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. 2022 Jan 5:11:763229.
doi: 10.3389/fonc.2021.763229. eCollection 2021.

A Systematic Review and Meta-Analysis of the Effectiveness of Neuroprotectants for Paclitaxel-Induced Peripheral Neuropathy

Alisha Joan Leen  1   2   3 , Dominic Wei Ting Yap  4 , Chong Boon Teo  4 , Benjamin Kye Jyn Tan  4 , Alex Molassiotis  5 , Hiroshi Ishiguro  6 , Sarah Wei Xian Fan  3 , Raghav Sundar  2   3   4   7 , Yu Yang Soon  8 , Aishwarya Bandla  3   7
Affiliations

A Systematic Review and Meta-Analysis of the Effectiveness of Neuroprotectants for Paclitaxel-Induced Peripheral Neuropathy

Alisha Joan Leen et al. Front Oncol. .

Abstract

Background: Paclitaxel-induced peripheral neuropathy (PIPN) is a disabling side effect of paclitaxel with few effective preventive strategies. We aim to determine the efficacy of pharmacological and non-pharmacological neuroprotective interventions in preventing PIPN incidence.

Methods: Biomedical literature databases were searched from years 2000 to 2021 for trials comparing neuroprotective interventions and control. Meta-analysis was performed using the random-effects model. The primary outcome was the incidence of PIPN.

Results: Of 24 relevant controlled trials, 14 were eligible for meta-analysis. Pooled results from seven non-pharmacological trials were associated with a statistically significant 48% relative reduction of PIPN risk with low heterogeneity. Conversely, pooled results from six pharmacological trials were associated with a significant 20% relative reduction of PIPN risk with moderate heterogeneity. Both pharmacological and non-pharmacological approaches appear effective in reducing PIPN incidence in the treatment arm compared to control (pooled RR < 1).

Conclusion: Current evidence suggests that both interventions may reduce PIPN risk. Non-pharmacological interventions appear more effective than pharmacological interventions.

Keywords: chemotherapy-induced peripheral neuropathy (CIPN); neuroprotection; non-invasive; paclitaxel-induced peripheral neuropathy; prevention; taxane.

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Conflict of interest statement

RS has received honoraria from Bristol-Myers Squibb, Lilly, Roche, Taiho, Astra Zeneca, DKSH, and MSD; has advisory activity with Bristol-Myers Squibb, Merck, Eisai, Bayer, Taiho, Novartis, MSD, and AstraZeneca; received research funding from MSD and Paxman Coolers; and has received travel grants from AstraZeneca, Eisai, Roche, and Taiho Pharmaceutical. AB reports grants from Paxman Coolers Ltd., outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart describing the search and selection of studies according to the PRISMA guidelines.
Figure 2
Figure 2
Risk of bias summary for studies investigating pharmacological approaches to prevent PIPN. Green circles represent low risk of bias, yellow circles represent unclear risk of bias, and red circles represent high risk of bias for their corresponding component categories.
Figure 3
Figure 3
Risk of bias summary for studies investigating non-pharmacological approaches to prevent PIPN. Green circles represent low risk of bias, yellow circle represents unclear risk of bias, and red circle represents high risk of bias for their corresponding component categories.
Figure 4
Figure 4
Forest plot comparing the incidence of PIPN between the experimental (pharmacological approaches) and control (placebo) arms. Black diamonds are the estimated pooled hazard ratio for each meta-analysis; blue box sizes reflect the relative weight apportioned to studies in the meta-analysis.
Figure 5
Figure 5
(A) Forest plot comparing the incidence of PIPN between the experimental (non-pharmacological approaches) with control (placebo) arms. (B) Forest plot comparing the incidence of PIPN between experimental (cryotherapy) and control (placebo) arms. Black diamonds are the estimated pooled hazard ratio for each meta-analysis; blue box sizes reflect the relative weight apportioned to studies in the meta-analysis.
See this image and copyright information in PMC

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