The multivariate ordered logistic regression analysis performed in the present study showed that the significant predictors for the development of nab-PTX-induced peripheral neuropathy included smoking history with neuropathy evaluated by CTCAE, BMI with neuropathy evaluated by PNQ (sensory), and smoking history and advanced age with neuropathy evaluated by PNQ (motor). The dominant side hand on the breast cancer-affected side tended to develop CIPN evaluated by CTCAE. Surgical glove size and average difference in fingertip temperature before and after administration were also predictors on univariate analysis.
Several studies have reported that smoking was the predictor for CIPN development [17–20]. The result of the current study is consistent with this previous finding. Thus, clinicians need to know that the incidence and severity of CIPN are higher in patients with a smoking history.
Greenlee et al. in their prospective, observational, cohort study showed that obesity was associated with CIPN in breast cancer patients who received taxane treatment [21]. In this study, BMI was a predictor for CIPN development. The result of the current study is consistent with this previous finding [21–24]. Clinicians need to pay particular attention to the development of CIPN in obese patients.
Furthermore, the present study also found that advanced age is a predictor for CIPN [19, 25]. This result is consistent with previous studies. Therefore, clinicians also should be aware that the risk of CIPN increases with age.
In addition, the current study, dominant side hand on the breast cancer-affected side tended to develop CIPN evaluated by CTCAE, though it was not significant. This result was also consistent with findings in routine clinical practice. Therefore, clinicians should be aware that, in breast cancer patients, the risk of developing CIPN is higher in patients whose dominant side is the breast cancer-affected side. It was suggested that excessive use of the breast cancer-affected side hand (dominant hand) in daily life may be a predictor for the development of CIPN. Further verification of this is needed.
Surgical glove size (small) and average difference (large) in fingertip temperature before and after administration were also predictors on univariate analysis. In other words, it was suggested that CIPN could be prevented if the glove pressure is strong, or the cooling temperature is low. This is consistent with the results of previous studies [6–8].
There were several limitations to the current study. First, both hands of the same patient were considered to be independent. Second, the methods of evaluating CIPN is subjective which may underestimate the real number of patients with CIPN. Third, since this study was conducted at a single institute, it only analyzed a relatively small number of patients. Therefore, a prospective, multicenter study will be needed to confirm these results.
In conclusion, smoking history, BMI, and advanced age were identified as significant predictors of the development of CIPN in cancer patients treated with nab-PTX. CIPN may develop more easily in dominant hand on the breast cancer-affected side. However, these preliminary findings will need to be confirmed in a larger randomized, controlled trial. Nevertheless, these findings may assist in developing chemotherapeutic strategies, including of taxane chemotherapy, with better safety and efficacy, and to improve the quality of life of patients.