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Meta-Analysis
. 2025 Apr;210(3):595-604.
doi: 10.1007/s10549-024-07597-z. Epub 2025 Jan 19.

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

Prashanth Ashok Kumar  1   2 , Parth Sampat  3 , Michael Sandhu  4 , Vishnu Charan Suresh Kumar  5 , Abigail Smith  6 , Shweta Paulraj  7 , Ghanshyam Ghelani  3   8 , Danning Huang  9 , Dongliang Wang  9 , Abirami Sivapiragasam  3   10
Affiliations
Meta-Analysis

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

Prashanth Ashok Kumar et al. Breast Cancer Res Treat. 2025 Apr.

Abstract

Background: Cryotherapy with taxane infusion is a noninvasive strategy for preventing peripheral neuropathy (PN), but the efficacy of this approach has not been proven.

Methods: A 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.

Results: The 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).

Conclusions: The 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.

Keywords: Breast cancer; Chemotherapy induced neuropathy; Cooling device; Cryotherapy; Nab-paclitaxel; Paclitaxel; Peripheral neuropathy.

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Conflict of interest statement

Declarations. Conflict of interest: The authors have no relevant financial or nonfinancial interests to disclose. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Since this was a meta-analysis and systematic search, ethics approval was not needed. Consent to participate: Not applicable.

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