Background: Chemotherapy induced peripheral neuropathy (CIPN) remains a common treatment related adverse event for breast cancer (BC) patients. CIPN interferes with the ability to complete chemotherapy & therefore potentially compromises survival outcomes. CIPN can worsen health-related quality of life and also add to the ongoing morbidity experienced by BC survivors. Previously, systematic reviews & ASCO guidelines have examined CIPN across many cancer types & different chemotherapies, which may lead to the introduction of confounding factors not relevant to BC patients. A recent prospective cohort also identified other specific lifestyle factors associated with CIPN in BC patients (1). From our search, a systematic review specifically looking at CIPN in BC patients has not previously been undertaken.

Methods: We conducted a systematic search in PubMed, EMBASE, CINAHL and CENTRAL. Clinical trials and observational studies for all potential pharmacological and non-pharmacological interventions were included. Risk of bias for full-text papers was assessed using the Cochrane Risk of Bias Assessment or the modified Newcastle Ottawa score.

Results: Of 706 records being identified, 601 unique citations were screened with 21 full text papers retrieved for assessment, and 16 studies included in the qualitative assessment. We identified 10 randomised controlled trials (RCTs), one observational cohort study, and five controlled before-and-after studies (CBA). Pharmacological interventions which were investigated included calcium/magnesium infusion, glutamine, amifostine, goshajinkigan, omega 3 fatty acids, acetyl-L-carnitine, pregabalin, alpha-lipoic acid and minocycline. Non-pharmacological interventions included body mass index & lifestyle factors, electroacupuncture, exercise, limb hypothermia, carbon dioxide limb bathing and limb compression therapy. All trials identified were investigating primary prevention of CIPN in the setting of taxane chemotherapy. Improvements in the incidence of CIPN were reported with omega 3 fatty acids, glutamine and alpha-lipoic acid, but only one of these studies is a published RCT. In two of the studies, the benefit was identified only on physical examination, but no significant benefit with nerve conduction (NCS) testing. On subgroup analysis of trials investigating exercise, there was a benefit in the use of high intensity exercise versus low intensity exercise, particularly in patients <50 years old within a healthy weight range. Mixed results were seen with goshajinkigan. An increase in CIPN was seen with antioxidant use, electroacupuncture and acetyl L carnitine. Majority of the RCTs were associated with a high overall risk of bias.

Conclusions: There has been a paucity of research on CIPN in BC patients. There were no interventions identified in this systematic review which show a clear clinical benefit in the prevention of CIPN in BC patients. BC patients may have specific lifestyle and hormonal factors which influence CIPN and this should prompt ongoing specific patient focussed research within this subgroup with large, blinded, randomised controlled trials.

Greenlee, et al. Natl Cancer Inst 2017; 109(2).

Citation Format: Roberts KE, Feng S, Adsett I, Rickett K, Woodward N. The prevention and management of chemotherapy-induced peripheral neuropathy in breast cancer patients: A systematic review [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-14-06.