How to Prevent Chemotherapy-Induced Peripheral Neuropathy

Chemotherapy-induced peripheral neuropathy (CIPN) is common with taxanes, platinums, vinca alkaloids, and eribulin and leads to long-term disability in up to 30% of patients. Evaluation of strategies to prevent or mitigate peripheral neuropathy has been challenging due to different methods for assessing CIPN and other conditions that can also cause peripheral neuropathy (e.g., diabetes, alcohol).

Now, investigators in Germany assessed the effect of hand cryotherapy and hand compression on taxane-induced peripheral neuropathy in 101 patients with early-stage breast cancer who received weekly paclitaxel or nab-paclitaxel as a component of adjuvant therapy. Patients were randomized to wear a frozen glove or two tight-fitting surgical gloves on the dominant hand 30 minutes before, during, and after treatment. The other hand served as a control. Patients with pre-existing peripheral neuropathy, prior chemotherapy, use of drugs that mask neuropathy, or certain disorders (e.g., diabetes) were excluded.

Both interventions decreased the incidence of grade ≥2 CIPN — the primary outcome — but cooling had a greater effect than compression (relative risk reduction, 42% vs. 38%). With cooling, the incidence was 29% versus 50% for the control hand; with compression, 24% versus 38%. A total of 24 patients discontinued therapy, most (67%) because of CIPN. Patients experiencing grade ≥2 CIPN had reduced quality of life 6 to 8 months after completing taxane therapy compared with patients without CIPN.