A meta-analysis of the utility of cryotherapy for preventing peripheral neuropathy among breast cancer patients receiving paclitaxel and nab-paclitaxel

BackgroundCryotherapy with taxane infusion is a noninvasive strategy for preventing peripheral neuropathy (PN), but the efficacy of this approach has not been proven.MethodsA systematic search was conducted, and 477 records were initially identified. The titles were screened independently by 2 reviewers. Fourteen studies were ultimately included for meta-analysis, which was conducted using the meta package in the R software. Only studies that analysed cryotherapy use in breast cancer patients who received paclitaxel or nab-paclitaxel were included. Relative risks (RRs) were calculated using the random effects model to compare the occurrence of PN between the paclitaxel and nab-paclitaxel groups.ResultsThe incidence of Common Terminology Criteria for Adverse Events (CTCAE) grade >= 2 PN was 24.85% (81/326) in the cryotherapy arm and 42.35% (72/170) in the placebo arm. The overall RR CTCAE grade >= 2 PN in the cryotherapy group compared with the placebo group was 0.45 [0.27, 0.77, p = 0.0031]. The RR for sensory PN was 0.19 [0.05, 0.66, p = 0.009], and that for motor PN was 0.18 [0.03, 0.99, p = 0.0491]. The RR for Patient Neurotoxicity Questionnaire (PNQ) scores >= D, which indicate severe neuropathy, was 0.24 [0.09, 0.62; p = 0.0035]. Cold intolerance was the most reported t adverse effect, with a prevalence of 15% (37/247).ConclusionsThe use of cryotherapy decreased the occurrence of CTCAE grade >= 2 PN by 55%. Cold intolerance was the most frequently reported adverse effect associated with cryotherapy, but this adverse effect did not lead to high discontinuation rates.