Long-term Peripheral Neuropathy in Breast Cancer Patients Treated With Adjuvant Chemotherapy: NRG Oncology/NSABP B-30.

MedStar author(s):
Citation: Journal of the National Cancer Institute. 110(2), 2018 Feb 01PMID: 28954297Institution: MedStar Franklin Square Medical Center | Washington Cancer InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Antineoplastic Combined Chemotherapy Protocols/ae [Adverse Effects] | *Antineoplastic Combined Chemotherapy Protocols/tu [Therapeutic Use] | *Breast Neoplasms/dt [Drug Therapy] | *Peripheral Nervous System Diseases/ci [Chemically Induced] | Chemotherapy, Adjuvant | Cyclophosphamide/ae [Adverse Effects] | Doxorubicin/ad [Administration & Dosage] | Doxorubicin/ae [Adverse Effects] | Drug Administration Schedule | Female | Humans | Middle Aged | Quality of Life | Taxoids/ad [Administration & Dosage] | Taxoids/ae [Adverse Effects]Year: 2018Local holdings: Available online from MWHC library: 1996 - present (after 1 year), Available in print through MWHC library: 1999 - 2006ISSN:
  • 0027-8874
Name of journal: Journal of the National Cancer InstituteAbstract: Background: The long-term effects of chemotherapy are sparsely reported. Peripheral neuropathy (PN) is one of the most frequent toxicities associated with taxane use for the treatment of early-stage breast cancer. We investigated the impact of the three different docetaxel-based regimens and patient characteristics on long-term, patient-reported outcomes of PN and the impact of PN on long-term quality of life (QOL).Conclusions: The administration of docetaxel is associated with long-term PN. The lower rate of long-term PN in AT and ACT patients might be an important consideration in supporting choosing these therapies for individuals with preexisting neuropathic symptoms or other risk factors for neuropathy.Methods: The National Surgical Adjuvant Breast and Bowel Project Protocol B-30 was a randomized trial comparing sequential doxorubicin (A) and cyclophosphamide (C) followed by docetaxel (T) (AC->T), concurrent ACT, or AT in women with node-positive, early-stage breast cancer. The AC->T group had a higher cumulative dose of T. PN was one of the symptoms assessed in a QOL substudy. Statistical methods included simple and mixed ordinal logistic regression and general linear models. All statistical tests were two-sided.Results: Of 1512 patients, 41.9% reported PN two years after treatment initiation. Treatment with AT and ACT was associated with less severe long-term PN compared with AC->T (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.35 to 0.58; OR=0.59, 95% CI=0.46 to 0.75). Preexisting PN, older age, obesity, mastectomy, and greater number of positive nodes were also associated with higher risk of long-term PN. Patients who reported worse PN symptoms at 24months had statistically significantly worse QOL (Ptrend < .001).All authors: Bandos H, Brufsky AM, Fehrenbacher L, Ganz PA, Julian TB, Margolese RG, McCarron EC, Melnikow J, Rivera DR, Sturtz K, Swain SM, Wade JL 3rdFiscal year: FY2018Digital Object Identifier: Date added to catalog: 2017-09-29
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 28954297 Available 28954297

Available online from MWHC library: 1996 - present (after 1 year), Available in print through MWHC library: 1999 - 2006

Background: The long-term effects of chemotherapy are sparsely reported. Peripheral neuropathy (PN) is one of the most frequent toxicities associated with taxane use for the treatment of early-stage breast cancer. We investigated the impact of the three different docetaxel-based regimens and patient characteristics on long-term, patient-reported outcomes of PN and the impact of PN on long-term quality of life (QOL).

Conclusions: The administration of docetaxel is associated with long-term PN. The lower rate of long-term PN in AT and ACT patients might be an important consideration in supporting choosing these therapies for individuals with preexisting neuropathic symptoms or other risk factors for neuropathy.

Methods: The National Surgical Adjuvant Breast and Bowel Project Protocol B-30 was a randomized trial comparing sequential doxorubicin (A) and cyclophosphamide (C) followed by docetaxel (T) (AC->T), concurrent ACT, or AT in women with node-positive, early-stage breast cancer. The AC->T group had a higher cumulative dose of T. PN was one of the symptoms assessed in a QOL substudy. Statistical methods included simple and mixed ordinal logistic regression and general linear models. All statistical tests were two-sided.

Results: Of 1512 patients, 41.9% reported PN two years after treatment initiation. Treatment with AT and ACT was associated with less severe long-term PN compared with AC->T (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.35 to 0.58; OR=0.59, 95% CI=0.46 to 0.75). Preexisting PN, older age, obesity, mastectomy, and greater number of positive nodes were also associated with higher risk of long-term PN. Patients who reported worse PN symptoms at 24months had statistically significantly worse QOL (Ptrend < .001).

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