The tool used for measuring PIPN was reduced Total Neuropathy Score (r-TNS) that consists of both clinical and electrophysiological parameters including subjective sensory symptoms, deep tendon reflexes, pin sensibility and sensory action potential amplitude of sural nerve (a-SAP) as well as amplitude of compound muscle action potential (a-CMAP) of peroneal nerve. Neurologic assessmentįor all the recruited patients, development and severity of PIPN was assessed by the same neurologist. The ethical committee of Tehran University of Medical Sciences approved the study (No: 9683) and written informed consent was received from all the patients before the intervention. Paclitaxel (Ebetaxel, Ebewe Pharmaceutical Company, Austria), at a dose of 175 mg/m 2 based on a 3-h infusion every three weeks for 4 cycles was prescribed for all the patients. Patients were excluded from the study if they had diabetes mellitus, prior polyneuropathy due to any reasons, had received neurotoxic drugs before chemotherapy with paclitaxel, presence of obvious abnormalities in their nerve conduction studies (NCS) before the onset of treatment, and poor performance status. Other inclusion criteria were having functional kidney and liver, and WHO performance scores of 0–1. The results of the current study were obtained from a randomized double-blind placebo controlled trial, in which we studied the prophylactic effect of n-3 polyunsaturated fatty acids on incidence and severity of PIPN in female patients with a node positive breast cancer undergoing chemotherapy with 4 courses of 175 mg/m 2paclitaxel,(protocol ID: NCT01049295). The aim of this study was to evaluate the possible association between the age, BMI, BSA, pathological grade, and molecular biomarkers of estrogen and progesterone receptors (ERs and PRs), tumor protein p53 and human epidermal growth factor receptor 2 (HER2) with PIPN in order to help oncologists make more accurate medical decisions being tailored to the individual patients based on their characteristics. Īge, body mass index (BMI), and body surface area (BSA) pathological grade and molecular biomarkers may be related to peripheral neuropathy, there are some adverse changes in the peripheral nervous system observed with aging, and higher doses of neurotoxic medications for those with greater body surface area which may results in more severe neurotoxicity and patients with higher grade of the disease may experience more side effects due to chemotherapy. Microtubules aggregation in axons and Schwan cells maybe underlying the sensory axonal peripheral neuropathy due to paclitaxel, while motor and autonomic nervous system are less affected. Paclitaxel induced peripheral neuropathy (PIPN), is the main dose-limiting and long lasting side effect of paclitaxel, with no fully understood mechanisms. Older patients, those with greater BSA and PR + patients may need closer follow up and more medical attention due to greater incidence and severity of PIPN. ConclusionĪge, BSA and the status of PR +, should be considered as the risk factors for PIPN before commencement of chemotherapy with paclitaxel in patients with breast cancer.
Multivariate analysis showed that age and the status of PR + were independent risk factor for incidence and the status of PR + was the only independent risk factor for severity of PIPN. Incidence and severity of PIPN were much more pronounced in progesterone receptor positive (PR +) patients (RR:1.88, P = .015 and B:1.54, P = .012). Also, BSA showed a significant association with the risk of PIPN (RR: 2.28, P = .035 B: 3.88, P = .035). Body mass index and BSA had significant association with severity of PIPN (B:1.28, P = .025 and B: 3.88, P = .010 respectively). Age was significantly associated with risk of PIPN (RR:1.50, P value = .024). Resultsįifty-seven patients with breast cancer were investigated. The association between age, BMI, BSA, pathological grade, molecular biomarkers and PIPN was evaluated. All analyses were performed adjusting for intervention effect. Reduced total neuropathy score (r-TNS) was used for measuring PIPN.
#Wechsel pain and rehab trial#
They belonged to an initial randomized controlled trial in which the effectiveness of omega-3 fatty acids in preventing and reducing severity of PIPN was evaluated (protocol ID: NCT01049295). MethodsĮligible patients with node positive breast cancer undergoing chemotherapy with paclitaxel were assessed. The aim of the study was to find out the possible risk factors for PIPN. Paclitaxel induced peripheral neuropathy (PIPN) is a major debilitating side effect of paclitaxel in patients with breast cancer with no fully known mechanisms.
0 kommentar(er)
