Purpose: Chemotherapy-induced peripheral neuropathy (CIPN) is the major treatment-limiting toxicity of paclitaxel, which predominantly presents as sensory symptoms, with motor symptoms in some patients. Differentiating CIPN into subtypes has been recommended to direct CIPN research. The objective of this study was to investigate whether sensory and motor CIPN are distinct subtypes with different predictive biomarkers in patients with breast cancer receiving paclitaxel.Methods: European Organisation for Research and Treatment of Cancer Quality of Life questionnaire CIPN20 was used to evaluate CIPN. Clusters of the time course of sensory (CIPN S ), motor (CIPN M ), and the difference between sensory and motor (CIPN S -CIPN M ) were identi ed using k-means clustering on principal component scores. Predictive metabolomic biomarkers of maximum CIPN S and CIPN M were investigated using linear regressions adjusted for baseline CIPN, systemic paclitaxel exposure, and body mass index.Results: More sensory than motor CIPN was found (CIPN S change: mean=10.8, ranged [-3.3, 52.1]; CIPN M change: mean=3.5, range: [-7.5, 35.0]). Three groups were identi ed with No CIPN, Mixed CIPN, and Sensory-dominant CIPN (maximum CIPN S : mean=12.7 vs. 40.9 vs. 74.3, p<0.001; maximum CIPN M : mean=5.4 vs. 25.5 vs. 36.1, p<0.001; average CIPN S -CIPN M : mean=2.8 vs. 5.8 vs. 24.9, p<0.001).Biomarkers of motor CIPN were similar to previously identi ed biomarkers of sensory CIPN, including lower serum histidine (p=0.029). Conclusion: Our ndings suggest that sensory and motor CIPN co-occur and may not have differentiating metabolic biomarkers. These ndings need to be validated in larger cohorts of patients treated with paclitaxel and other neurotoxic agents to determine the optimal approach to predict, prevent, and treat CIPN and improve patients' outcomes.