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Title: Limb hypothermia for preventing paclitaxel-induced peripheral neuropathy in breast cancer patients: A pilot study
Authors: Sundar, R 
Bandla, A 
Tan, S.S.H 
Liao, L.-D 
Kumarakulasinghe, N.B
Jeyasekharan, A.D 
Ow, S.G.W
Ho, J
Tan, D.S.P
Lim, J.S.J 
Vijayan, J
Therimadasamy, A.K
Hairom, Z
Ang, E
Ang, S
Thakor, N.V 
Lee, S.-C 
Wilder-Smith, E.P.V 
Keywords: cyclophosphamide
hemoglobin A1c
breast cancer
cancer chemotherapy
clinical article
continuous flow limb hypothermia
controlled study
induced hypothermia
motor nerve conduction
muscle action potential
patient safety
peripheral neuropathy
pilot study
prospective study
side effect
skin temperature
visual analog scale
Issue Date: 2017
Citation: Sundar, R, Bandla, A, Tan, S.S.H, Liao, L.-D, Kumarakulasinghe, N.B, Jeyasekharan, A.D, Ow, S.G.W, Ho, J, Tan, D.S.P, Lim, J.S.J, Vijayan, J, Therimadasamy, A.K, Hairom, Z, Ang, E, Ang, S, Thakor, N.V, Lee, S.-C, Wilder-Smith, E.P.V (2017). Limb hypothermia for preventing paclitaxel-induced peripheral neuropathy in breast cancer patients: A pilot study. Frontiers in Oncology 6 (JAN) : 274. ScholarBank@NUS Repository.
Abstract: Background: Peripheral neuropathy (PN) due to paclitaxel is a common dose-limiting toxicity with no effective prevention or treatment. We hypothesize that continuous-flow limb hypothermia can reduce paclitaxel-induced PN. Patients and methods: An internally controlled pilot trial was conducted to investigate the neuroprotective effect of continuous-flow limb hypothermia in breast cancer patients receiving weekly paclitaxel. Patients underwent limb hypothermia of one limb for a duration of 3 h with every paclitaxel infusion, with the contralateral limb used as control. PN was primarily assessed using nerve conduction studies (NCSs) before the start of chemotherapy, and after 1, 3, and 6 months. Skin temperature and tolerability to hypothermia were monitored using validated scores. Results: Twenty patients underwent a total of 218 cycles of continuous-flow limb hypothermia at a coolant temperature of 22°C. Continuous-flow limb hypothermia achieved mean skin temperature reduction of 1.5 ± 0.7°C and was well tolerated, with no premature termination of cooling due to intolerance. Grade 3 PN occurred in 2 patients (10%), grade 2 in 2 (10%), and grade 1 in 12 (60%). Significant correlation was observed between amount of skin cooling and motor nerve amplitude preservation at 6 months (p < 0.0005). Sensory velocity and amplitude in the cooled limbs were less preserved than in the control limbs, but the difference did not attain statistical significance. One patient with a history of diabetes mellitus had significant preservation of compound muscle action potential in the cooled limb on NCS analysis. Conclusion: This study suggests that continuous limb hypothermia accompanying paclitaxel infusion may reduce paclitaxel-induced PN and have therapeutic potential in select patients and warrants further investigation. The method is safe and well tolerated. © 2017 Sundar, Bandla, Tan, Liao, Kumarakulasinghe, Jeyasekharan, Ow, Ho, Tan, Lim, Vijayan, Therimadasamy, Hairom, Ang, Ang, Thakor, Lee and Wilder-Smith.
Source Title: Frontiers in Oncology
ISSN: 2234-943X
DOI: 10.3389/fonc.2016.00274
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