Chemotherapy-induced peripheral neuropathy associated with docetaxel or nab-paclitaxel among patients with lung cancer: a prospective dual-center cohort study

Objective To compare the distinct clinical manifestations of chemotherapy-induced peripheral neuropathy (CIPN) in patients with different types of lung cancer treated with docetaxel or nab-paclitaxel, as well as to evaluate the post-intervention symptom improvement following therapeutic management. Methods This prospective cohort study was conducted from September 2024 to August 2025 across two medical centers in China. Participants were lung cancer patients who had received treatment with either docetaxel or nab-paclitaxel. Chemotherapy-induced peripheral neuropathy (CIPN) was assessed using patient-reported outcomes from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-CIPN 20-item scale (EORTC QLQ-CIPN20). Multivariable regression models were adjusted for patient baseline characteristics, tumor status, and medication-related features. Evaluations were performed using overlap propensity score weighting. Data analysis was carried out from September 2025 to December 2025. Results Among the 850 participants, the mean (SD) age was 63.2 (10.5) years, with 385 patients (45.3%) receiving docetaxel and 465 patients (54.7%) receiving nab-paclitaxel. The docetaxel group primarily reported motor symptoms (e.g., leg weakness: 92 patients [34.2%]) and autonomic symptoms (e.g., blurred vision: 108 patients [40.1%]). In contrast, the nab-paclitaxel group predominantly reported sensory symptoms, such as numbness in the hands and feet (68 patients [25.3%]). The onset of patient-reported motor symptoms occurred earlier than sensory abnormalities, with median times of 2.3 weeks (95% CI, 1.3–5.4) in the docetaxel group and 0.8 weeks (95% CI, 0.6–1.2) in the nab-paclitaxel group. After adjustment using overlap propensity score weighting, patients in the docetaxel group had a lower risk of reported CIPN compared to those in the nab-paclitaxel group (HR, 0.65 [95% CI, 0.54–0.86]; P = 0.015). Patients treated with docetaxel reported fewer sensory discomforts compared to those receiving nab-paclitaxel (HR, 0.61 [95% CI, 0.49–0.89]; P = 0.001). However, the risk of reported motor symptoms (HR, 0.54 [95% CI, 0.44–0.69]; P = 0.061) and/or autonomic symptoms (HR, 0.87 [95% CI, 0.62–1.22]; P = 0.229) was not significantly lower in the docetaxel group than in the nab-paclitaxel group. Conclusion In this cohort study of lung cancer patients, nab-paclitaxel was associated with more severe CIPN compared to docetaxel, regardless of patients’ clinical characteristics. Multivariate analysis identified taxane type, number of prior treatment cycles, treatment phase, and the use of pregabalin for intervention as independent factors associated with patient-reported CIPN. These findings may contribute to early intervention and therapeutic decision-making for CIPN during taxane-based treatment of lung cancer.