A Meta-analysis Studying the Utility of Cryotherapy in the Prevention of Peripheral Neuropathy in Breast Cancer Patients Receiving Paclitaxel and Nab-Paclitaxel.

Abstract Background Cryotherapy with taxane infusion is a non-invasive strategy to prevent PN, but its efficacy is not proven Methods A systematic search was conducted, and 477 records were identified. The titles were screened independently by 2 reviewers. 14 were included for the meta-analysis using R package meta. Only studies that analyzed cryotherapy use in BC patients who received paclitaxel or nab-paclitaxel were included. Relative risk (RR) derived from random effects model was used to compare the occurrence of PN. Results Incidence of Common Terminology Criteria for Adverse Events (CTCAE) grade ≥ 2 PN was 24.85% (81/326) in the cryotherapy arm and 42.35% (72/170) in the placebo arm. Overall RR for CTCAE grade ≥ 2 PN with cryotherapy compared to placebo was 0.45 0.27,0.77, p = 0.0031. RR for sensory PN was 0.19 0.05,0.66, p = 0.009 and for motor PN was 0.18 0.03,0.99, p = 0.0491. RR for Patient Neurotoxicity Questionnaire (PNQ) score ≥ D which connotes severe neuropathy was 0.24 0.09,0.62, p = 0.0035. Cold intolerance was the predominant adverse effect at 15% (37/247). Conclusions Use of cryotherapy decreased the occurrence of CTCAE grade ≥ 2 PN by 55%. Cold intolerance was the most frequently reported issue with its use but lead to relatively low discontinuation rates.