Long-term Peripheral Neuropathy in Breast Cancer Patients Treated with Adjuvant Chemotherapy: NRG Oncology/NSABP B-30

Hanna Bandos, Joy Melnikow, Donna R. Rivera, Sandra M. Swain, Keren Sturtz, Louis Fehrenbacher, James L. Wade, Adam M. Brufsky, Thomas B. Julian, Richard G. Margolese, Edward C. McCarron, Patricia A. Ganz

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Abstract

Background The long-term effects of chemotherapy are sparsely reported. Peripheral neuropathy (PN) is one of the most frequent toxicities associated with taxane use for the treatment of early-stage breast cancer. We investigated the impact of the three different docetaxel-based regimens and patient characteristics on long-term, patient-reported outcomes of PN and the impact of PN on long-term quality of life (QOL). Methods The National Surgical Adjuvant Breast and Bowel Project Protocol B-30 was a randomized trial comparing sequential doxorubicin (A) and cyclophosphamide (C) followed by docetaxel (T) (ACâ †'T), concurrent ACT, or AT in women with node-positive, early-stage breast cancer. The ACâ †'T group had a higher cumulative dose of T. PN was one of the symptoms assessed in a QOL substudy. Statistical methods included simple and mixed ordinal logistic regression and general linear models. All statistical tests were two-sided. Results Of 1512 patients, 41.9% reported PN two years after treatment initiation. Treatment with AT and ACT was associated with less severe long-term PN compared with ACâ †'T (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.35 to 0.58; OR = 0.59, 95% CI = 0.46 to 0.75). Preexisting PN, older age, obesity, mastectomy, and greater number of positive nodes were also associated with higher risk of long-term PN. Patients who reported worse PN symptoms at 24 months had statistically significantly worse QOL (P trend <.001). Conclusions The administration of docetaxel is associated with long-term PN. The lower rate of long-term PN in AT and ACT patients might be an important consideration in supporting choosing these therapies for individuals with preexisting neuropathic symptoms or other risk factors for neuropathy.

Original languageEnglish (US)
JournalJournal of the National Cancer Institute
Volume110
Issue number2
DOIs
StatePublished - 2017

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Peripheral Nervous System Diseases
Adjuvant Chemotherapy
Breast Neoplasms
docetaxel
Quality of Life
Odds Ratio
Confidence Intervals
Mastectomy
Therapeutics
Doxorubicin
Cyclophosphamide
Linear Models
Breast
Obesity
Logistic Models
Drug Therapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Long-term Peripheral Neuropathy in Breast Cancer Patients Treated with Adjuvant Chemotherapy : NRG Oncology/NSABP B-30. / Bandos, Hanna; Melnikow, Joy; Rivera, Donna R.; Swain, Sandra M.; Sturtz, Keren; Fehrenbacher, Louis; Wade, James L.; Brufsky, Adam M.; Julian, Thomas B.; Margolese, Richard G.; McCarron, Edward C.; Ganz, Patricia A.

In: Journal of the National Cancer Institute, Vol. 110, No. 2, 2017.

Research output: Contribution to journalArticle

Bandos, H, Melnikow, J, Rivera, DR, Swain, SM, Sturtz, K, Fehrenbacher, L, Wade, JL, Brufsky, AM, Julian, TB, Margolese, RG, McCarron, EC & Ganz, PA 2017, 'Long-term Peripheral Neuropathy in Breast Cancer Patients Treated with Adjuvant Chemotherapy: NRG Oncology/NSABP B-30', Journal of the National Cancer Institute, vol. 110, no. 2. https://doi.org/10.1093/jnci/djx162
Bandos, Hanna ; Melnikow, Joy ; Rivera, Donna R. ; Swain, Sandra M. ; Sturtz, Keren ; Fehrenbacher, Louis ; Wade, James L. ; Brufsky, Adam M. ; Julian, Thomas B. ; Margolese, Richard G. ; McCarron, Edward C. ; Ganz, Patricia A. / Long-term Peripheral Neuropathy in Breast Cancer Patients Treated with Adjuvant Chemotherapy : NRG Oncology/NSABP B-30. In: Journal of the National Cancer Institute. 2017 ; Vol. 110, No. 2.
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title = "Long-term Peripheral Neuropathy in Breast Cancer Patients Treated with Adjuvant Chemotherapy: NRG Oncology/NSABP B-30",
abstract = "Background The long-term effects of chemotherapy are sparsely reported. Peripheral neuropathy (PN) is one of the most frequent toxicities associated with taxane use for the treatment of early-stage breast cancer. We investigated the impact of the three different docetaxel-based regimens and patient characteristics on long-term, patient-reported outcomes of PN and the impact of PN on long-term quality of life (QOL). Methods The National Surgical Adjuvant Breast and Bowel Project Protocol B-30 was a randomized trial comparing sequential doxorubicin (A) and cyclophosphamide (C) followed by docetaxel (T) (AC{\^a} †'T), concurrent ACT, or AT in women with node-positive, early-stage breast cancer. The AC{\^a} †'T group had a higher cumulative dose of T. PN was one of the symptoms assessed in a QOL substudy. Statistical methods included simple and mixed ordinal logistic regression and general linear models. All statistical tests were two-sided. Results Of 1512 patients, 41.9{\%} reported PN two years after treatment initiation. Treatment with AT and ACT was associated with less severe long-term PN compared with AC{\^a} †'T (odds ratio [OR] = 0.45, 95{\%} confidence interval [CI] = 0.35 to 0.58; OR = 0.59, 95{\%} CI = 0.46 to 0.75). Preexisting PN, older age, obesity, mastectomy, and greater number of positive nodes were also associated with higher risk of long-term PN. Patients who reported worse PN symptoms at 24 months had statistically significantly worse QOL (P trend <.001). Conclusions The administration of docetaxel is associated with long-term PN. The lower rate of long-term PN in AT and ACT patients might be an important consideration in supporting choosing these therapies for individuals with preexisting neuropathic symptoms or other risk factors for neuropathy.",
author = "Hanna Bandos and Joy Melnikow and Rivera, {Donna R.} and Swain, {Sandra M.} and Keren Sturtz and Louis Fehrenbacher and Wade, {James L.} and Brufsky, {Adam M.} and Julian, {Thomas B.} and Margolese, {Richard G.} and McCarron, {Edward C.} and Ganz, {Patricia A.}",
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T1 - Long-term Peripheral Neuropathy in Breast Cancer Patients Treated with Adjuvant Chemotherapy

T2 - NRG Oncology/NSABP B-30

AU - Bandos, Hanna

AU - Melnikow, Joy

AU - Rivera, Donna R.

AU - Swain, Sandra M.

AU - Sturtz, Keren

AU - Fehrenbacher, Louis

AU - Wade, James L.

AU - Brufsky, Adam M.

AU - Julian, Thomas B.

AU - Margolese, Richard G.

AU - McCarron, Edward C.

AU - Ganz, Patricia A.

PY - 2017

Y1 - 2017

N2 - Background The long-term effects of chemotherapy are sparsely reported. Peripheral neuropathy (PN) is one of the most frequent toxicities associated with taxane use for the treatment of early-stage breast cancer. We investigated the impact of the three different docetaxel-based regimens and patient characteristics on long-term, patient-reported outcomes of PN and the impact of PN on long-term quality of life (QOL). Methods The National Surgical Adjuvant Breast and Bowel Project Protocol B-30 was a randomized trial comparing sequential doxorubicin (A) and cyclophosphamide (C) followed by docetaxel (T) (ACâ †'T), concurrent ACT, or AT in women with node-positive, early-stage breast cancer. The ACâ †'T group had a higher cumulative dose of T. PN was one of the symptoms assessed in a QOL substudy. Statistical methods included simple and mixed ordinal logistic regression and general linear models. All statistical tests were two-sided. Results Of 1512 patients, 41.9% reported PN two years after treatment initiation. Treatment with AT and ACT was associated with less severe long-term PN compared with ACâ †'T (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.35 to 0.58; OR = 0.59, 95% CI = 0.46 to 0.75). Preexisting PN, older age, obesity, mastectomy, and greater number of positive nodes were also associated with higher risk of long-term PN. Patients who reported worse PN symptoms at 24 months had statistically significantly worse QOL (P trend <.001). Conclusions The administration of docetaxel is associated with long-term PN. The lower rate of long-term PN in AT and ACT patients might be an important consideration in supporting choosing these therapies for individuals with preexisting neuropathic symptoms or other risk factors for neuropathy.

AB - Background The long-term effects of chemotherapy are sparsely reported. Peripheral neuropathy (PN) is one of the most frequent toxicities associated with taxane use for the treatment of early-stage breast cancer. We investigated the impact of the three different docetaxel-based regimens and patient characteristics on long-term, patient-reported outcomes of PN and the impact of PN on long-term quality of life (QOL). Methods The National Surgical Adjuvant Breast and Bowel Project Protocol B-30 was a randomized trial comparing sequential doxorubicin (A) and cyclophosphamide (C) followed by docetaxel (T) (ACâ †'T), concurrent ACT, or AT in women with node-positive, early-stage breast cancer. The ACâ †'T group had a higher cumulative dose of T. PN was one of the symptoms assessed in a QOL substudy. Statistical methods included simple and mixed ordinal logistic regression and general linear models. All statistical tests were two-sided. Results Of 1512 patients, 41.9% reported PN two years after treatment initiation. Treatment with AT and ACT was associated with less severe long-term PN compared with ACâ †'T (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.35 to 0.58; OR = 0.59, 95% CI = 0.46 to 0.75). Preexisting PN, older age, obesity, mastectomy, and greater number of positive nodes were also associated with higher risk of long-term PN. Patients who reported worse PN symptoms at 24 months had statistically significantly worse QOL (P trend <.001). Conclusions The administration of docetaxel is associated with long-term PN. The lower rate of long-term PN in AT and ACT patients might be an important consideration in supporting choosing these therapies for individuals with preexisting neuropathic symptoms or other risk factors for neuropathy.

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