Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2019

Dose Modifications for Taxane Chemotherapy Induced Peripheral Neuropathy: A survey of Australian medical oncologists   (#122)

Wanyuan Cui 1 , Julia Shingleton 2 , Aisling Kelly 2 , Liesel Byrne 2 , Lisa King 2 , Phillipa Smith 2 , Craig R Lewis 3 4 , Brian N Stein 5 , Jeremy Shapiro 6 , Chris Karapetis 7 8 , Rachel Wong 1 9
  1. Medical Oncology, Eastern Health, Box Hill, VIC, Australia
  2. Cancer Institute NSW, Everleigh, NSW, Australia
  3. University of New South Wales, Randwick, NSW, Australia
  4. Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
  5. Medical Oncology, Adelaide Cancer Centre, Kurralta Park, SA, Australia
  6. Medical Oncology, Cabrini Haematology and Oncology Centre, Malvern, VIC, Australia
  7. Medical Oncology, Flinders Medical Centre, Bedford Park, SA, Australia
  8. Flinders University, Bedford Park, SA, Australia
  9. Monash University, Box Hill, VIC, Australia

Aims: Chemotherapy-induced peripheral neuropathy (CIPN) is a recognised adverse effect of taxane chemotherapy that affects long-term quality of life. Evidence for dose modification of antineoplastic therapy for CIPN is limited. eviQ is an online resource providing cancer treatment protocols with dose modification guidelines formulated by expert opinion and evidence-based review. These guidelines recommend omitting taxanes for G3 CIPN, 25% dose reduction for the first incidence of G2 CIPN, and 50% dose reduction if G2 CIPN persists. We sought to evaluate how rigidly Australian medical oncologists adhered to eviQ recommended dose modifications for taxane-related CIPN.

Methods: An online survey was distributed to over 400 MOGA and eviQ medical oncology reference committee members. Toxicity grading was based on CTCAE version 5.0.

Results: 66% of 153 respondents (response rate 35%) followed the eviQ CIPN recommendations. 14% of respondents would stop or dose reduce taxane chemotherapy when patients experienced G1 CIPN, 89% with G2 and 100% with G3.  Reasons for not following the eviQ recommendations included: dose modification according to the individual clinical situation (23%), too aggressive (22%) and too conservative (8%).

92% of respondents would continue the current taxane dose on first occurrence of G1 CIPN. Fewer clinicians continued the current dose on the second (63%), third (42%) or fourth recurrence (42%). At first occurrence of G2 CIPN, 27% would continue the current taxane dose, 65% would dose reduce and 8% would cease. On second recurrence, only 11% would continue the current dose, and 5% on the third and fourth recurrence.

Conclusions: This survey demonstrated that clinicians readily dose modified taxane chemotherapy for CIPN and the majority of respondents followed the eviQ recommendations. The eviQ recommendations were not changed. Notable deviations from the eviQ guidelines included dose reduction for G1 CIPN and no dose reduction at the first occurrence of G2 CIPN.