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William J. Gradishar, MD, FACP, FASCO
William J. Gradishar, MD, FACP, FASCO
Posted: Thursday, October 20, 2022
Hand cooling and compression decreased the risk of chemotherapy-induced peripheral neuropathy in patients with primary breast cancer undergoing taxane-based (neo)adjuvant chemotherapy, according to Laura Michel, MD, of University Hospital Heidelberg, Germany, and colleagues. The first results of the POLAR trial, which were presented during the European Society for Medical Oncology (ESMO) Congress 2022 (Abstract 1552O), may have clinical implications for other tumor types.
“Chemotherapy-induced peripheral neuropathy is a common, dose-limiting side effect of taxane-based chemotherapy,” the investigators remarked. “Currently, there is no established strategy for prevention or treatment.”
A total of 122 patients who underwent weekly (nab-)paclitaxel-based (neo)adjuvant chemotherapy were randomly assigned in a 1:1 ratio to receive cooling or compression of the dominant hand, with the other hand acting as a control. Cooling was performed with a frozen glove, and compression was applied by two surgical gloves (one size smaller than a tight-fitting size) 30 minutes before, during, and 30 minutes after taxane therapy.
The efficacy to prevent sensory polyneuropathy of grade 2 or higher was evaluated as the primary endpoint. The rates of chemotherapy-induced peripheral neuropathy between both intervention groups were compared in a second hierarchical test. Chemotherapy-induced peripheral neuropathy was further assessed by the Total Neuropathy Score, patient self-report questionnaires, magnetic resonance neurography (n = 21), and nerve conduction studies. Onycholysis, skin toxicity, quality of life, chemotherapy-induced peripheral neuropathy–associated dose reductions, treatment discontinuations, and potential risk factors were also evaluated in this trial.
The incidence of chemotherapy-induced peripheral neuropathy of grade 2 or higher was improved with cooling (25% vs. 46%; P = .0008) and compression (23% vs. 39%; P = .0016); both interventions demonstrated similar efficacy (P = .7303). Magnetic resonance neurography showed high sensitivity detecting chemotherapy-induced peripheral neuropathy; increased T2 nerve-to-muscle signal ratios, which seemed to indicate edematous nerve changes, were observed on imaging data.
Disclosure: For full disclosures of the study authors, visit cslide.ctimeetingtech.com.
