Comorbidities and risk of chemotherapy-induced peripheral neuropathy among participants in SWOG clinical trials.

10001 Background: Neuropathy is a debilitating toxicity associated with various chemotherapy agents. We evaluated the association between common comorbid conditions and the development of peripheral neuropathy in patients treated with taxane-based chemotherapy. Methods: We examined the SWOG database to identify phase II/III trials that included taxane therapy from 1999-2011. We linked the SWOG clinical records to Medicare claims data according to social security number, sex, and date of birth. The following disease conditions potentially associated with peripheral neuropathy were evaluated: diabetes, hypothyroid, hypercholesterolemia, hypertension, varicella zoster, peripheral vascular disease, and autoimmune diseases. Multivariate logistic regression was used to model the odds of experiencing Grade 2-4 neuropathy. Results: A total of n = 1401 patients from 23 studies were included in the analysis. Of these 251/1401 patients (18%) had Grade 2-4 neuropathy. Patients receiving paclitaxel were more likely to experience neuropathy (25% vs. 12%; OR = 2.20,95% CI:1.52-3.18, p < .0001) compared to docetaxel. The inclusion of a platinum agent in addition to a taxane was also associated with greater neuropathy (OR = 1.68,95% CI:1.18-2.40, p = .004). For each increase in age of one year, the odds of neuropathy increased 4% (p = .006). Patients with complications from diabetes had twice the odds of neuropathy (OR = 2.13, 95%CI:1.31-3.46, p = .002) compared to patients with no diabetes. In contrast, patients with autoimmune disease were half as likely to experience neuropathy (OR = 0.49, 95%CI:0.24-1.02, p = .06). There were higher rates of Grade 2-4 neuropathy (22% vs. 0%, p = .0005) among diabetics on taxane therapy compared diabetics who did not receive a taxane or a platinum agent. Conclusions: In summary, we found that in addition to drug-related factors, age and history of diabetes are independent predictors of the development of CIPN. Interestingly, we also observed that a history of autoimmune disease was associated with reduced odds of neuropathy. Patients with diabetic complications may choose to avoid paclitaxel, or taxane/platinum combination therapies, if other efficacious options exist.