Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan.
Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
Support Care Cancer. 2023 Nov 29;31(12):730. doi: 10.1007/s00520-023-08193-5.
Chemotherapy-induced peripheral neuropathy (CIPN) has been reported to reduce patients' quality of life and impair cancer treatment by causing anticancer drug withdrawal or interruption. However, there are currently no effective methods for the prevention of CIPN. Renin-angiotensin-aldosterone system (RAAS) inhibitors may be associated with a reduced risk of developing oxaliplatin-induced peripheral neuropathy, and it would be valuable to examine whether they have the same effect on CIPN caused by other anticancer drugs. Our study explored the potential preventive effects of RAAS inhibitors on preventing paclitaxel-induced peripheral neuropathy (PIPN).
An exploratory cohort study was conducted using commercially available administrative claims data on lung cancer patients treated with paclitaxel-based chemotherapy. Cumulative paclitaxel doses, RAAS inhibitor prescriptions, and incidences of PIPN were identified using patient medical records. Fine-Gray analyses with death as a competing risk were performed. A propensity score approach was applied to address the problem of confounding.
Patients with lung cancer who received paclitaxel-based chemotherapy were classified into users of RAAS inhibitor (n = 1320) and non-users of RAAS inhibitor (n = 4566). The doses of RAAS inhibitors in our study were similar to those commonly used to treat hypertension. The PIPN incidence was significantly lower in users of RAAS inhibitor than in the non-users of RAAS inhibitor (sub-distribution hazard ratio, 0.842; 95% confidence interval, 0.762-0.929). The result was consistent in various sensitivity analyses and important subgroup analyses.
RAAS inhibitors at doses commonly used for hypertension were associated with a reduced incidence of PIPN in patients with lung cancer.
化疗引起的周围神经病（CIPN）已被报道通过导致抗癌药物停药或中断来降低患者的生活质量并影响癌症治疗。然而，目前尚无预防 CIPN 的有效方法。肾素-血管紧张素-醛固酮系统（RAAS）抑制剂可能与降低奥沙利铂诱导的周围神经病的风险有关，因此，研究它们对其他抗癌药物引起的 CIPN 是否具有相同的作用将具有重要价值。本研究探讨了 RAAS 抑制剂预防紫杉醇引起的周围神经病（PIPN）的潜在作用。
使用基于商业的肺癌患者接受紫杉醇为基础的化疗的管理索赔数据进行探索性队列研究。通过患者病历确定累积紫杉醇剂量、RAAS 抑制剂处方和 PIPN 的发生率。使用 Fine-Gray 分析（以死亡为竞争风险）进行分析。采用倾向评分法解决混杂问题。
接受紫杉醇为基础的化疗的肺癌患者分为 RAAS 抑制剂使用者（n=1320）和非 RAAS 抑制剂使用者（n=4566）。本研究中 RAAS 抑制剂的剂量与通常用于治疗高血压的剂量相似。RAAS 抑制剂使用者的 PIPN 发生率明显低于非 RAAS 抑制剂使用者（亚分布危险比，0.842；95%置信区间，0.762-0.929）。该结果在各种敏感性分析和重要亚组分析中是一致的。
用于治疗高血压的 RAAS 抑制剂剂量与肺癌患者 PIPN 的发生率降低相关。
