Frozen gloves or tight surgical gloves offered during every weekly taxane infusion

The positive trial. POLAR randomised 122 women with early breast cancer receiving weekly paclitaxel or nab-paclitaxel to cooling (a frozen glove) or compression (two surgical gloves one size smaller than a tight fit) of the dominant hand, 30 minutes before, during and after each infusion, with the other hand left untreated as the control; 101 were analysed. Grade 2 or higher sensory neuropathy occurred in 29 per cent of cooled hands against 50 per cent of untreated hands, and in 24 per cent of compressed hands against 38 per cent. Neuropathy was the main reason for stopping treatment in 16 of the 24 who stopped.

The trial that did not reach its target. CryoPac randomised 268 patients receiving taxanes to frozen gloves and socks at every infusion or to usual care; 217 were analysed. Neuropathy on the Total Neuropathy Score at the end of treatment was 74 per cent with cryotherapy and 84 per cent with usual care (P = .071), so the primary endpoint was not met. Patient-reported tingling and numbness in the hands, numbness in the feet and trouble handling small objects were all lower with cryotherapy, there was no difference in grade 2 or higher neuropathy by the clinician scale, and compliance with the gloves and socks was 67 per cent. A smaller self-controlled study (Hanai, 2018) also favoured frozen gloves and socks on the treated side.

Where guidance stands. The 2020 ASCO guideline on chemotherapy nerve damage states that no agents are recommended for prevention; it was written before both randomised trials above. Adoption has not been measured. The harms reported are discomfort and the risk of cold injury with prolonged contact, and the trials enrolled patients on taxanes only, so the result does not transfer to other drugs that damage nerves.