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PARIS -- Hand cooling and compression each cut the risk of high-grade chemotherapy-induced peripheral neuropathy (CIPN) in patients undergoing treatment for primary breast cancer, according to the first prospective trial comparing the two techniques.

Patients were randomized to have one of the interventions on one hand during the administration of chemotherapy, with the other hand acting as a control. Incidence of grade ≥2 CIPN was reduced from 50% to 29% with hand cooling, and from 38% to 24% with compression, reported Laura Michel, MD, of University Hospital Heidelberg in Germany.

"The efficacy of cooling and compression was similar," she said here at the annual congress of the European Society for Medical Oncology (ESMO). "However, since compression is easily accessible, inexpensive, and better tolerated, it could play an increasing role in clinical practice and should be further investigated in clinical trials."

In addition to evaluating CIPN -- a common, dose-limiting side effect of taxane-based chemotherapy -- during the administration of chemotherapy, she and her colleagues also assessed the incidence of the condition at certain time points after chemotherapy was completed:

• At 1 month, the incidence of CIPN was 10% in the cooling hands vs 19% in the control hands, and 19% with compression compared with 28% in the control hands
• At 6 to 8 months, the CIPN rates were 3% in the cooling hands vs 8% in the control hands, and 5% in both the compression and control hands

The POLAR trial included 122 breast cancer patients who received weekly paclitaxel- or nab-paclitaxel (Abraxane)-based chemotherapy. Most were treated with neoadjuvant nab-paclitaxel and underwent 10 to 12 taxane administrations, and those patients treated with nab-paclitaxel received higher doses than those who received paclitaxel.

Patients were randomized 1:1 to either cooling or compression of the dominant hand, with no intervention performed on the other hand. Cooling was performed with a frozen glove, and compression was applied by two surgical gloves (one size smaller than a tight-fitting size) 30 minutes before, during, and 30 minutes after taxane therapy.

Michel reported that patients treated with nab-paclitaxel had a greater risk of developing high-grade CIPN compared with patients who received paclitaxel. And while there was no difference in high-grade CIPN risk according to the number of taxane administrations, the risk was highly dose-dependent in patients treated with nab-paclitaxel, she said.

No significant differences were observed according to age, body mass index, HbA1C level, alcohol intake, smoking, or pathologic complete response rate.

Of the 122 patients in the study, 21 dropped out. Of the nine patients who dropped out in the cooling group, the main reason was intolerance of cooling; of the 12 who dropped out in the compression group, however, just one reported intolerance as a reason.

A total of 24 patients had to discontinue chemotherapy, with two-thirds of those discontinuing due to CIPN -- "which highlights the clinical importance of this trial and the need for further preventive strategies," Michel said.

ESMO-invited discussant Galina Velikova, MD, PhD, of the University of Leeds in England, raised several questions concerning the trial's methodology.

For example, regarding the use of dominant and non-dominant hands as the study arms, she pointed out that while "we are taught in medical school peripheral neuropathy is symmetrical -- what if it isn't?" She also noted that a definition of a grade 2 adverse event -- "moderate symptoms; limiting self care activities of daily living" -- is subjective.

Although the trial found that both cooling and compression were highly effective, "I would view this as a very good pilot study," Velikova said. "We still need a bigger randomized trial."

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