Clinical Observations for the Treatment of Albumin-bound Paclitaxel-related Peripheral Neurotoxicity by Combined Internal-external Therapy

Abstract Aim: This retrospective study aimed to observe the therapeutic efficacy (both immediate and sustained) and safety of Shi Xuan acupoint bloodletting combined with oral Chinese herbal medicine therapy (SXAB-OCHM therapy) for the treatment of Albumin-bound Paclitaxel-related peripheral neurotoxicity (APPN) and to evaluate an effective method for the treatment of APPN. Methods 1. Clinical treatment: The patients who received the SXAB-OCHM therapy were scored immediately after bloodletting and followed up between 7-14 days. Sustained efficacies were observed and recorded. 2. Assessment methods: The European Organization for Research and Treatment of Cancer on Quality-of-Life Questionnaire of Chemotherapy-induced Peripheral Neuropathy 20 Scale (EORTC QLQ-CIPN 20) and Peripheral Neuropathy Grading Scale ( National Cancer Institute on Common Terminology Criteria Adverse Events [NCI-CTCAE]) (version: 5.0) were used to assess the conditions of the patients. Symptoms of numbness and acmesthesia were observed and recorded before and after treatment based on the above scales; the score range of both scales was 0-10, with 0 being ‘no symptom at all’ and 10 being ‘the worst status that the patients could imagine for a particular symptom’.[A2] Self-scored based on patient reporting was performed, with decreasing scores indicating efficacious treatment. 3. Statistical methods: A questionnaire survey using The Impact of APPN symptoms on Quality of Life (QOL), was conducted on the Sojump platform (https://www.wjx.cn). SPSS software (version: 16.0) was used for descriptive statistical analysis. Indicators were used to assess the APPN symptoms, including immediate efficacy, degree of peripheral nerve injury, impact on daily life, and general condition of patients. Enumeration data were analyzed using the Pearson's X 2 test and P<0.05 was considered as a statistically significant difference between the bloodletting group and the non-bloodletting groups. In addition, the non-parametric test (rank-sum test) was used for comparisons within the group. Results: The immediate efficacy and the sustained efficacy rates of SXAB-OCHM therapy were 70.45% and 72.7%, respectively, for the patients in this study; no other adverse events were recorded. The immediate or sustained efficacious rate was 100% for patients who received SXAB-OCHM therapy with Modified Huangqi Guizhi Wuwu Decoction (MHGW Decoction), while inefficacious results were observed for 13.3% of patients who received SXAB-OCHM therapy without MHGW Decoction reported, which suggested that MHGW Decoction could relieve the symptoms and increase the therapeutic efficacy. However, the P-value for the chi-square test was >0.05[A3] . This observation was not statistically significant, which may be due to the small sample size. Conclusion: The immediate efficacy and the sustained efficacy rates of SXAB-OCHM therapy alone were 70.45% and 72.7%, respectively. Moreover, the immediate or sustained efficacious rate was 100% in patients who received SXAB-OCHM therapy with MHGW Decoction. Overall, this study provided new insight for the treatment of APPN symptoms.