Prevention of paclitaxel-induced peripheral neuropathy using limb cryotherapy: Evidence from a resource-constrained setting.

e12690 Background: Paclitaxel-induced peripheral neuropathy (PIPN) is a common, dose-limiting toxicity that significantly impacts quality of life and treatment adherence, particularly with weekly paclitaxel regimens. Currently, no validated preventive strategy exists. Regional limb cryotherapy may reduce drug delivery to peripheral nerves through transient vasoconstriction, thereby mitigating neurotoxicity. We prospectively evaluated the efficacy of limb cryotherapy in preventing PIPN. Methods: This prospective, self-controlled study enrolled 30 patients receiving weekly paclitaxel (80 mg/m² for 12 weeks) for breast cancer. Cryotherapy using pre-cooled gel mittens and socks was applied unilaterally (intervention side) for 15 minutes before, during, and 15 minutes after each paclitaxel infusion; the contralateral limb served as control. Neuropathy assessments were performed at baseline, week 6, and week 12 using objective neurological tests (vibration sense, monofilament testing, thermo-sensory assessment, and manipulative dexterity) and patient-reported outcomes using the EORTC QLQ-CIPN20 questionnaire. Comparisons between intervention and control sides were analyzed using the Wilcoxon signed-rank test. Results: All patients completed planned chemotherapy without cryotherapy-related discontinuation. At week 12, the cryotherapy-treated limbs demonstrated significantly lower neuropathy burden compared with control limbs. Median EORTC QLQ-CIPN20 scores were significantly lower on the intervention side (27.0 vs 29.5; p < 0.001), indicating better quality of life. Preservation of vibration sense, monofilament sensation, thermo-sensory function, and manipulative dexterity was significantly greater in cryotherapy-treated limbs (p ≤ 0.025 for key sensory endpoints). No significant motor deficits were observed in either arm. Conclusions: Limb cryotherapy significantly reduced the severity of paclitaxel-induced peripheral neuropathy and preserved quality of life in this prospective self-controlled study. This low-cost, well-tolerated intervention may represent a feasible preventive strategy for PIPN, particularly in resource-constrained settings. Larger randomized trials are warranted to confirm these findings and define its role in routine clinical practice. Keywords Paclitaxel, chemotherapy-induced peripheral neuropathy, cryotherapy, quality of life, supportive care.