Delayed recovery and increased severity of Paclitaxel-induced peripheral neuropathy in patients with diabetes.

PURPOSE: Although diabetes mellitus (DM) is recognized as a risk factor for chemotherapy-induced neurotoxicity, its true impact on intensity and time course of peripheral neuropathy is still unclear. The goal was to analyze the relevance of preexisting DM to weekly paclitaxel-induced peripheral neuropathy (PIPN). METHODS: We performed a retrospective case-control study (1:2) including a total of 129 patients with breast cancer (43 with DM and 86 controls) treated with single-agent weekly paclitaxel (wP). RESULTS: Compared with controls, patients with DM treated with wP experienced PIPN more frequently (74.4% vs 58.4%; P=.016) and with higher severity (grade 2-3: 51.2% vs 27.7%; P=.014). A significant delay in PIPN resolution was observed in women with DM (P=.001) and, in a multivariate analysis, DM was the only independent predictor for delayed recovery (hazard ratio [HR], 0.16; 95% CI, 0.05-0.55; P=.003). After 2 years, 68.7% of patients with DM (vs 29.2% of women without DM) still experienced PIPN, which was functionally significant (grade 2-3) in 18.2%. CONCLUSIONS: Significantly more dose delays and reductions because of PIPN occurred in patients with DM. Preexisting DM associates with long-lasting significant PIPN in patients treated with wP. Benefits and risks of long-term significant PIPN should be carefully balanced in patients with DM before starting wP chemotherapy.

Bacteremia in adult cancer patients with apparently stable febrile neutropenia: data from a cohort of 692 consecutive episodes from a single institution.

BACKGROUND: Bacteremia is associated with increased risk of complications in patients with febrile neutropenia (FN), although few clinical studies have reported outcomes in apparently stable patients (ASPs) who could be candidates for home treatment. OBJECTIVE: To assess the risk factors and the impact of bacteremia in ASPs. METHODS: We retrospectively analyzed 861 consecutive episodes of FN that were classifed according to their presentation into 2 categories: clearly unstable patients and ASPs. We estimated the incidence of bacteremia and severe complications in ASPs. We analyzed predictors for bacteremia and the discriminatory ability of the MASCC score in this setting. RESULTS: We classifed 692 episodes as ASPs. Bacteremia occurred in 6%, major complications were noted in 7.3%, and death occurred in 1.3%. Patients with bacteremia had more complications (odds ratio [OR], 8.2), and mortality (OR, 8.2). The integration of the MASCC score and bacteremic status predicted complications with an area under the receiver operating characteristic (ROC) curve of 0.74, sensitivity of 36%, and specifcity of 94%. Predictors of bacteremia were temperature ≥ 39°C/102.2°F (OR, 3), rigors (OR, 2.2), ECOG PS ≥ 2 (OR, 2.1), and advanced cancer (OR, 2.5). Two percent of patients who remained afebrile for 48 hours had positive blood cultures afterward. LIMITATIONS: A single-center, retrospective analysis, and the absence of a validation set to test the model's discriminatory ability. CONCLUSIONS: Bacteremia is infrequent among ASPs but is associated with a high risk of complications. We identifed several variables that could improve the prognostic classifcation of clinically stable FN.