Reports as to whether older patients with cancer are at a greater risk for chemotherapy-induced neuropathy (CIN) are conflicting. A recent study published in The Oncologist, sheds new light on this debate. According to these results, although CIN is common among patients with early-stage breast cancer, it does not appear to be age-related.
The recent study utilized data from CALGB 40101, a phase 3 trial that compared single-agent paclitaxel with doxorubicin and cyclophosphamide as adjuvant therapy in patients with breast cancer with 0 to 3 tumor-positive lymph nodes. Patients received paclitaxel 80 mg/m2 once per week or 175 mg/m2 every 2 weeks. Patients were assessed at baseline and every 6 months for 2 years, then annually for 15 years. Utilizing data from this trial, the study authors investigated age-related risks for neuropathy.
The study included a total of 1881 patients, 230 of whom were 65 years or older, 556 were between 55 and 65 years, and 1095 were younger than 55. In 65% of patients, 1226 neuropathy events occurred at grade 1 or 2. At grade 2 or worse, neuropathy events occurred in 63 patients in the 65 years or older group, 155 patients in the 55 to 65 group, and 266 patients in the younger than 55 group. No statistically significant age-based differences were seen in onset of neuropathy or time to improvement. Interestingly, obesity was associated with neuropathy, and a dose of paclitaxel every 2 weeks was associated with a trend toward neuropathy.
The study authors recommended that “all patients, regardless of age, should be closely monitored for neuropathy during paclitaxel administration, and future studies should focus on reducing the incidence of this common adverse event.”
Barginear M, Dueck AC, Allred JB, et al. Age and the risk of paclitaxel-induced neuropathy in women with early-stage breast cancer (Alliance A151411): results from 1,881 patients from cancer and leukemia group B (CALGB) 40101 [published online November 8, 2018]. Oncologist. doi: 10.1634/theoncologist.2018-0298