Chemotherapy dose reduction due to chemotherapy induced peripheral neuropathy in breast cancer patients receiving chemotherapy in the neoadjuvant or adjuvant settings: a single-center experience

Bhatnagar, Bhavana; Gilmore, Stephen; Goloubeva, Olga; Pelser, Colleen; Medeiros, Michelle; Chumsri, Saranya; Tkaczuk, Katherine H.; Edelman, Martin J.; Bao, Ting

doi:10.1186/2193-1801-3-366

Cited by 110 publications

(97 citation statements)

References 40 publications

(43 reference statements)

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“…These sensory changes can be debilitating to the extent that a reduction in the dose of therapy given to a patient is required. For example, a recent report found that 17% of patients receiving the chemotherapeutic agent paclitaxel required a dose reduction because of CIPN, and such dose reductions have been linked to poorer survival rates [2]. …”

mentioning

confidence: 99%

Mechanisms Involved in the Development of Chemotherapy-Induced Neuropathy

2015

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SUMMARY Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and painful condition seen in patients undergoing treatment with common agents such as vincristine, paclitaxel, oxaliplatin and bortezomib. The mechanisms of this condition are diverse, and include an array of molecular and cellular contributions. Current research implicates genetic predispositions to this condition, which then may influence cellular responses to chemotherapy. Processes found to be influenced during CIPN include increased expression of inflammatory mediators, primarily cytokines, which can create cascading effects in neurons and glia. Changes in ion channels and neurotransmission, as well as changes in intracellular signaling and structures have been implicated in CIPN. This review explores these issues and suggests considerations for future research.

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confidence: 99%

Mechanisms Involved in the Development of Chemotherapy-Induced Neuropathy

2015

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“…Similarly, a prior single-institution retrospective analysis demonstrated higher risk of TIPN for AAs. 8-10 …”

Section: Discussionmentioning

confidence: 99%

Impact of Genetic Ancestry on Outcomes in ECOG-ACRIN-5103

Schneider

Shen

Jiang

et al. 2017

JCO Precision Oncology

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Purpose Racial disparity in breast cancer outcomes exists between African American and Caucasian women in the United States. We have evaluated the impact of genetically determined ancestry on disparity in efficacy and therapy-induced toxicity for breast cancer patients in the context of a randomized, phase III adjuvant trial. Patients and Methods This study compared outcomes between 386 patients of African ancestry (AA) and 2473 patients of European ancestry (EA) in a randomized, phase III breast cancer trial; ECOG-ACRIN-E5103. The primary efficacy endpoint, invasive disease free survival (DFS) and clinically significant toxicities were compared including: anthracycline-induced congestive heart failure (CHF), taxane-induced peripheral neuropathy (TIPN), and bevacizumab-induced hypertension. Results Overall, AAs had significantly inferior DFS (p=0.002; HR=1.5) compared with EAs. This was significant in the estrogen receptor-positive subgroup (p=0.03); with a similar, non-significant trend for those who had triple negative breast cancer (TNBC; p=0.12). AAs also had significantly more grade 3-4 TIPN (OR=2.9; p=2.4 ×10-11) and grade 3-4 bevacizumab-induced hypertension (OR=1.6; p=0.02), with a trend for more CHF (OR=1.8; p=0.08). AAs had significantly more dose reductions for paclitaxel (p=6.6 ×10-6). In AAs, dose reductions in paclitaxel had a significant negative impact on DFS (p=0.03); whereas in EAs, dose reductions did not impact outcome (p=0.35). Conclusion AAs had inferior DFS with more clinically important toxicities in ECOG-ACRIN-E5103. The altered risk to benefit ratio for adjuvant breast cancer chemotherapy should lead to additional research with the focus centered on the impact of genetic ancestry on both efficacy and toxicity. Strategies to minimize dose reductions for paclitaxel, especially due to TIPN, are warranted for this population.

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“…Most cases may develop myalgias or arthralgias [2] . However, in its severe form, dose reduction is required reducing the efficacy of the drug especially in breast cancer treatment [11] .…”

Section: Chemotherapy Induced Peripheral Neuropathy (Cipn)mentioning

confidence: 99%

“…This leads to disruption of peripheral nerve signaling causing sensory, motor, or autonomic peripheral neuropathy influencing the patient routine daily activities or even causes significant disability [8][9][10][11] .…”

Section: Chemotherapy Induced Peripheral Neuropathy (Cipn)mentioning

confidence: 99%

The Possible Role of Propolis in Ameliorating Paclitaxel-Induced Peripheral Neuropathy in Sciatic Nerve of Adult Male Albino Rats

Kassab

Elkaliny

2017

Egyptian Journal of Histology

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Background: Paclitaxel is a neurotoxic chemotherapeutic agent. The sensorimotor peripheral neuropathy is a serious dose limiting complication of paclitaxel therapy. Propolis is a natural honeybee product collected from plants. It has broad biological and pharmacological activities and a proposed neuroprotective role. Aim: To assess the possible protective role of propolis on paclitaxel-induced peripheral neuropathy in rat's sciatic nerve. Material and Methods: Twenty-four adult male albino rats were divided into four equal groups; control group, propolistreated group (50 mg/kg orally once daily), paclitaxel -treated group (16 mg/kg intraperitoneally once a week), and both paclitaxel & propolis-treated group. Animals were treated for 5 consecutive weeks. Specimens of sciatic nerve were processed for histological study by light and electron microscopy. Immunohistochemical study was carried out using CD68 antibody. Morphometric study and statistical analysis of light microscopic data were performed for all groups. Results: Compared to the control group, the sciatic nerve specimens of the paclitaxel-treated rats showed splitting of myelin lamellae with infolded myelin loops, together with invagination and evagination of the myelin sheath. Changes in the axons included formation of myelin figures, compression and irregularity. Schwann cells showed cytoplasmic vacuolation and dilated rER. Immunohistochemical study revealed a significant increase in the number of CD68 positive cells. On the other hand, minimal changes were observed in rats treated concomitantly with both paclitaxel and propolis, with a non-significant increase in CD68 positive cells. Conclusion: Paclitaxel induced structural changes in the myelinated fibers of sciatic nerve of albino rats. The concomitant treatment with propolis ameliorated these changes.

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Chemotherapy dose reduction due to chemotherapy induced peripheral neuropathy in breast cancer patients receiving chemotherapy in the neoadjuvant or adjuvant settings: a single-center experience

Cited by 110 publications

References 40 publications

Mechanisms Involved in the Development of Chemotherapy-Induced Neuropathy

Mechanisms Involved in the Development of Chemotherapy-Induced Neuropathy

Impact of Genetic Ancestry on Outcomes in ECOG-ACRIN-5103

The Possible Role of Propolis in Ameliorating Paclitaxel-Induced Peripheral Neuropathy in Sciatic Nerve of Adult Male Albino Rats

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