LAUSR

© E LE N A V A SI LC H EN K O / SH U TT ER ST O C K .C O M F ollow-up data from a large clinical trial have demonstrated that many patients with breast cancer who receive taxanebased chemotherapy experience long-term peripheral neuropathy. In a study published in the Journal of the National Cancer Institute, more than 40% of participants said they still experienced symptoms 2 years after the initiation of treatment, and approximately 10% rated these symptoms as severe.1 Symptoms included numbness and tingling in the hands and feet. Moreover, patients with severe neuropathy reported having a lower quality of life compared with those who did not experience it. Senior author Patricia Ganz, MD, of the Jonsson Comprehensive Cancer Center at the University of California at Los Angeles, says providers should ensure patients understand both the benefits and harms of treatment. She notes that, typically, patients are only told about acute side effects and therefore can be very surprised when they are left with lingering neuropathy, pain, fatigue, or cognitive difficulties. Many women with early-stage breast cancer, or even stage II or III disease, are expected to live for a long time and therefore providers need to gain more awareness of these chronic toxicities, says Ann O’Mara, PhD, RN, MPH, head of palliative research in the division of cancer prevention at the National Cancer Institute in Bethesda, Maryland. The study assessed women enrolled in the National Surgical Adjuvant Breast and Bowel Project (NSABP) Protocol B-30 who had breast cancer that could be removed surgically but who were deemed to be at high risk of disease recurrence because cancer cells had spread to nearby lymph nodes. The study’s main goal was to compare overall survival in women randomly assigned to 1 of 3 different chemotherapy regimens containing docetaxel, a type of taxane. Peripheral neuropathy is a common side effect of taxane chemotherapy. Women were randomly assigned to receive either doxorubicin or docetaxel at the same time; doxorubicin, cyclophosphamide, and docetaxel at the same time (ACT); or doxorubicin and cyclophosphamide at the same time followed by docetaxel (AC T). Participants in the third group received the highest doses of taxane and demonstrated the best overall survival 8 years after therapy. Those patients in the ACT group experienced the second longest survival. By 6 months after the initiation of treatment, neuropathy rates had increased among all patients, but those who received docetaxel after the other 2 drugs had particularly high rates. In addition, although the percentage of patients in this group who experienced symptoms decreased to just under 50% at 24 months after the initiation of treatment, neuropathy rates remained higher for them than for patients in the other 2 groups. Other characteristics that increased the risk of lingering neuropathy at 24 months were the presence of neuropathy before treatment, older age, being overweight or obese, having undergone a mastectomy, and having a greater number of lymph nodes containing cancer cells. Dr. Ganz notes that patients treated outside of clinical trials often are older and less healthy than their counterparts. Therefore, the “real-world” percentage of women who experience these symptoms from taxane-based chemotherapy is likely higher than the study findings would indicate. She adds that other studies have found that women with chronic neuropathy after treatment were at greater risk of disability and falls. The results of the trial demonstrated that ACT produced nearly as much of a survival benefit as AC T but much less neuropathy, indicating that the treatment could be an alternative for a patient who is at high risk of persistent neuropathy. Dr. Ganz says that determining that risk should involve oncologists asking patients about preexisting neuropathy before treatment and taking other risk factors into account. Overall, she emphasizes the importance of using strategies that include such discussions in treatment decision making.