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Randomized Controlled Trial
. 2025 Apr 1;11(4):408-415.
doi: 10.1001/jamaoncol.2025.0001.

Efficacy of Hand Cooling and Compression in Preventing Taxane-Induced Neuropathy: The POLAR Randomized Clinical Trial

Laura L Michel  1 , Daniel Schwarz  2 , Philipp Romar  1 , Manuel Feisst  3 , Daniel Hamberger  4 , Anastasia Priester  2 , Eileen Kurre  1 , Eva Klein  1 , Jana Müller  1   5 , Timo Schinköthe  6 , Markus Weiler  7 , Katharina Smetanay  1   8 , Carlo Fremd  1 , Sabine Heublein  1   8 , Verena Thewes  1 , Michael O Breckwoldt  2 , Dirk Jäger  1 , Martin Bendszus  2 , Frederik Marmé  9 , Andreas Schneeweiss  1
Affiliations
Randomized Controlled Trial

Efficacy of Hand Cooling and Compression in Preventing Taxane-Induced Neuropathy: The POLAR Randomized Clinical Trial

Laura L Michel et al. JAMA Oncol. .

Abstract

Importance: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, dose-limiting adverse effect of taxane-based chemotherapies. Currently, there is no established strategy for prevention or treatment.

Objective: To compare the effectiveness of 1-sided hand cooling and compression for preventing CIPN in patients with primary breast cancer receiving taxane-based chemotherapy.

Design, setting, and participants: The POLAR randomized clinical trial was conducted at the National Center for Tumor Diseases Heidelberg between November 2019 and January 2022. Female patients with breast cancer who received weekly nab-paclitaxel-based or paclitaxel-based neoadjuvant or adjuvant chemotherapy were enrolled. Patients with prior chemotherapy, preexisting neuropathy, or neuropathy-related comorbidities were excluded.

Interventions: Patients were randomized 1:1 to cooling or compression of the dominant hand. No intervention was performed on the other hand. Cooling was performed with a frozen glove and compression was applied by 2 surgical gloves (1 size smaller than the tight-fitting size) 30 minutes before, after, and during taxane administration.

Main outcomes and measures: The primary end point was the efficacy to prevent grade 2 or higher sensory CIPN evaluated by Common Terminology Criteria for Adverse Events, version 5.0. Further CIPN assessment included the clinical version of the Total Neuropathy Score and QLQ CIPN20. CIPN rates were compared between intervention groups. Nail toxic effects, quality of life, CIPN-associated dose reductions, treatment discontinuations, and risk factors were evaluated. Follow-up examinations were performed 1 week, 1 month, and 6 to 8 months after the last taxane dose.

Results: A total of 122 female patients with primary breast cancer (mean [SD] age, 50 [12] years) were randomized to either cooling or compression of the dominant hand. Twenty-one individuals withdrew from the study, so 101 patients were included in the final analysis (n = 52 and n = 49 for cooling and compression, respectively). Both interventions significantly reduced the incidence of grade 2 or higher CIPN (cooling: 15 participants experiencing high-grade CIPN in the cooling arm [29%] vs 26 in the control arm [50%]; P = .002; effect size, 21.15% [95% CI, 5.98%-35.55%]; compression: 12 participants experiencing CIPN in the intervention arm [24%] vs 19 in the control arm [38%]; P = .008; effect size, 14.29% [95% CI, 2.02%-27.24%]). CIPN was the main reason for treatment discontinuations in 16 of 24 participants (67%). The predominant risk factors were the cumulative taxane dosage and the neurotoxic agent. Participants experiencing grade 2 or higher CIPN showed a reduced global health status during and 6 to 8 months after taxane therapy.

Conclusions and relevance: In this randomized clinical trial, cooling and compression were highly effective and significantly reduced the risk of high-grade CIPN.

Trial registration: ClinicalTrials.gov Identifier: NCT06541769.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Michel was supported by the Olympia Morata fellowship of the Medical Faculty, University of Heidelberg, and reported fees for speaking engagements and travel expenses from Roche, Pfizer, Lilly Pharma, Daiichi Sankyo, AstraZeneca, and Gilead outside the submitted work. Dr Romar reported personal fees from AstraZeneca, Novartis, and Lilly outside the submitted work. Dr Schinköthe reported being a shareholder of CANKADO GmbH outside the submitted work. Dr Weiler is a member of the European Reference Network for Neuromuscular Diseases. Dr Smetanay reported fees for speaking engagements and travel expenses from Daiichi Sankyo, Gilead, Lilly, MSD, Pfizer, and AstraZeneca outside the submitted work. Dr Heublein reported personal fees from Novartis, GSK, AstraZeneca, SAGA, Clovis, Roche, Eisai, MSD, Pfizer, Daiichi Sankyo, and AbbVie outside the submitted work. Dr Thewes reported travel expenses from Gilead and substance provision from Gilead, Roche, and AstraZeneca outside the submitted work. Dr Breckwoldt is supported by the Emmy Noether program of the DFG (BR382 6153/1-1). Dr Bendszus reported grants from the German Research Foundation (DFG) to the institution; consulting fees from Guerbet, Boehringer Ingelheim, and NeuroSCios; honoraria for presentations from Novartis, Boehringer Ingelheim, and Guerbet; and serving as editor-in-chief for Clinical Neuroradiology (Springer) outside the submitted work. Dr Marme reported personal fees from Roche, Novartis, Pfizer, AstraZeneca, Clovis Oncology, Eisai, Genomic Health, MSD, Seagen, Myriad Genetics, Pierre-Fabre, GSK, Lilly, Agendia, Gilead Sciences, Daiichi Sankyo, Menarini Stemline, Boehringer Ingelheim, Novocure, BioNTech, Pharma&, Immunomedics, CureVac, Amgen, Vaccibody, Incyte, and Tesaro outside the submitted work. No other disclosures were reported.

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