Highlights
- •Thirty-six percent of screened patients developed grade II chemotherapy-induced peripheral neuropathy (CIPN).
- •Only 1 of 27 patients in the intervention phase developed grade III CIPN.
- •Only one patient developed grade III CIPN, so acupuncture was worthy of further study.
- •Acupuncture was well tolerated, with 15% of patients reporting mild bruising.
Abstract
Purpose
Chemotherapy-induced peripheral neuropathy (CIPN) is a common and potentially dose-limiting
side-effect of neurotoxic chemotherapy for cancer patients. We evaluated the preliminary
efficacy of acupuncture in preventing worsening CIPN in patients receiving paclitaxel.
Methods
In this phase IIA single-arm clinical trial, we screened stage I–III breast cancer
patients receiving neoadjuvant/adjuvant weekly paclitaxel for development of CIPN.
The primary objective was to assess acupuncture's efficacy in preventing the escalation
of National Cancer Institute-Common Toxicity Criteria for Adverse Events (NCI-CTCAE),
version 4.0, grade II CIPN to higher grades. Acupuncture was deemed worthy of further
study if 23 or more of the 27 enrolled patients did not develop grade III CIPN. Outcome
measures (NCI-CTCAE CIPN grade, Functional Assessment of Cancer Therapy/Gynecologic
Oncology Group-Neurotoxicity [FACT/GOG-Ntx], Neuropathic Pain Scale [NPS]) were obtained
weekly during the intervention.
Results
Of 104 patients screened, 37 developed grade II CIPN (36%), and 28 (27%) enrolled
into the intervention phase; one was removed due to protocol violation. Of the 27
patients receiving acupuncture, 26 completed paclitaxel treatment without developing
grade III CIPN, meeting our prespecified success criteria for declaring acupuncture
worthy of further study. FACT/GOG-Ntx and NPS scores remained stable during the intervention
while continuing weekly paclitaxel. Acupuncture treatment was well tolerated; 4 of
27 (15%) patients reported grade I bruising.
Conclusions
Acupuncture was safe and showed preliminary evidence of effectiveness in reducing
the incidence of high grade CIPN during chemotherapy. A follow-up randomised controlled
trial is needed to establish definitive efficacy in CIPN prevention for patients at
risk.
Keywords
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Article info
Publication history
Published online: July 12, 2018
Accepted:
June 11,
2018
Received in revised form:
June 4,
2018
Received:
March 8,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
