R. Fernandes, S. Mazzarello, A. A. Joy, G. R. Pond, J. Hilton, M. F. K. Ibrahim, C. Canil, M. Ong, C. Stober, L. Vandermeer, B. Hutton, M. da Costa, S. Damaraju6 & Mark Clemons. Supportive Care in Cancer

Main findings

• TAPS is typically reported as the presence of both myalgias and arthralgias, starting 2–3 days after taxane infusion and lasting for 5–7 days. TAPS remains an important therapeutic challenge as it can interfere with activities of daily living, decrease quality of life, as well as lead to chemotherapy dose reductions, delays, and discontinuation.
• The incidence of TAPS varies not only between taxanes but also differs with specific patient populations.
• Overall, TAPS was observed to occur in 33/ 69 (44%) patients at any time on study, and 23 (30%) of these patients had repeated occurrence of TAPS after multiple infusions.
• Among the 25 patients observed to have TAPS after their first taxane infusion, 5 (20%) patients had symptoms which last for 3 days or less, 7 (28%) patients had symptoms which last 4– 5 days, while 13 (52%) had symptoms which last for >5 days. The most common pain interventions for patients with TAPS were acetaminophen (n=15, 60%), NSAIDs (n=5, 20%), codeine (n=2, 8%), and morphine (n=2,8%).Itis important to note that five (20%) patients required multiple analgesics. Six patients (24%) required no pain intervention.
• No baseline factor was significantly prognostic for the development of TAPS following infusion 1 or for the development of TAPS at anytime in any univariable model
• Patients with TAPS after the first chemotherapy infusion had significantly lower quality of life scores.
• There were no chemotherapy dose reductions, delays, or treatment discontinuation required due to TAPS toxicity.
• From a clinical perspective, TAPS is common. It is typically described as a diffuse aching discomfort beginning 2–3 days after the taxane infusion and lasting for 3–5 days. However, its incidence, management, consequences, and treatment are poorly reported in the literature. This contrast between clinical practice and the literature is likely due to a number of factors including different types of taxane, doses, schedules, and chemotherapy combinations, as well as differences in sex, metabolism, and concurrent agents such as corticosteroids and G-CSF use. In addition, tools that are validated for evaluating chemotherapy-induced peripheral neuropathy (CIPN) have been reported as being at the same time as TAPS. While TAPS may predispose to the subsequent risk of CIPN, TAPS typically resolves completely prior to the next cycle of chemotherapy. Whatever the cause of the variable incidence and severity of TAPS, it has been the lack of a validated tool to measure TAPS that has proved particularly challenging.
• There are some limitations to the study. First, the presence of both arthralgias and myalgias as used as the defining tool for the presence of TAPS.
• There were differences in the way chemotherapy is given, for example, patients receiving docetaxel had chemotherapy every 3 weeks, while patients receiving paclitaxel were frequently treated on weekly or 2-weekly cycles. As a result, the number of questionnaires completed varied upon the chemotherapy regimens used.
• TAPS remains an important, relatively poorly researched and challenging issue for cancer patients with a negative impact on quality of life. The current study confirms that not only is TAPS common, but once a patient has TAPS they are likely, irrespective of treatment, to develop TAPS in subsequent chemotherapy cycles.