Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Cancer. 2019 Sep 1;125(17):2945-2954. doi: 10.1002/cncr.32175. Epub 2019 May 15.
In the current study, the authors investigated the incidence of moderate to severe chemotherapy-induced peripheral neuropathy (CIPN) for chemotherapy regimens commonly used in current clinical practice for the treatment of patients with early breast cancer. Patient-reported and clinician-assessed CIPN severity scores were compared, and risk factors for CIPN severity were identified.
Patients completed a Patient-Reported Symptom Monitoring form and oncologists completed a Common Terminology Criteria for Adverse Events form. CIPN reports were collected prospectively during regularly scheduled infusion visits throughout the duration of chemotherapy.
The sample included 184 women with a mean age of 55 years; approximately 73% were white. The 4 chemotherapy regimens used were doxorubicin and cyclophosphamide plus paclitaxel (60 patients); docetaxel and cyclophosphamide (50 patients); docetaxel, carboplatin, and anti-human epidermal growth factor receptor 2 (HER2) (24 patients); and doxorubicin and cyclophosphamide plus paclitaxel and carboplatin (18 patients). All patients treated with doxorubicin and cyclophosphamide plus paclitaxel and doxorubicin and cyclophosphamide plus paclitaxel and carboplatin received paclitaxel; all patients treated with docetaxel and cyclophosphamide and docetaxel, carboplatin, and anti-HER2 received docetaxel. The chemotherapy dose was reduced in 52 patients (28%); in 15 patients (29%), this reduction was due to CIPN. Chemotherapy was discontinued in 26 patients (14%), 8 because of CIPN. Agreement between patient-reported and clinician-assessed CIPN severity scores was minimal (weighted Cohen kappa, P = .34). Patient-reported moderate to severe CIPN was higher for paclitaxel (50%) compared with docetaxel (17.7%) (P < .001). Pretreatment arthritis and/or rheumatism (relative risk [RR], 1.58; 95% CI, 1.06-2.35 [P = .023]) and regimens containing paclitaxel (RR, 2.88; 95% CI, 1.72-4.83 [P < .0001]) were associated with higher CIPN severity. Being married (RR, 0.57; 95% CI, 0.37-0.887 [P = .01]) was found to be associated with lower CIPN severity.
The discrepancy between patient-reported and clinician-assessed CIPN underscores the need for both patient and clinician perspectives regarding this common, dose-limiting, and potentially disabling side effect of chemotherapy.
在当前的研究中，作者调查了当前临床实践中常用于治疗早期乳腺癌患者的化疗方案引起的中度至重度化疗诱导性周围神经病（CIPN）的发生率。比较了患者报告的和临床医生评估的 CIPN 严重程度评分，并确定了 CIPN 严重程度的危险因素。
患者完成了一份患者报告的症状监测表，而肿瘤医生则完成了一份常见不良事件术语标准表。在整个化疗期间，通过定期安排的输注就诊期间前瞻性地收集 CIPN 报告。
该样本包括 184 名平均年龄为 55 岁的女性；约 73%为白人。使用的 4 种化疗方案为多柔比星和环磷酰胺加紫杉醇（60 例）；多西他赛和环磷酰胺（50 例）；多西他赛、卡铂和抗人表皮生长因子受体 2（HER2）（24 例）；以及多柔比星和环磷酰胺加紫杉醇和卡铂（18 例）。所有接受多柔比星和环磷酰胺加紫杉醇和多柔比星和环磷酰胺加紫杉醇和卡铂治疗的患者均接受紫杉醇；所有接受多西他赛和环磷酰胺以及多西他赛、卡铂和抗 HER2 治疗的患者均接受多西他赛。52 名患者（28%）减少了化疗剂量；在 15 名患者（29%）中，这种减少是由于 CIPN 引起的。26 名患者（14%）停止了化疗，其中 8 名是因为 CIPN。患者报告的 CIPN 严重程度与临床医生评估的 CIPN 严重程度之间的一致性最小（加权 Cohen kappa，P =.34）。与多西他赛（17.7%）相比，紫杉醇（50%）患者报告的中度至重度 CIPN 更高（P <.001）。预处理关节炎和/或风湿病（相对风险 [RR]，1.58；95%置信区间，1.06-2.35 [P =.023]）和含有紫杉醇的方案（RR，2.88；95%置信区间，1.72-4.83 [P <.0001]）与更高的 CIPN 严重程度相关。已婚（RR，0.57；95%置信区间，0.37-0.887 [P =.01]）与较低的 CIPN 严重程度相关。
患者报告的和临床医生评估的 CIPN 之间的差异强调了需要从患者和临床医生两个角度来考虑这种常见的、剂量限制的、潜在致残的化疗副作用。
