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How do you manage grade 2-3 chemotherapy- induced peripheral neuropathy (CIPN) developing during adjuvant paclitaxel therapy for breast cancer?
How would you manage symptoms? How would you adjust the adjuvant regimen (dose reduce, omit paclitaxel etc)? What strategies would you consider for preventing CIPN in other patients undergoing adjuvant paclitaxel?
Answer from: Medical Oncologist at Academic Institution
In cases with grade 2-3 neuropathy, I consider dose reduction of paclitaxel by at least 20%. I have also used duloxetine (30 mg daily for the 1st week and then 60 mg daily based on the randomized study by Smith et al (JAMA 2013)), with fair amount of success. I have also used gabapentin, although wi...
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Answer from: Medical Oncologist at Academic Institution
CTCAE grading for peripheral motor sensory neuropathy remains a bit challenging, as Grade 1 is asymptomatic and grade 2 is already moderate (or limiting IADLs). However, I do agree with the 20% dose reduction if patients have moderate symptoms or impact on IADLs, and have also utilized duloxetine wi...