Abstract P5-15-13: Restoration by compression therapy of skin blood perfusion levels decreased during breast cancer chemotherapy, alleviating peripheral neuropathy

Nanoparticle albumin-bound paclitaxel (nab-PTX) has become a key drug used in chemotherapy for breast cancer, but it often causes adverse effects such as peripheral neuropathy (PN). No effective prophylactic management has so far been established. We have applied a "3S" approach to prevent and treat PN based on two concepts: compression therapy using stockings and sleeves, and medication therapy using selected prophylactic medications. We previously reported better CTCAE v4.0 PN grades and notably superior nab-PTX dose maintenance in a 3S group compared to a control group. However, little is known about the effects of compression therapy on a patient’s level of skin blood perfusion; it is also unknown whether any such effects might vary by 1) PN grade or 2) the number of nab-PTX cycles. To establish whether a compression therapy-skin perfusion relationship exists, the skin perfusion of the lower limbs was measured before and after stocking use in a 3S prophylactic treatment group for nab-PTX therapy (n=44), and in a control group of healthy volunteers (n=50). The skin perfusion was measured using a laser Doppler blood flow meter with an integrated probe (NL-101 Nahri Nexis Japan). To find how compression therapy affects skin perfusion by PN grade, the 3S group was subdivided into three PN grade subgroups (n = 12 for Grade 0, n = 20 for Grade 1, and n = 12 for Grades 2 and 3 combined). To find how compression therapy affects skin perfusion by number of nab-PTX treatment cycles undergone by patients, the 3S group was subdivided into the following three subgroups: 1 to 5 cycles of nab-PTX treatment (first period group; 1P, n=18), 6 to 10 cycles (second period group; 2P, n=16), and more than 10 cycles (third period group; 3P, n=12). In the control group of healthy volunteers, stocking use tended to increase the median skin perfusion level (mL/min/100g) from 10.9 ± 3.8 to 11.8 ± 4.3 (p=0.06). Interestingly, the median skin perfusion level for the 3S group as a whole significantly increased from 8.7 ± 3.3 before stocking use to 11.3 ± 3.8 after stocking use (p< 0.001). When examining the effects of stocking use on skin perfusion by PN grade, the increase in median skin perfusion level was significant in the Grade 0 subgroup (8.2 ± 2.7 to 12.4 ± 4.5, p=0.005), in the Grade 1 subgroup (8.3 ± 3.8 to 10.4 ± 4.0, p=0.0499), and in the Grades 2 and 3 subgroup (7.9 ± 2.3 to 10.6 ± 2.4, p=0.005). When examining the effects of stocking use on skin perfusion by number of treatment cycles, the increase in median skin perfusion level was significant in the 1P subgroup (7.9 ± 3.0 to 11.4 ± 4.8, p=0.007) and in the 2P (7.9 ± 2.9 to 10.8 ± 2.9, p=0.005), but not in the 3P (9.3 ± 3.5 to 10.8 ± 3.2, p=0.15). This study demonstrated that the skin perfusion of the lower limbs is decreased following nab-PTX chemotherapy, and also that the skin perfusion is improved by compression therapy. Compression therapy appeared to successfully restore the skin perfusion levels across every grade of chemotherapy-induced PN. Therefore, our 3S approach is suitable for alleviating CIPN by proactively maintaining skin perfusion from the beginning of nab-PTX therapy. Citation Format: Tsuyoshi Ohno, Takashi Mine, Hiroki Yoshioka, Mikiko Kosaka, Kazuhiro Matsuda, Maiko de Kerckhove, Charles de Kerckhove. Restoration by compression therapy of skin blood perfusion levels decreased during breast cancer chemotherapy, alleviating peripheral neuropathy [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-15-13.