Effect of Exercise on Taxane Chemotherapy–Induced Peripheral Neuropathy in Women With Breast Cancer: A Randomized Controlled Trial

• Published in: Clinical breast cancer Vol. 19; no. 6; pp. 411 - 422
• Main Authors: Bland, Kelcey A., Kirkham, Amy A., Bovard, Joshua, Shenkier, Tamara, Zucker, David, McKenzie, Donald C., Davis, Margot K., Gelmon, Karen A., Campbell, Kristin L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2019
• Subjects: Aerobic exercise; Breast neoplasm; Polyneuropathy; Quality of life; Resistance training; Polyneuropathy; Resistance training; Aerobic exercise; Breast neoplasm; Quality of life
• ISSN: 1526-8209; 1938-0666
• DOI: 10.1016/j.clbc.2019.05.013

Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting adverse effect of taxanes. We sought to evaluate the effect of exercise on taxane CIPN in women with breast cancer. Women (n = 27) were randomized to immediate exercise (IE, during taxane chemotherapy) or delayed exercise (DE, after chemotherapy). Supervised aerobic, resistance, and balance training was offered 3 days a week for 8-12 weeks. CIPN symptoms and quality of life were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30 and CIPN20 (scored from 0 to 100). The percentage of participants reporting moderate to severe sensory symptoms (‘3/4’ or ‘4/4’ for CIPN20 sensory items) was also evaluated, along with clinical sensory testing at the lower limb (vibration sense and pinprick). Taxane treatment adherence, including relative dose intensity, was extracted from patient medical records. Assessments occurred at: baseline (before taxane chemotherapy), pre-cycle 4 (before the final taxane cycle), the end of chemotherapy, and follow-up (10-15 weeks after chemotherapy). No differences in the EORTC QLQ CIPN20 symptom scores were detected between groups at any time point. At pre-cycle 4, there was a significant difference between groups in patient-reported moderate to severe numbness in the toes or feet (IE: n = 1, 9%, DE: n = 7, 50%, P = .04) and impaired vibration sense in the feet (IE: n = 2, 18%, DE: n = 10, 83%, P < .01). Overall global health status/quality of life was higher in IE compared to DE at the end of chemotherapy (P = .05), yet both groups had worse CIPN20 sensory (Δ24.3 ± 4.6, P < .01) and motor symptom scores (Δ10.5 ± 1.9, P < .01) relative to baseline. By the end of chemotherapy, no differences between groups were found for moderate to severe numbness in the toes or feet (P = 1.0) or impaired vibration sense in the feet (P = .71). More IE participants received ≥ 85% relative dose intensity (IE: n = 12, 100%, DE: n = 10, 67%, P < .05). Exercise may attenuate CIPN over the course of taxane chemotherapy and possibly improve taxane adherence in women with breast cancer. These findings, as well as whether exercise can attenuate CIPN by the end of taxane chemotherapy, should be confirmed in larger trials. Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting adverse effect of taxanes used to treat breast cancer. In this proof-of-concept trial, 27 breast cancer patients were randomized to exercise during versus after taxane chemotherapy to explore the effect on CIPN and taxane treatment adherence. Our findings suggest exercise may mediate patient-reported CIPN during taxane chemotherapy, but not by the end of chemotherapy, and potentially help patients better tolerate their taxane treatment.