Meta-analysis of studies of cryotherapy for prevention of peripheral neuropathy among breast cancer patients receiving paclitaxel or nab-paclitaxel

Cryotherapy is a strategy for prevention of peripheral neuropathy (PN) induced by chemotherapy, but the efficacy of this approach has not been proven. A meta-analysis of 14 randomized studies evaluated cryotherapy for PN prevention in breast cancer patients receiving paclitaxel or nab-paclitaxel. In the pooled cryotherapy group the incidence of grade ≥2 PN was 24.9%, compared with 42.4% in the pooled control group (relative risk 0.45; p=0.0031). The RR for sensory PN was 0.19 (p=0.009) and the RR for motor PN was 0.18 (p=0.0491). The RR for Patient Neurotoxicity Questionnaire score ≥ D (indicating severe neuropathy) was 0.24 (p=0.0035). Cold intolerance was the most reported adverse effect, with a prevalence of 15%. This effect did not lead to high discontinuation rates. The authors conclude that among patients receiving paclitaxel or nab-paclitaxel for breast cancer, the use of cryotherapy decreased the occurrence of grade ≥ 2 PN by 55%.