Comorbidities and Risk of Chemotherapy-Induced Peripheral Neuropathy Among Participants 65 Years or Older in Southwest Oncology Group Clinical Trials.
Neuropathy is a debilitating toxicity associated with various chemotherapy agents. We evaluated the association between common comorbid conditions and the development of peripheral neuropathy in patients treated with taxane-based chemotherapy.



We examined the Southwest Oncology Group database to identify phase II and III trials that included taxane therapy from 1999 to 2011. We linked the Southwest Oncology Group clinical records to Medicare claims data according to Social Security number, sex, and date of birth. The following disease conditions potentially associated with peripheral neuropathy were evaluated: diabetes, hypothyroidism, hypercholesterolemia, hypertension, varicella zoster, peripheral vascular disease, and autoimmune diseases. Multivariate logistic regression was used to model the odds of experiencing grade 2 to 4 neuropathy.



A total of 1,401 patients from 23 studies were included in the analysis. Patients receiving paclitaxel were more likely to experience grade 2 to 4 neuropathy compared with docetaxel (25% v 12%, respectively; OR, 2.20; 95% CI, 1.52 to 3.18; P < .001). The inclusion of a platinum agent was also associated with greater neuropathy (OR, 1.68; 95% CI, 1.18 to 2.40; P = .004). For each increase in age of 1 year, the odds of neuropathy increased 4% (P = .006). Patients with complications from diabetes had more than twice the odds of having neuropathy (OR, 2.13; 95% CI, 1.31 to 3.46; P = .002) compared with patients with no diabetes. In contrast, patients with autoimmune disease were half as likely to experience neuropathy (OR, 0.49; 95% CI, 0.24 to 1.02; P = .06). The other conditions were not associated with neuropathy.



We found that in addition to drug-related factors, age and history of diabetes were independent predictors of the development of chemotherapy-induced peripheral neuropathy. Interestingly, we also observed that a history of autoimmune disease was associated with reduced odds of neuropathy. Patients with diabetic complications may choose to avoid paclitaxel or taxane plus platinum combination therapies if other efficacious options exist.
Dawn L. Hershman, Jason D. Wright, and Danielle Awad, Columbia University Medical Center, New York, NY; Cathee Till, Scott D. Ramsey, and Joseph Unger, Fred Hutchinson Cancer Research Center; William E. Barlow, University of Washington, Seattle, WA; and Lori M. Minasian, National Cancer Institute, Bethesda, MD. dlh23@columbia.edu.
Dawn L
DL
Hershman
Dawn L. Hershman, Jason D. Wright, and Danielle Awad, Columbia University Medical Center, New York, NY; Cathee Till, Scott D. Ramsey, and Joseph Unger, Fred Hutchinson Cancer Research Center; William E. Barlow, University of Washington, Seattle, WA; and Lori M. Minasian, National Cancer Institute, Bethesda, MD.
Cathee
C
Till
Dawn L. Hershman, Jason D. Wright, and Danielle Awad, Columbia University Medical Center, New York, NY; Cathee Till, Scott D. Ramsey, and Joseph Unger, Fred Hutchinson Cancer Research Center; William E. Barlow, University of Washington, Seattle, WA; and Lori M. Minasian, National Cancer Institute, Bethesda, MD.
Jason D
JD
Wright
Dawn L. Hershman, Jason D. Wright, and Danielle Awad, Columbia University Medical Center, New York, NY; Cathee Till, Scott D. Ramsey, and Joseph Unger, Fred Hutchinson Cancer Research Center; William E. Barlow, University of Washington, Seattle, WA; and Lori M. Minasian, National Cancer Institute, Bethesda, MD.
Danielle
D
Awad
Dawn L. Hershman, Jason D. Wright, and Danielle Awad, Columbia University Medical Center, New York, NY; Cathee Till, Scott D. Ramsey, and Joseph Unger, Fred Hutchinson Cancer Research Center; William E. Barlow, University of Washington, Seattle, WA; and Lori M. Minasian, National Cancer Institute, Bethesda, MD.
Scott D
SD
Ramsey
Dawn L. Hershman, Jason D. Wright, and Danielle Awad, Columbia University Medical Center, New York, NY; Cathee Till, Scott D. Ramsey, and Joseph Unger, Fred Hutchinson Cancer Research Center; William E. Barlow, University of Washington, Seattle, WA; and Lori M. Minasian, National Cancer Institute, Bethesda, MD.
William E
WE
Barlow
Dawn L. Hershman, Jason D. Wright, and Danielle Awad, Columbia University Medical Center, New York, NY; Cathee Till, Scott D. Ramsey, and Joseph Unger, Fred Hutchinson Cancer Research Center; William E. Barlow, University of Washington, Seattle, WA; and Lori M. Minasian, National Cancer Institute, Bethesda, MD.
Lori M
LM
Minasian
Dawn L. Hershman, Jason D. Wright, and Danielle Awad, Columbia University Medical Center, New York, NY; Cathee Till, Scott D. Ramsey, and Joseph Unger, Fred Hutchinson Cancer Research Center; William E. Barlow, University of Washington, Seattle, WA; and Lori M. Minasian, National Cancer Institute, Bethesda, MD.
Joseph
J
Unger
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009017:Morbidity; D009369:Neoplasms / Q000188:drug therapy* / Q000473:pathology; D020258:Neurotoxicity Syndromes / Q000209:etiology* / Q000473:pathology; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000473:pathology; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects
D009944:Organoplatinum Compounds; D043823:Taxoids