Early taxane-induced neurotoxicity and quality of life in patients with breast cancer: A single center, retrospective study.
Authors: Cimbro Erika , Dessì Mariele , Ziranu Pina , Madeddu Clelia , Atzori Francesco , Lai Eleonora , Pretta Andrea , Mariani Stefano , Sardo Salvatore , Finco Gabriele , Scartozzi Mario 
Published: June 2023

e12533

Background: Taxane administration in breast cancer patients relates to significant chemotherapy-induced peripheral neuropathy (CIPN). In our four years retrospective observational study, we aimed to evaluate early onset of neuropathy and its influence in patients’ quality of life, assessed through certified questionnaires. Methods: We retrospectively collected data from stage I-III breast cancer patients treated with taxane-based therapy between 2018 and 2022 at the Medical Oncology Unit of the University Hospital of Cagliari. We included 300 patients. The median age was 57 years (range, 32-85). All patients followed a schedule of PCT 80mg/m2 ± 30 weekly; they received up to a maximal cumulative dose of PCT 960 ± 30 mg/m2. Peripheral neuropathy was evaluated by the NCI-CTC scale (national cancer institute, common toxicity criteria for adverse events) at every drug administration. Patient-reported EORTC QLQ-CIPN20 and FACT-TAXANE questionnaires were collected at baseline, at 4 and 12 weeks of treatment. We used the Kruskal-Wallis test for the association between the neurotoxicity grade and quality of life. Difference in the questionnaire score at the different timing was assessed by ANOVA test for repeated measures. To assess the strength of the correlation between the different quality-of-life questionnaires, we used Spearmann's Rho test. Statistical analysis was performed with the MedCalc Statistical Software Version 14.10.2. Results: Our analysis revealed that neurotoxicity influences the quality of life assessed with the QLQ at cycle IV (p = 0.000001) and cycle XII (p = 0.008). With just a cumulative dose of 320 mg/m2 (cycle IV), patients without neurotoxicity achieved a median value of 32 in the QLQ, compared to a median value of 34 in patients with grade 1 toxicity and 43 in the group of patients with grade 2 toxicity. Similarly, at cycle XII and with cumulative dose of 960 mg/m2, patients without neurotoxicity achieved a median value of 27 at the QLQ, compared to a median value of 33 in patients with grade 1 toxicity and 34 in the group of patients with grade 2 toxicity. The ANOVA test showed a significant increase (worsening) in the CIPN20 questionnaire at 4 and 12 weeks versus baseline (p < 0.001 for both). The score remained significantly higher in comparison to baseline also at the evaluation at 3 (p < 0.001), 6 (p < 0.001) and 12 months (p < 0.0001). Similarly, the FACT-TAXANE questionnaire showed a significant worsening at 4 (p < 0.001) and 12 (p < 0.001) weeks in comparison to baseline. Conclusions: The majority of women who received a taxane based chemotherapy regimen for breast cancer reported neurotoxicity. In our study, the use of specific questionnaires (EORTC QLQ-CIPN20 and FACT-TAXANE) allowed to identify early neurotoxicity onset and its correlation to quality of life, yet at an initial phase of treatment (after a cumulative dose of 320 mg/m2 of paclitaxel at IV cycle).