Prevention and treatment of chemotherapy-induced peripheral neuropathy

• Published in: American journal of health-system pharmacy 2014-01, Vol.71 (1), p.19-25
• Main Authors: PICCOLO, JENNIFER, KOLESAR, JILL M
• Format: Article
• Language: English
• Subjects: Antidepressive Agents - therapeutic use; Antineoplastic Agents - adverse effects; Biological and medical sciences; Calcium - therapeutic use; Cancer; Care and treatment; Chemotherapy; Complications and side effects; Drug toxicity and drugs side effects treatment; Humans; Magnesium - therapeutic use; Medical sciences; Neuroprotective Agents - therapeutic use; Neurotransmitter Uptake Inhibitors - therapeutic use; Peripheral Nervous System Diseases - chemically induced; Peripheral Nervous System Diseases - prevention & control; Pharmacology. Drug treatments; Polyneuropathies; Prevention; Toxicity: nervous system and muscle
• ISSN: 1079-2082; 1535-2900
• DOI: 10.2146/ajhp130126

PURPOSEThe prevention and treatment of chemotherapy-induced peripheral neuropathy (CIPN) are reviewed. SUMMARYA number of agents, including amifostine, glutathione, and vitamin E, were evaluated as prevention strategies for CIPN, with no agent demonstrating efficacy. Calcium and magnesium are effective for the prevention of CIPN; however, concerns regarding reduced chemotherapy efficacy linger. Venlafaxine, a serotonin–norepinephrine reuptake inhibitor (SNRI), was evaluated for the prevention of neuropathy in a randomized, double-blind, placebo-controlled Phase III trial of patients receiving an oxaliplatin-based regimens every two weeks and demonstrated significantly less acute neurotoxicity compared with the control group. Treatment options for CIPN include reducing the dosage of the chemotherapy, changing the chemotherapy, and treating CIPN with adjunct therapy. Adjunct therapy with topical agents, tricyclic antidepressants, and anticonvulsants, such as pregabalin and gabapentin, have shown limited efficacy. However, a randomized, double-blind, crossover, Phase III trial of duloxetine versus placebo for the treatment of CIPN caused by paclitaxel or oxaliplatin found that patients treated with duloxetine 60 mg daily had a larger average decrease in pain score than those receiving placebo, regardless of the chemotherapy used. CONCLUSIONCalcium and magnesium infusions and venlafaxine are effective in preventing CIPN but are not routinely used because of concerns related to decreased chemotherapy efficacy. Adjunct treatment options for CIPN include a topical analgesic, a tricyclic antidepressant, an anticonvulsant, or an SNRI. Duloxetine is more effective than placebo in treating oxaliplatin- or paclitaxel-induced CIPN, is well tolerated, and should be considered to be a first-line treatment option for CIPN.