Coasting Does Not Occur in Taxane-Based Chemotherapy
Unlike platinum-based chemotherapeutics, taxanes do not exhibit the "coasting" phenomenon where neuropathy worsens after treatment completion. 1
Taxane-Induced Neuropathy Characteristics
- Paclitaxel-induced peripheral neuropathy begins improving immediately after treatment completion, unlike oxaliplatin-induced neuropathy which may worsen for 2-6 months after treatment cessation 1
- Taxane neuropathy presents primarily as a sensory axonal neuropathy that typically begins during the first 2 months of treatment 1
- Symptoms tend to resolve between doses and improve over several months after treatment completion 1
- Symptoms are not worsened, on average, in subsequent cycles of treatment 1
Evidence Against Coasting in Taxanes
- A systematic review examining coasting in taxane-induced peripheral neuropathy in breast cancer patients found only one study reporting coasting events (14.3% of patients), while eight studies reported no coasting events 2
- Paclitaxel neuropathy follows a different recovery pattern than oxaliplatin, with improvement beginning immediately after treatment completion rather than worsening 1
- Most patients experience improvement in symptoms over several months following treatment cessation 1
Clinical Presentation of Taxane Neuropathy
- Primarily sensory neuropathy with a stocking-glove distribution that begins distally in fingers and toes and can progress proximally as the condition worsens 1
- Most common symptoms include numbness, tingling, and pain 1
- Numbness and tingling appear earlier and are generally more prominent problems than pain 1
- Paclitaxel causes an acute pain syndrome (often labeled as arthralgia/myalgia) that typically develops within 1-3 days after administration and largely resolves within a week 1, 3
- Taxane acute pain syndrome (TAPS) has been reported in 14-46% of patients receiving taxane-based chemotherapy 3
Risk Factors for Taxane Neuropathy
- Diabetes mellitus, increasing age, concurrent exposure to other neurotoxic agents, pre-existing neuropathy, and conditions predisposing to neuropathy 1
- Smoking appears to increase the risk of long-term prevalent paraesthesia 1
- Medium to high levels of anxiety before treatment may impact the development of CIPN during and after treatment 4
Management Considerations
- For painful taxane-induced neuropathy, duloxetine is the recommended first-line treatment option 5
- Home-based, moderate-intensity walking and resistance exercise programs have shown benefit in reducing CIPN symptoms 5
- Cryotherapy (cooling of hands and feet) has demonstrated a clinically meaningful impact on reducing occurrence of CIPN from taxanes 6
Clinical Pitfalls and Caveats
- Taxane-induced neuropathy can persist as a debilitating problem for years in some patients despite the general trend of improvement 1
- Monitoring for neuropathy should continue after treatment completion, as symptoms may persist or evolve 1
- Taxane-induced neuropathy is often confused with other forms of neuropathic pain but has distinct pathophysiology and symptomatology 1