Impact of patient-reported taxane-induced peripheral neuropathy on dose reductions or worsening quality of life in Black women with breast cancer: Analysis from ECOG-ACRIN EAZ171.

Abstract

Black patients with breast cancer experience higher rates of taxane-induced peripheral neuropathy (TIPN), which may compromise chemotherapy dose delivery and health-related quality of life (HRQOL). Using the prospective ECOG-ACRIN EAZ171 trial, the authors examined whether patient-reported TIPN predicts dose reductions and longer-term declines in HRQOL and physical function. EAZ171 enrolled 249 Black patients planned for (neo)adjuvant taxane; 239 with available patient-reported outcome (PRO) data were analyzed. TIPN was assessed during treatment using the Functional Assessment of Cancer Therapy GOG Neurotoxicity scale (FACT-GOG/NTx) (4-item, 11-item, and single items) and PRO-Common Terminology Criteria for Adverse Events numbness/tingling and interference. HRQOL (FACT-G) and physical function (PROMIS PF-10a) were measured through 12 months. Multivariable mixed-effects logistic models evaluated associations between TIPN, taxane dose reduction due to neuropathy, and 12-month HRQOL or physical function decline. All TIPN PROs were associated with dose reduction, with the FACT-GOG/NTx 4-item subscale showing the strongest association (odds ratio [OR], 10.8; 95% CI, 4.5-25.9). Twelve-month PRO data were available for 140 patients (59%). Neuropathy reported during treatment was not associated with reduced HRQOL or physical function at 12 months; however, persistent neuropathy at 12 months was associated with worse HRQOL (OR, 5.05; 95% CI, 1.33-19.17) and physical function (OR, 5.29; 95% CI, 1.57-17.83). TIPN was common and strongly predicted taxane dose reduction in Black patients. The FACT-GOG/NTx 4-item subscale performed best, supporting its use in future trials. Although early TIPN did not predict long-term functional decline, persistent neuropathy adversely affected HRQOL, underscoring the importance of early identification and supportive care to improve dose delivery and equity in breast cancer outcomes.