Hand Interventions Cut Neuropathy Risk in Breast Cancer Tx

TOPLINE:

Hand cooling and compression reduced the incidence of grade ≥ 2 chemotherapy-induced peripheral neuropathy (CIPN) by nearly 50% in patients with breast cancer receiving taxane-based chemotherapy. Both methods were highly effective, with cooling reducing relative risk by 42% and compression reducing relative risk by 37%.

METHODOLOGY:

• A total of 122 women with primary breast cancer (mean age, 50 years) were randomly assigned to receive either cooling or compression on their dominant hand, while the untreated hand served as an intraindividual control.
• Participants received weekly taxane-based chemotherapy with either nab-paclitaxel or solvent-based paclitaxel, with interventions performed 30 minutes before administration, during administration, and 30 minutes after administration.
• Cooling was implemented using frozen gloves stored at −20°C, replaced every 30 minutes, whereas compression involved wearing two surgical gloves — one size smaller than the tight-fitting size — on the dominant hand.
• The primary endpoint was the occurrence of high-grade CIPN in the interventional vs control hand; follow-up examinations were conducted at 1 week, 1 month, and 6-8 months after the last taxane dose.

TAKEAWAY:

• The cooling intervention significantly reduced the incidence of high-grade CIPN, with 15 participants experiencing CIPN in the interventional hand vs 26 participants experiencing CIPN in the control hand (effect size, 21.15%; 95% CI, 5.98%-35.55%; P = .002).
• Compression therapy showed similar efficacy, with 12 participants experiencing CIPN in the interventional hand vs 19 participants experiencing CIPN in the control hand (effect size, 14.29%; 95% CI, 2.02%-27.24%; P = .008).
• After 6-8 months, in the cooling group, three participants experienced high-grade CIPN in the control hand and one participant experienced high-grade CIPN in the interventional hand. In the compression group, only two participants experienced persistent high-grade CIPN in both hands.
• Participants with grade ≥ 2 CIPN had reduced global health status during taxane treatment, which persisted 6-8 months after treatment.

IN PRACTICE:

“POLAR is the first randomised clinical trial, to our knowledge, comparing the efficacy of cooling and compression for CIPN prevention. Both methods nearly halved the risk of high-grade sensory CIPN. Compression, being accessible, cost-effective, and well tolerated, could have an important role in clinical practice. These findings may enhance the tolerability of taxane therapies beyond gynaecological oncology,” the authors concluded.

SOURCE:

The study was led by Laura L. Michel, MD, National Center for Tumor Diseases, University Hospital and German Cancer Research Centre Heidelberg, Heidelberg, Germany. It was published online on March 6, 2025, in JAMA Oncology.

LIMITATIONS:

The study excluded patients with preexisting neuropathy or neuropathy-related comorbidities or those taking drugs that could mask CIPN symptoms, thereby limiting generalisability. Additionally, the unilateral, self-controlled approach and lack of blinding for participants and healthcare professionals may have influenced the observed results. The researchers also noted that as peripheral neuropathy is typically bilateral in clinical practice, focusing the intervention on one hand may have introduced bias.

DISCLOSURES:

The study was funded by the elevator pitch of the National Center for Tumor Diseases, Heidelberg. Several authors reported receiving personal fees or having ties with various sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.