Post-treatment recovery patterns among patients with early-stage cancer who develop taxane-induced peripheral neuropathy (TIPN): SWOG S1714 (NCT03939481).

Abstract

12117 Background: The primary analysis of S1714 developed and validated a TIPN risk prediction model including 5 clinical risk factors. Recovery patterns of TIPN are not well described. Although some symptoms may improve with time, other symptoms may persist or worsen as a result of permanent nerve damage. We describe the incidence of TIPN over 3 years and report on the post-treatment patterns of TIPN in those individuals who report TIPN at the end of taxane treatment (EOT) as a secondary analysis of S1714. Methods: S1714 enrolled participants > 18 years with Stage I-III primary lung, breast, or ovarian cancer starting treatment with a taxane-based regimen for a planned duration of 8 to 18 weeks. Participants were followed over the course of 3 years and assessed for TIPN using the patient-reported EORTC QLQ-CIPN20, which is composed of 3 subscale scores reported from 0-100, with increasing scores representing worse TIPN. EOT TIPN was defined as an increase in the CIPN20 sensory subscale score of ≥8 points from pre-treatment to EOT. Results: Among 1336 enrolled patients, N = 1321 were evaluable: Median age 55.7 years (range 23-85), 98.9% female, 11.3% Black/4.5% Asian/10.5% Hispanic/Latino, 90.7% with breast cancer. Paclitaxel was administered to 60.3% and docetaxel to 39.7%; 98.4% planned to start treatment with full dose of taxane. EOT TIPN was reported in 553 participants (41.9%). We identified 3 patterns of TIPN in these 553 participants over the 3 year period using the EOT CIPN20 sensory score as the reference. Improvement in TIPN from EOT was seen in 268 participants (48.5%), defined as a decrease of ≥8 points from the EOT CIPN20 sensory score. Stable TIPN was seen in 187 participants (33.8%), defined as < 8 point increase or decrease from the EOT CIPN20 sensory score. Worsening of TIPN from EOT was seen in 98 participants (17.7%), defined as an increase of ≥8 points from the EOT CIPN20 sensory score. Of the 553 individuals with TIPN at EOT, 283 (51.2%) still had clinically meaningful TIPN at 3 years compared to the baseline pre-treatment CIPN20 sensory score (defined as increase in CIPN20 sensory score > 8 points from pre-treatment timepoint to final assessment). Conclusions: Among individuals experiencing TIPN at EOT, nearly half experienced clinically meaningful TIPN improvement but almost one fifth had worsening of TIPN by the final 3-year assessment. The identification of clinical and correlative risk factors for persistent or worsening TIPN after completion of taxane treatment will allow for more informed decision-making regarding the long-term risks of taxane treatment and prioritize selection of patients in the investigation of interventions for prevention and treatment of TIPN. Funding: NIH/NCI/NCORP grant UG1CA189974, The Hope Foundation for Cancer Research. Clinical trial information: NCT03939481 .