Comparative incidence of peripheral neuropathy associated with taxane chemotherapy in patients with breast cancer: A network meta-analysis

IntroductionTaxane-induced peripheral neuropathy (TIPN) is a common toxicity among patients with breast cancer (BC). Numerous pairwise comparisons have been performed to evaluate neuropathy associated with different taxane agents (docetaxel, paclitaxel, cabazitaxel, nab-paclitaxel, liposomal paclitaxel, and paclitaxel injection concentrate for nanodispersion [PICN]). This network meta-analysis aimed to study the comparative incidence of TIPN associated with taxane agents in females with BC.MethodsA comprehensive data search was performed in PubMed, Web of Science, and Scopus up to August 2024. The studies that compare neuropathy in taxane agents were systematically reviewed. A network meta-analysis was carried out based on a Bayesian framework to evaluate the incidence of peripheral neuropathy in taxanes compared to paclitaxel, as reference comparator. The Surface Under the Cumulative Ranking Curve (SUCRA) was used to rank taxanes based on their neuropathy.ResultsA total of 27 studies with 12101 patients were included. When compared with paclitaxel, nab-paclitaxel was associated with a significantly higher incidence of peripheral neuropathy (OR: 1.74, CrI: 1.22-2.48). Docetaxel (OR: 0.626, CrI: 0.441-0.881) and cabazitaxel (OR: 0.158, CrI: 0.0664-0.375) demonstrated a significantly lower incidence of peripheral neuropathy compared to paclitaxel. Liposomal paclitaxel and PICN lack significant difference compared to paclitaxel. Our analysis provided the order for peripheral neuropathy (from lowest to highest) as follows: cabazitaxel, docetaxel, liposomal paclitaxel, paclitaxel, PICN, nab-paclitaxel.ConclusionsNab-paclitaxel is associated with a significantly higher incidence of peripheral neuropathy compared to paclitaxel in females with BC. Docetaxel and cabazitaxel are linked with less peripheral neuropathy compared with paclitaxel in this population. No significant differences were observed in liposomal paclitaxel and PICN compared to paclitaxel.