overall level of CIPN in the breast cancer population.…”

Section: Discussionmentioning

confidence: 99%

Risk of incident claims for chemotherapy‐induced peripheral neuropathy among women with breast cancer in a Medicare population

Greenwald

Ruterbusch

Beebe‐Dimmer

et al. 2018

Cancer

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Background Chemotherapy‐induced peripheral neuropathy (CIPN) is a common and disabling consequence of neurotoxic therapies, yet factors that modulate the development and clinical impact of CIPN are poorly understood. This epidemiological analysis identifies risk factors for the incidence of CIPN. Methods This retrospective analysis of Surveillance, Epidemiology, and End Results–Medicare data examined predictors of incident CIPN claims among 11,149 women aged 66 years or older with American Joint Commission on Cancer (AJCC) stage II to IV breast cancer (and no secondary cancer diagnosis or preexisting neuropathy) who received chemotherapy. Results Overall, new CIPN claims occurred for 8.3% of patients within 1 year of starting chemotherapy. Risk emerged approximately 3 months after the start of chemotherapy and increased throughout 1 year. Paclitaxel as part of first‐line therapy increased CIPN risk 2.7‐fold in comparison with nonneurotoxic agents (15.9% vs 5.0%), with lower incidence rates for carboplatin and paclitaxel (11.9%), carboplatin and docetaxel (9.3%), carboplatin alone (7.7%), and docetaxel alone (6.6%). The CIPN incidence rate was higher for women who at the time of their breast cancer diagnosis were relatively young (within this Medicare sample), were at AJCC stage II or III, were married or had an equivalent status, and had fewer comorbidities, but it did not differ by race/ethnicity or poverty level. Conclusions These Medicare claims database findings indicate that women aged 66 years or older with breast cancer are susceptible to CIPN from taxane and/or platinum compounds, with risk emerging approximately 3 months into treatment. Prospective studies of symptom emergence and clinical response (eg, stopping chemotherapy and adjunctive treatments) are indicated to determine how best to inform patients of this risk and to manage CIPN in this population.

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BMI, Lifestyle Factors and Taxane-Induced Neuropathy in Breast Cancer Patients: The Pathways Study

Abstract: Obesity and low MVPA were associated with CIPN in breast cancer patients who received taxane treatment.

Cited by 100 publications

References 39 publications

Age and the Risk of Paclitaxel-Induced Neuropathy in Women with Early-Stage Breast Cancer (Alliance A151411): Results from 1,881 Patients from Cancer and Leukemia Group B (CALGB) 40101

Age and the Risk of Paclitaxel-Induced Neuropathy in Women with Early-Stage Breast Cancer (Alliance A151411): Results from 1,881 Patients from Cancer and Leukemia Group B (CALGB) 40101

Muscle mass at the time of diagnosis of nonmetastatic colon cancer and early discontinuation of chemotherapy, delays, and dose reductions on adjuvant FOLFOX: The C‐SCANS study

Risk of incident claims for chemotherapy‐induced peripheral neuropathy among women with breast cancer in a Medicare population

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