#0422

Extremity cooling for the prevention of Taxane-Induced nail changes and neuropathy in castration-resistant prostate cancer: Prospective intrapatient comparison study

Y. Matsui¹, W. Yanagida¹, T. Fukagai²

¹Hitachi medical center, Department of Urology, Ibaraki, Japan
²Showa University School of Medicine, Department of Urology, Tokyo, Japan

Introduction:

Taxanes, such as docetaxel and cabazitaxel, are microtubule inhibitors discovered in the 1960s. While effective, they are associated with adverse effects, including nail toxicity and chemotherapy-induced peripheral neuropathy (CIPN). Nail toxicity affects up to 85% of docetaxel-treated patients, ranging from mild discoloration and Beau’s lines to severe onycholysis and subungual hematomas. CIPN, with incidence rates of 29%–68%, leads to sensory deficits, pain, and functional impairment, negatively impacting quality of life and treatment adherence. Cryotherapy has been explored as a preventive strategy, leveraging vasoconstriction to reduce drug distribution and cellular uptake. However, previous studies using frozen gloves (-20° to -30°C) reported frostbite risks, leading to a recall of cooling equipment. Post-exercise muscle cooling at 15°C has demonstrated safety without frostbite, yet its efficacy in preventing CIPN remains unclear. We previously demonstrated that 15°C cooling reduces peripheral blood flow safely. This study aims to evaluate its impact on CIPN and nail toxicity in taxane-treated patients using an intrapatient comparison model.

Material and methods:

Patients receiving docetaxel (planned dose = 75 mg/m²) for castration-resistant prostate cancer were included. The treated hand was cooled to 15°C using a cooling device, while the contralateral hand served as an internal control. The primary endpoint was the occurrence of CIPN or nail toxicity. Both intention-to-treat (ITT) and per-protocol (PPP) populations were analyzed.

Results:

Eleven patients treated with docetaxel were enrolled between 04/2022 and 12/2024. While nail toxicity was not significantly improved in the ITT or PPP populations, a significant benefit was observed across visits in the ITT group. Cooling significantly reduced CIPN occurrence across visits in both the ITT and PPP groups. The cooling intervention was well tolerated without complications.