Cryotherapy significantly reduced the incidence of paclitaxel-induced tactile sensitivity in the hands (27.8% vs 80.6%; OR 20.00; P<0.001) and feet (25.0% vs 63.9%; P<0.001) compared to untreated sides.
Does cryotherapy prevent paclitaxel-induced neuropathy in breast cancer patients?
Cryotherapy using frozen gloves and socks significantly reduces the incidence of objective and subjective paclitaxel-induced peripheral neuropathy in breast cancer patients.
Effect estimate: OR 20.00 (95% CI 3.20 to 828.96)
Absolute Event Rate: 27.8% vs 80.6%
p-value: p=<.001
Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting and disabling side effect of taxane anticancer agents. We prospectively evaluated the efficacy of cryotherapy for CIPN prevention. Methods: Breast cancer patients treated weekly with paclitaxel (80 mg/m2 for one hour) wore frozen gloves and socks on the dominant side for 90 minutes, including the entire duration of drug infusion. Symptoms on the treated sides were compared with those on the untreated (nondominant) sides. The primary end point was CIPN incidence assessed by changes in tactile sensitivity from pretreatment baseline in a monofilament test at a cumulative dose of 960 mg/m2. We also assessed thermosensory deficits, subjective symptoms (Patient Neuropathy Questionnaire PNQ), manipulative dexterity, and the time to events and hazard ratio by PNQ. All statistical tests were two-sided. Results: Among the 40 patients, four did not reach the cumulative dose (due to the occurrence of pneumonia, severe fatigue, severe liver dysfunction, and macular edema), leaving 36 patients for analysis. None dropped out due to cold intolerance. The incidence of objective and subjective CIPN signs was clinically and statistically significantly lower on the intervention side than on the control (hand: tactile sensitivity = 27.8% vs 80.6%, odds ratio OR = 20.00, 95% confidence interval CI = 3.20 to 828.96, P < .001; foot: tacile sensitivity = 25.0% vs 63.9%, OR = infinite, 95% CI = 3.32 to infinite, P < .001; hand: warm sense = 8.8% vs 32.4%, OR = 9.00, 95% CI = 1.25 to 394.48, P = .02; foot: warm sense: 33.4% vs 57.6%, OR = 5.00, 95% CI = 1.07 to 46.93, P = .04; hand: PNQ = 2.8% vs 41.7%, OR = infinite, 95% CI = 3.32 to infinite, P < .001; foot: PNQ = 2.8% vs 36.1%, OR = infinite, 95% CI = 2.78 to infinite, P < .001; hand: hazard ratio HR = 0.13, 95% CI = 0.05 to 0.34; foot: HR = 0.13, 95% CI = 0.04 to 0.38, dexterity mean delay = -2.5 seconds, SD = 12.0 seconds, vs + 8.6 seconds, SD = 25.8 seconds, P = .005). Conclusions: Cryotherapy is useful for preventing both the objective and subjective symptoms of CIPN and resultant dysfunction.
Hanai et al. (Thu,) conducted a other in Paclitaxel-induced peripheral neuropathy in breast cancer (n=40). Cryotherapy (frozen gloves and socks) vs. Untreated (nondominant) sides was evaluated on CIPN incidence assessed by changes in tactile sensitivity from pretreatment baseline in a monofilament test at a cumulative dose of 960 mg/m2 (hand) (OR 20.00, 95% CI 3.20 to 828.96, p=<.001). Cryotherapy significantly reduced the incidence of paclitaxel-induced tactile sensitivity in the hands (27.8% vs 80.6%; OR 20.00; P<0.001) and feet (25.0% vs 63.9%; P<0.001) compared to untreated sides.
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