Background: Peripheral neuropathy (PN) and hypersensitivity reactions (HSR) are frequent toxicities experienced by patients receiving paclitaxel chemotherapy.
Aims: To describe the frequency, nature and management of PN and HSR in early breast cancer patients receiving paclitaxel.
Method: A retrospective review of all patients with early breast cancer that received paclitaxel-based chemotherapy in 3 South Western Sydney hospitals from January 2021 to December 2023. The planned sample size was 300. Patient demographics and management strategies including dose reductions, dose delays and early cessation were recorded. Dose intensity of paclitaxel was calculated (dose planned / dose given) as well as the proportion of patients completing at least 80% of the planned treatment. Multivariable logistic regression was used to determine factors associated with PN and HSR.
Results: Of 345 patients, the median age was 53 years, 99% were female, 52.0% were non-Anglo-Celtic, 11% had diabetes and 6% pre-existing PN. Paclitaxel was administered weekly in 96% and with carboplatin in 16%. 248 patients (72%) had documented PN and 55% had PN grade documented (53% grade 1, 39% grade 2, 7% grade 3). PN resulted in: early cessation of paclitaxel in 23%; dose reduction in 28%; and dose delay in 4%. Cool gloves and socks were used in 10 patients (3%), and 12 (3%) were prescribed medication to treat PN. Pre-existing neuropathy was the only factor increasing the odds of stopping paclitaxel due to PN (OR 3.4, 95% CI 1.1-10.0, p =0.03). HSR were recorded in 21% of patients, with 89% in the first 3 weeks. One patient required adrenaline and 6% stopped paclitaxel early due to HSR. Average paclitaxel dose intensity overall was 80%, and 72% completed 80% or more of the planned paclitaxel.
Conclusion: Most patients completed at least 80% of the planned paclitaxel with 29% ceasing early due to PN and HSR.