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William J. Gradishar, MD, FACP, FASCO
William J. Gradishar, MD, FACP, FASCO
Posted: Tuesday, June 4, 2024
Weekly paclitaxel for early-stage breast cancer is associated with higher rates of taxane-induced peripheral neuropathy in Black women than in White women—a disparity not seen with every-3-week docetaxel regimens. Tarah Jean Ballinger, MD, of Indiana University Simon Comprehensive Cancer Center, Indianapolis, and colleagues aimed to validate germline predictors of taxane-induced peripheral neuropathy among women with African ancestry who were treated with paclitaxel or docetaxel. The results of this study, which suggest docetaxel should be the preferred taxane, were presented during the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract LBA503).
“In this prospective trial enrolling only Black women with breast cancer, germline variation did not significantly impact risk of taxane-induced peripheral neuropathy with weekly paclitaxel or every-3-week docetaxel,” the investigators concluded. “However, every-3-week docetaxel was more tolerable, evidenced by less grade 2 to 4 taxane-induced peripheral neuropathy and fewer dose reductions compared to weekly paclitaxel.”
More than 200 Black women with early-stage breast cancer were randomly assigned to receive (neo)adjuvant weekly paclitaxel (n = 121) or every-3-week docetaxel (n = 118). High or low germline neuropathy was identified via genotyping. Grade 2 to 4 taxane-induced peripheral neuropathy was compared between high- and low-risk genotypes in the paclitaxel and docetaxel arms at 1 year.
Genotyping identified 77.8% and 73.7% of patients as high risk in the paclitaxel and docetaxel arms, respectively. The rate of grade 2 to 4 taxane-induced peripheral neuropathy did not statistically differ between high- vs low-risk genotypes, regardless of treatment type. Of note, the rate of taxane-induced peripheral neuropathy was significantly higher in the weekly paclitaxel group compared with the every-3 -week docetaxel group in both the physician-rated (P = .02) and patient-reported (P = .03) outcomes. Furthermore, more dose reductions attributed to taxane-induced peripheral neuropathy (P < .001) or any cause (P = .02) were reported in the paclitaxel group than in the docetaxel group.
Disclosure: For full disclosures of the study authors, visit coi.asco.org.
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