title: Chemotherapy dose reduction due to chemotherapy induced peripheral neuropathy in breast cancer patients receiving chemotherapy in the neoadjuvant or adjuvant settings: a single-center experience.
abstract: OBJECTIVE
  Taxanes are a cornerstone treatment in early and advanced stage breast cancer and in other common solid tumor malignancies; however, the development of chemotherapy induced peripheral neuropathy (CIPN) often necessitates dose-reduction, which may hamper the effectiveness of the drug and compromise survival outcomes especially when used in the adjuvant setting. Limited literature is available on the prevalence and severity of dose reduction due to CIPN. We sought to determine the frequency and severity of CIPN-induced dose reduction in early stage breast cancer patients who received taxane-based chemotherapy in the neoadjuvant or adjuvant settings.
  
  
  METHODS
  We conducted a retrospective single-institution breast cancer clinic chart review of 123 newly diagnosed breast cancer patients and treated with taxane-based neoadjuvant/adjuvant chemotherapy at the University of Maryland Greenebaum Cancer Center between January 2008 and December 2011.
  
  
  RESULTS
  Forty-nine of 123 (40%; 95% CI: 31-49%) patients required dose reduction. Twenty-one (17%; 95% CI: 11-25%) of these patients were dose-reduced specifically due to CIPN that developed during treatment. The median relative dose intensity (received dose/planned dose) for the 21 CIPN-induced dose reduction patients was 73.4% (range, 68.0-94.0%). Patients with diabetes appeared to have a higher risk of taxane-induced dose reduction (p-value=0.01). African-American patients and those treated with paclitaxel (rather than docetaxel) experienced a higher-risk of CIPN-induced dose reduction (p-values are <0.001 and 0.001, respectively).
  
  
  CONCLUSIONS
  The incidence of CIPN-associated dose reduction in our patient population was 17%. African-American patients, diabetics and subjects treated with paclitaxel had a higher risk for CIPN-associated dose reduction in our study.
authors.affiliation: Department of Internal Medicine, Division of Hematology and Medical Oncology, University of Maryland School of Medicine, 22 S. Greene St N9E24, Baltimore, MD 21201 USA.
authors.forename: Bhavana
authors.initials: B
authors.lastname: Bhatnagar
authors.affiliation: Department of Pharmacology, University of Maryland School of Medicine, Baltimore, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Gilmore
authors.affiliation: Department of Epidemiology and Biostatistics, University of Maryland School of Medicine, Baltimore, USA.
authors.forename: Olga
authors.initials: O
authors.lastname: Goloubeva
authors.affiliation: Department of Internal Medicine, Division of Hematology and Medical Oncology, University of Maryland School of Medicine, 22 S. Greene St N9E24, Baltimore, MD 21201 USA.
authors.forename: Colleen
authors.initials: C
authors.lastname: Pelser
authors.affiliation: Department of Internal Medicine, Division of Hematology and Medical Oncology, University of Maryland School of Medicine, 22 S. Greene St N9E24, Baltimore, MD 21201 USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Medeiros
authors.affiliation: Department of Internal Medicine, Division of Hematology and Medical Oncology, University of Maryland School of Medicine, 22 S. Greene St N9E24, Baltimore, MD 21201 USA.
authors.forename: Saranya
authors.initials: S
authors.lastname: Chumsri
authors.affiliation: Department of Internal Medicine, Division of Hematology and Medical Oncology, University of Maryland School of Medicine, 22 S. Greene St N9E24, Baltimore, MD 21201 USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Tkaczuk
authors.affiliation: Department of Internal Medicine, Division of Hematology and Medical Oncology, University of Maryland School of Medicine, 22 S. Greene St N9E24, Baltimore, MD 21201 USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Edelman
authors.affiliation: Department of Internal Medicine, Division of Hematology and Medical Oncology, University of Maryland School of Medicine, 22 S. Greene St N9E24, Baltimore, MD 21201 USA.
authors.forename: Ting
authors.initials: T
authors.lastname: Bao
keywords: Breast cancer; Dose reduction; Peripheral neuropathy; Taxanes
references.citation: J Clin Oncol. 1999 May;17(5):1413-24
references.pmid: 10334526
references.citation: Semin Oncol. 1993 Aug;20(4 Suppl 3):1-15
references.pmid: 8102012
references.citation: Clin Adv Hematol Oncol. 2008 Jun;6(6):455-67
references.pmid: 18567992
references.citation: J Clin Oncol. 2005 Nov 1;23(31):7794-803
references.pmid: 16172456
references.citation: J Clin Oncol. 2011 Apr 10;29(11):1472-8
references.pmid: 21383290
references.citation: Drugs. 2003;63(15):1549-63
references.pmid: 12887262
references.citation: J Neurooncol. 1999;45(3):241-6
references.pmid: 10845395
references.citation: Crit Rev Oncol Hematol. 2008 Jun;66(3):218-28
references.pmid: 18329278
references.citation: Pain. 2002 Jul;98(1-2):195-203
references.pmid: 12098632
references.citation: Eur J Cancer. 2006 Jan;42(1):24-30
references.pmid: 16293411
references.citation: JAMA. 2013 Apr 3;309(13):1359-67
references.pmid: 23549581
references.citation: J Clin Oncol. 2004 Jun 1;22(11):2061-8
references.pmid: 15169793
references.citation: Support Care Cancer. 2013 Jul;21(7):2059-66
references.pmid: 23446880
references.citation: Ann Pharmacother. 2008 Oct;42(10):1481-5
references.pmid: 18698011
references.citation: Pain Res Treat. 2011;2011:920807
references.pmid: 22110934
references.citation: N Engl J Med. 1994 May 5;330(18):1253-9
references.pmid: 8080512
references.citation: J Clin Oncol. 2006 Nov 1;24(31):4963-70
references.pmid: 17033039
references.citation: Cancer. 2008 Jun 15;112(12):2802-8
references.pmid: 18428211
references.citation: J Tradit Chin Med. 2010 Mar;30(1):13-4
references.pmid: 20397454
references.citation: Am J Clin Oncol. 2009 Jun;32(3):319-25
references.pmid: 19887992
references.citation: J Clin Oncol. 1995 Oct;13(10):2575-81
references.pmid: 7595709
references.citation: Cochrane Database Syst Rev. 2011 Feb 16;(2):CD005228
references.pmid: 21328275
references.citation: Breast Cancer. 2004;11(1):100-4
references.pmid: 14718801
references.citation: J Clin Oncol. 2012 Sep 1;30(25):3051-7
references.pmid: 22851566
references.citation: J Clin Oncol. 1999 Nov;17(11):3403-11
references.pmid: 10550134
references.citation: J Clin Oncol. 2005 Aug 20;23(24):5542-51
references.pmid: 16110015
references.citation: N Engl J Med. 1995 Apr 6;332(14):901-6
references.pmid: 7877646
references.citation: Support Care Cancer. 2012 Mar;20(3):583-9
references.pmid: 21380613
references.citation: J Clin Oncol. 1996 Jun;14(6):1858-67
references.pmid: 8656254
references.citation: Clin Cancer Res. 2005 Jul 1;11(13):4843-50
references.pmid: 16000582
references.citation: Cancer. 2007 Nov 1;110(9):2110-8
references.pmid: 17853395
references.citation: Support Care Cancer. 2011 Nov;19(11):1769-77
references.pmid: 20936417
references.citation: J Clin Oncol. 1999 Aug;17(8):2341-54
references.pmid: 10561296
references.citation: N Engl J Med. 1995 Apr 13;332(15):1004-14
references.pmid: 7885406
references.citation: J Clin Oncol. 2008 Apr 1;26(10):1642-9
references.pmid: 18375893
references.citation: Oncologist. 2007 Mar;12(3):312-9
references.pmid: 17405895
references.citation: Clin Oncol (R Coll Radiol). 2005 Jun;17(4):271-6
references.pmid: 15997923
references.citation: Cancer. 2012 Oct 15;118(20):5171-8
references.pmid: 22415454
references.citation: J Natl Cancer Inst. 1998 Aug 19;90(16):1205-11
references.pmid: 9719081
references.citation: Int J Clin Oncol. 2013 Feb;18(1):132-8
references.pmid: 22105895
references.citation: J Clin Oncol. 2006 Apr 1;24(10):1633-42
references.pmid: 16575015