Racial differences in peripheral neuropathy and associated supportive treatment in breast cancer patients on platinum- and taxane-based chemotherapy regimens.

Abstract

e24107 Background: Neoadjuvant and adjuvant chemotherapy for breast cancer (BC) is associated with significant side effects such as chemotherapy-induced peripheral neuropathy (CIPN). This study compares incidence of neuropathy by race in a large multi-institutional database of BC patients. Methods: We performed a retrospective review of adult females with non-metastatic BC treated with platinum- and taxane-based chemotherapy from January 2018 to December 2023 using the TriNetX Analytics Network database, which includes over 101 million individuals. Primary outcomes were new diagnosis of neuropathy within one year of treatment and prescription of supportive measures compared between Black, Hispanic and Asian versus White patients. Patients with metastatic disease, prior history of neuropathy, depression or anxiety or prior use of included medications were excluded. Patients were propensity score-matched by age, BC-directed therapy, and comorbidities including history of diabetes and hemoglobin A1c level. Results: Black (n=2476) vs. White patients (n=2476) had increased diagnoses of drug induced and general neuropathy within one year of treatment initiation. They also received increased prescriptions of gabapentin/pregabalin, duloxetine and capsaicin. Asian (n=1803) vs. White (n=1803) patients had increased drug induced and general neuropathy within their first-year post treatment. Prescription patterns were mixed with increased duloxetine and tramadol, but decreased pregabalin/gabapentin and venlafaxine. There were no statistically significant differences in neuropathy incidence or prescription patterns with Hispanic (n=746) vs. White (n=746) patients. Conclusions: The incidence of neuropathy was higher in Black and Asian vs. White patient on platinum- and taxane- based chemotherapy plans. This work supports previous literature regarding Black patient’s increased susceptibility to CIPN and shows appropriate increase in supportive care, which has been inconsistently reported prior. To our knowledge this is the first report of increased CIPN incidence in Asian patients; mixed supportive prescription patterns may reflect under-treatment and cultural differences. Further studies are needed to identify the cause of these differences. Black vs. White Asian vs. White Hispanic vs. White Drug induced neuropathy HR = 1.63 p < 0.01 HR = 1.54 p < 0.01 HR = 1.01p = 0.98 General neuropathy HR = 1.31 p < 0.01 HR = 1.30 p < 0.01 HR = 1.07p = 0.56 Gabapentin/ pregabalin HR = 1.42 p < 0.01 HR = 0.67 p < 0.01 HR = 1.17p = 0.10 Duloxetine HR = 1.90 p < 0.01 HR = 1.47 p = 0.05 HR = 1.14p = 0.59 Venlafaxine HR = 0.80p = 0.19 HR = 0.27 p < 0.01 HR = 0.93p = 0.80 Nortriptyline/ amitriptyline HR = 1.55p = 0.07 HR = 0.55p = 0.15 HR = 1.68p = 0.31 Capsaicin HR = 6.06 p < 0.01 HR = 1.98p = 0.99 HR = 0.70p = 0.70 Tramadol HR = 1.06p = 0.29 HR = 1.38 p < 0.01 HR = 0.96p = 0.70