Risk factors and pharmacotherapy for chemotherapy-induced peripheral neuropathy in paclitaxel-treated female cancer survivors: A retrospective study in Japan

PLoS One. 2021 Dec 31;16(12):e0261473. doi: 10.1371/journal.pone.0261473. eCollection 2021.

Abstract

Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting adverse reaction in cancer patients treated with several cytotoxic anticancer agents including paclitaxel. Duloxetine, an antidepressant known as a serotonin-noradrenalin reuptake inhibitor, is the only agent that has moderate evidence for the use to treat painful CIPN. The present retrospective cohort study aimed to analyze risk factors for paclitaxel-induced peripheral neuropathy (PIPN), and investigate ongoing prescription drug use for PIPN in Japan. Female breast and gynecologic cancer patients who underwent paclitaxel-based chemotherapy at a single center in Japan between January 2016 and December 2019 were enrolled in this study. Patients' information obtained from electronic medical records were statistically analyzed to test possible risk factors on PIPN diagnosis. Patients' age, total paclitaxel dose, the history of female hormone-related diseases, hypertension and body mass index (BMI), but not additional platinum agents, were significantly associated with increased PIPN diagnosis. Drugs prescribed for PIPN included duloxetine, pregabalin, mecobalamin and Goshajinkigan, a polyherbal medicine, regardless of poor evidence for their effectiveness against CIPN, and were greatly different between breast and gynecologic cancer patients diagnosed with PIPN at the departments of Surgery and Gynecology, respectively. Thus, older age, greater total paclitaxel dose, the history of estrogen-related diseases, hypertension and BMI are considered risk factors for PIPN in paclitaxel-based chemotherapy of female cancer patients. It appears an urgent need to establish a guideline of evidence-based pharmacotherapy for PIPN.

MeSH terms

  • Aged
  • Antineoplastic Agents / adverse effects*
  • Breast Neoplasms / complications
  • Breast Neoplasms / drug therapy
  • Cancer Survivors*
  • Drug Therapy / methods*
  • Duloxetine Hydrochloride / pharmacology
  • Female
  • Genital Neoplasms, Female / complications
  • Genital Neoplasms, Female / drug therapy
  • Humans
  • Japan / epidemiology
  • Middle Aged
  • Paclitaxel / pharmacology*
  • Peripheral Nervous System Diseases / chemically induced*
  • Peripheral Nervous System Diseases / drug therapy*
  • Retrospective Studies
  • Risk Factors

Substances

  • Antineoplastic Agents
  • Duloxetine Hydrochloride
  • Paclitaxel

Grants and funding

The authors received no specific funding for this work.