title: Delayed recovery and increased severity of Paclitaxel-induced peripheral neuropathy in patients with diabetes.
abstract: OBJECTIVE
  Although diabetes mellitus (DM) is recognized as a risk factor for chemotherapy-induced neurotoxicity, its true impact on intensity and time course of peripheral neuropathy is still unclear. The goal was to analyze the relevance of preexisting DM to weekly paclitaxel-induced peripheral neuropathy (PIPN).
  
  
  METHODS
  We performed a retrospective case-control study (1:2) including a total of 129 patients with breast cancer (43 with DM and 86 controls) treated with single-agent weekly paclitaxel (wP).
  
  
  RESULTS
  Compared with controls, patients with DM treated with wP experienced PIPN more frequently (74.4% vs 58.4%; P=.016) and with higher severity (grade 2-3: 51.2% vs 27.7%; P=.014). A significant delay in PIPN resolution was observed in women with DM (P=.001) and, in a multivariate analysis, DM was the only independent predictor for delayed recovery (hazard ratio [HR], 0.16; 95% CI, 0.05-0.55; P=.003). After 2 years, 68.7% of patients with DM (vs 29.2% of women without DM) still experienced PIPN, which was functionally significant (grade 2-3) in 18.2%.
  
  
  CONCLUSIONS
  Significantly more dose delays and reductions because of PIPN occurred in patients with DM. Preexisting DM associates with long-lasting significant PIPN in patients treated with wP. Benefits and risks of long-term significant PIPN should be carefully balanced in patients with DM before starting wP chemotherapy.
authors: From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain.
authors: Pilar
authors: P
authors: de la Morena Barrio
authors: From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain.
authors: María Ángeles Vicente
authors: MÁ
authors: Conesa
authors: From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain.
authors: Enrique
authors: E
authors: González-Billalabeitia
authors: From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain.
authors: Edgar
authors: E
authors: Urrego
authors: From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain.
authors: Elisa
authors: E
authors: García-Garre
authors: From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain.
authors: Elena
authors: E
authors: García-Martínez
authors: From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain.
authors: Marta Zafra
authors: MZ
authors: Poves
authors: From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain. From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain.
authors: Vicente
authors: V
authors: Vicente
authors: From the Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda Marques de los Velez, and Centro Regional de Hemodonación, Murcia, Spain.
authors: Francisco Ayala
authors: FA
authors: de la Peña
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy*; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000150:complications*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects*; D010523:Peripheral Nervous System Diseases / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel