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Limb Hypothermia for Preventing Paclitaxel-Induced Peripheral Neuropathy in Breast Cancer Patients: A Pilot Study
BACKGROUND: Peripheral neuropathy (PN) due to paclitaxel is a common dose-limiting toxicity with no effective prevention or treatment. We hypothesize that continuous-flow limb hypothermia can reduce paclitaxel-induced PN. PATIENTS AND METHODS: An internally controlled pilot trial was conducted to in...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5222823/ https://www.ncbi.nlm.nih.gov/pubmed/28119855 http://dx.doi.org/10.3389/fonc.2016.00274 |
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author | Sundar, Raghav Bandla, Aishwarya Tan, Stacey Sze Hui Liao, Lun-De Kumarakulasinghe, Nesaretnam Barr Jeyasekharan, Anand D. Ow, Samuel Guan Wei Ho, Jingshan Tan, David Shao Peng Lim, Joline Si Jing Vijayan, Joy Therimadasamy, Aravinda K. Hairom, Zarinah Ang, Emily Ang, Sally Thakor, Nitish V. Lee, Soo-Chin Wilder-Smith, Einar P. V. |
author_facet | Sundar, Raghav Bandla, Aishwarya Tan, Stacey Sze Hui Liao, Lun-De Kumarakulasinghe, Nesaretnam Barr Jeyasekharan, Anand D. Ow, Samuel Guan Wei Ho, Jingshan Tan, David Shao Peng Lim, Joline Si Jing Vijayan, Joy Therimadasamy, Aravinda K. Hairom, Zarinah Ang, Emily Ang, Sally Thakor, Nitish V. Lee, Soo-Chin Wilder-Smith, Einar P. V. |
author_sort | Sundar, Raghav |
collection | PubMed |
description | BACKGROUND: Peripheral neuropathy (PN) due to paclitaxel is a common dose-limiting toxicity with no effective prevention or treatment. We hypothesize that continuous-flow limb hypothermia can reduce paclitaxel-induced PN. PATIENTS AND METHODS: An internally controlled pilot trial was conducted to investigate the neuroprotective effect of continuous-flow limb hypothermia in breast cancer patients receiving weekly paclitaxel. Patients underwent limb hypothermia of one limb for a duration of 3 h with every paclitaxel infusion, with the contralateral limb used as control. PN was primarily assessed using nerve conduction studies (NCSs) before the start of chemotherapy, and after 1, 3, and 6 months. Skin temperature and tolerability to hypothermia were monitored using validated scores. RESULTS: Twenty patients underwent a total of 218 cycles of continuous-flow limb hypothermia at a coolant temperature of 22°C. Continuous-flow limb hypothermia achieved mean skin temperature reduction of 1.5 ± 0.7°C and was well tolerated, with no premature termination of cooling due to intolerance. Grade 3 PN occurred in 2 patients (10%), grade 2 in 2 (10%), and grade 1 in 12 (60%). Significant correlation was observed between amount of skin cooling and motor nerve amplitude preservation at 6 months (p < 0.0005). Sensory velocity and amplitude in the cooled limbs were less preserved than in the control limbs, but the difference did not attain statistical significance. One patient with a history of diabetes mellitus had significant preservation of compound muscle action potential in the cooled limb on NCS analysis. CONCLUSION: This study suggests that continuous limb hypothermia accompanying paclitaxel infusion may reduce paclitaxel-induced PN and have therapeutic potential in select patients and warrants further investigation. The method is safe and well tolerated. |
format | Online Article Text |
id | pubmed-5222823 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-52228232017-01-24 Limb Hypothermia for Preventing Paclitaxel-Induced Peripheral Neuropathy in Breast Cancer Patients: A Pilot Study Sundar, Raghav Bandla, Aishwarya Tan, Stacey Sze Hui Liao, Lun-De Kumarakulasinghe, Nesaretnam Barr Jeyasekharan, Anand D. Ow, Samuel Guan Wei Ho, Jingshan Tan, David Shao Peng Lim, Joline Si Jing Vijayan, Joy Therimadasamy, Aravinda K. Hairom, Zarinah Ang, Emily Ang, Sally Thakor, Nitish V. Lee, Soo-Chin Wilder-Smith, Einar P. V. Front Oncol Oncology BACKGROUND: Peripheral neuropathy (PN) due to paclitaxel is a common dose-limiting toxicity with no effective prevention or treatment. We hypothesize that continuous-flow limb hypothermia can reduce paclitaxel-induced PN. PATIENTS AND METHODS: An internally controlled pilot trial was conducted to investigate the neuroprotective effect of continuous-flow limb hypothermia in breast cancer patients receiving weekly paclitaxel. Patients underwent limb hypothermia of one limb for a duration of 3 h with every paclitaxel infusion, with the contralateral limb used as control. PN was primarily assessed using nerve conduction studies (NCSs) before the start of chemotherapy, and after 1, 3, and 6 months. Skin temperature and tolerability to hypothermia were monitored using validated scores. RESULTS: Twenty patients underwent a total of 218 cycles of continuous-flow limb hypothermia at a coolant temperature of 22°C. Continuous-flow limb hypothermia achieved mean skin temperature reduction of 1.5 ± 0.7°C and was well tolerated, with no premature termination of cooling due to intolerance. Grade 3 PN occurred in 2 patients (10%), grade 2 in 2 (10%), and grade 1 in 12 (60%). Significant correlation was observed between amount of skin cooling and motor nerve amplitude preservation at 6 months (p < 0.0005). Sensory velocity and amplitude in the cooled limbs were less preserved than in the control limbs, but the difference did not attain statistical significance. One patient with a history of diabetes mellitus had significant preservation of compound muscle action potential in the cooled limb on NCS analysis. CONCLUSION: This study suggests that continuous limb hypothermia accompanying paclitaxel infusion may reduce paclitaxel-induced PN and have therapeutic potential in select patients and warrants further investigation. The method is safe and well tolerated. Frontiers Media S.A. 2017-01-10 /pmc/articles/PMC5222823/ /pubmed/28119855 http://dx.doi.org/10.3389/fonc.2016.00274 Text en Copyright © 2017 Sundar, Bandla, Tan, Liao, Kumarakulasinghe, Jeyasekharan, Ow, Ho, Tan, Lim, Vijayan, Therimadasamy, Hairom, Ang, Ang, Thakor, Lee and Wilder-Smith. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Oncology Sundar, Raghav Bandla, Aishwarya Tan, Stacey Sze Hui Liao, Lun-De Kumarakulasinghe, Nesaretnam Barr Jeyasekharan, Anand D. Ow, Samuel Guan Wei Ho, Jingshan Tan, David Shao Peng Lim, Joline Si Jing Vijayan, Joy Therimadasamy, Aravinda K. Hairom, Zarinah Ang, Emily Ang, Sally Thakor, Nitish V. Lee, Soo-Chin Wilder-Smith, Einar P. V. Limb Hypothermia for Preventing Paclitaxel-Induced Peripheral Neuropathy in Breast Cancer Patients: A Pilot Study |
title | Limb Hypothermia for Preventing Paclitaxel-Induced Peripheral Neuropathy in Breast Cancer Patients: A Pilot Study |
title_full | Limb Hypothermia for Preventing Paclitaxel-Induced Peripheral Neuropathy in Breast Cancer Patients: A Pilot Study |
title_fullStr | Limb Hypothermia for Preventing Paclitaxel-Induced Peripheral Neuropathy in Breast Cancer Patients: A Pilot Study |
title_full_unstemmed | Limb Hypothermia for Preventing Paclitaxel-Induced Peripheral Neuropathy in Breast Cancer Patients: A Pilot Study |
title_short | Limb Hypothermia for Preventing Paclitaxel-Induced Peripheral Neuropathy in Breast Cancer Patients: A Pilot Study |
title_sort | limb hypothermia for preventing paclitaxel-induced peripheral neuropathy in breast cancer patients: a pilot study |
topic | Oncology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5222823/ https://www.ncbi.nlm.nih.gov/pubmed/28119855 http://dx.doi.org/10.3389/fonc.2016.00274 |
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