Timmer, J.C. (2016) Paclitaxel-geïnduceerde neuropathie en de gevolgen voor de behandeling van het mammacarcinoom : Een retrospectieve database studie. thesis, Medicine.
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Abstract
Introduction: Breast cancer is the most common cancer among women. In our institute the chemotherapy treatment of breast cancer stadium I-III consists of adriamycincyclophosphamide followed by paclitaxel (AC-P). Trastuzumab is added to the treatment when the tumor has a Her2Neu overexpression. Paclitaxel-induced neuropathy is a common adverse event. The main goal of this study is to evaluate the consequences of paclitaxelinduced neuropathy on the treatment of breast cancer. The occurrence and the consequences of neuropathy on the treatment in the daily practice will be evaluated. The administered given dose of paclitaxel of patients who had developed neuropathy will be compared to the planned cumulative dose and their dose intensity will be calculated (mg/m2/week). The presumption of doctors that there may be a difference in incidence of paclitaxel-induced neuropathy with or without trastuzumab will be explored. The effect of age on the development of neuropathy (<65 en ≥65 year) and other adverse events that lead to an adjustment of the treatment plan of paclitaxel will be investigated. Method: In this retrospective database study patients are included who received treatment in Isala between June 2014 and March 2016 with paclitaxel or with paclitaxel and trastuzumab. Dose reduction, delay and/or discontinuation of treatment are used to support the main goal. Descriptive analyses were performed to assess the incidence of paclitaxel-induced neuropathy, the consequences on treatment and possible other adverse events that lead to dose reduction, delay and/or discontinuation of treatment. Adverse events are graded according to the ‘Common Terminology Criteria for Adverse Events, version 4.03’. The paired T-test was performed to compare the received total given dose of paclitaxel and the planned cumulative dose. The Chi-square test en the Fisher’s exact test were performed to compare the incidence between both groups (AC-P and AC-P + trastuzumab) and to evaluate the effect of age on the development on neuropathy. Results: 120 patients were included in total of which 87 patients received AC-P and 33 patients received AC-P and trastuzumab. Within the total study population 97 patients (80,8%) developed neuropathy grade 1-3, no one developed grade 4. As a consequence of the neuropathy 53 patients (44,2%) received an altered treatment schedule by means of dose reduction, delay and/or discontinuation. The dose intensity of this group was 88%. Patients with neuropathy received 12,3% less chemotherapy then the planned cumulative dose, which is significant less (P = 0,000). No difference was shown in the frequency of occurrence of neuropathy between the AC-P and AC-P + trastuzumab groups. Furthermore, a higher age (≥ 65 year) is no risk factor for the development of neuropathy during the treatment with paclitaxel. No other adverse effects that occurred more than one time that lead to an altered treatment schedule were found. Conclusion: This study has shown that paclitaxel-induced neuropathy is a serious side effect with consequences for the treatment of breast cancer in the daily practice. Patients with neuropathy receive significant less chemotherapy then the planned cumulative dose. With 44,2% the treatment schedule of paclitaxel is altered more in the daily practice then expected based on current literature. Because there is no objective and reproducible method to diagnose and grade the neuropathy, the decisions regarding the adjustments of the treatment schedule will vary by doctor. It is unclear at which grade of neuropathy the chance of recovery is likely and when the probability of recovery is reduced. Moreover, research results can not be compared with one another due to the lack of an objective method.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Honkoop, Mw. dr. A.H. and Afdeling: Interne geneeskunde and Locatie: Isala, Zwolle |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:57 |
| Last Modified: | 25 Jun 2020 10:57 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1807 |
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