Clinical Review Abstract
Trials in Progress Abstract
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Dose reduction (DR) due to chemotherapy induced peripheral neuropathy (CIPN) in breast cancer (BC) patients (pts) in the neoadjuvant/adjuvant settings.
Symptom Management/Supportive Care/Palliative Care
Patient and Survivor Care
2013 ASCO Annual Meeting
J Clin Oncol 31, 2013 (suppl; abstr e20574)
Author(s): Bhavana Bhatnagar, Steven Gilmore, Olga G. Goloubeva, Lulu Wang, Michelle Medeiros, Saranya Chumsri, Katherine Hanna Tkaczuk, Martin J. Edelman, Ting Bao; University of Maryland, Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD
Background: CIPN is a common and potentially dose-limiting complication of many effective cytotoxic agents. Taxanes are the cornerstone of treatment in BC. Limited data are available regarding the prevalence and severity of DR due to CIPN following taxane use. Methods: Charts of 123 consecutive newly diagnosed BC pts treated with a taxane as part of standard neoadjuvant/adjuvant chemotherapy at the University of Maryland Greenebaum Cancer Center between 01/01/2008 and 12/31/2011 were reviewed. Treating physicians followed standard recommendations for DR. Results: Median age at diagnosis was 53 years (range, 32-78), 120 female/3 male, 48 Caucasian (C), 70 African-American (AA), 5 had a history of alcohol abuse, and 20 had a diagnosis of diabetes mellitus (DM). Seventy pts received docetaxel, 46 paclitaxel, 7 received both or nab-paclitaxel. Fifty (40%) pts required DR, with 21 (17%) due to CIPN and 29 (23%) due to other causes. The median relative dose intensity (received dose/planned dose) for the 21 CIPN-induced dose reduction pts was 88% (range, 62%-97%). A multivariable logistic regression model was used to compare pts who did and did not require DR based on the following possible risk factors: taxane received, DM, alcohol use, and race. Based on the effects estimated by statistical model, there was no difference between pts who did and did not undergo DR with regard to factors listed. However, diabetic pts were over twice as likely to require DR (OR = 2.4, 95% CI: 0.6-10.2, p=0.06). The univariable logistic regression model for 50 pts who had undergone DR revealed possible differences in developing CIPN between C and AA patients. The chances of DR due to CIPN are higher in AA pts (OR=4.3, 95% CI: 1.1-16.7, p=0.03). Pts who received paclitaxel are more likely to require DR due to CIPN than those treated with docetaxel (OR=10.4, 95% CI: 2.7-39.6, p=0.001). Conclusions: 1. CIPN-induced dose-reduction occurred in 17% of our study population. 2. The median relative dose intensity was 88%. 3. DM may increase the overall risk of dose reduction, and AA, paclitaxel therapy may confer a higher risk of CIPN-induced dose reduction.
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