Chemotherapy-induced Peripheral Neuropathy Guidelines 

Updated: Jul 27, 2017
  • Author: Alexandre Chan, PharmD, MPH, FCCP, BCPS, BCOP; more...
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Issuing Organizations

The following organizations have released guidelines for the management of chemotherapy-induced peripheral neuropathy (CIPN) in oncology patients:

  • American Society of Clinical Oncology (ASCO)
  • Oncology Nursing Society (ONS)

The ASCO guidelines were first published in 2014. [1] The ONS reaffirmed its 2007 guidelines in 2014. [2]

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ASCO Recommendations

Prevention

Due to lack of high-quality, consistent evidence, the ASCO guidelines do not recommend any agents for use in prevention of CIPN. The guidelines further specify that the following agents should not be offered for the prevention of CIPN due to the lack of benefits and possible risk of causing harm [1] :

  • Acetyl-L-carnitine
  • Amifostine
  • Amitriptyline
  • Calcium and magnesium for patients receiving oxaliplatin-based chemotherapy
  • Diethyldithio-carbamate
  • Glutathione for patients receiving paclitaxel/carboplatin chemotherapy
  • Nimodipine
  • Org 2766
  • Retinoic acid
  • Recombinant human leukemia inhibitory factor (rhuLIF)
  • Vitamin E

Although the available data support potential utility for venlafaxine, ASCO would require additional supporting data before recommending venlafaxine for preventing CPIN.

Due to inconclusive evidence, with limited studies showing neither substantial benefit nor substantial harm, ASCO could not make recommendations on the use of the following:

  • N-acetylcysteine
  • Carbamazepine/oxycarbazepine
  • Glutamate
  • Glutathione for patients receiving cisplatin or oxaliplatin-based chemotherapy
  • Goshajinkigan
  • Omega-3 fatty acids

Treatment

The ASCO guidelines recommend duloxetine to treat CIPN, based on efficacy data from a large randomized placebo-controlled trial. The guidelines, however, recommend against the use of lamotrigine.

No recommendation could be made on the use of tricyclic antidepressants, gabapentin, and a topical gel treatment containing baclofen, amitriptyline, and ketamine, although the guidelines consider it reasonable to try them after discussion with patients about the following [1] :

  • Limited evidence of efficacy
  • Potential harms and benefits
  • Cost
  • Patient preferences
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ONS Recommendations

The ONS guidelines include the following recommendations for treatment of chemotherapy-induced peripheral neuropathy [2] :

  • Duloxetine is likely to be effective
  • Lamotrigine is unlikely to be effective
  • Carnitine/L-carnitine and human leukemia inhibitory factor are not recommended

In addition, the ONS guidelines note that the effectiveness of the following treatments could not be determined:

  • Acupuncture
  • Alpha lipoic acid
  • Amifostine
  • Amitriptyline
  • Bee venom
  • Calcium and magnesium infusion
  • Calcium channel blockers
  • Cannabis/cannabinoids
  • Carbamazepine
  • Cutaneous stimulation
  • Gabapentin and opioid combination
  • Gabapentin monotherapy
  • Glutamine
  • Glutathione
  • Goshajinkigan
  • KRN5500
  • Nortriptyline
  • Omega-3 fatty acids (eicosapentaenoic acid and others)
  • Palmitoylethanolamide
  • Pregabalin
  • Topical ketamine formulations
  • Venlafaxine
  • Vitamin E
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Summary

Peripheral neuropathy is a common adverse effect of chemotherapy, caused by agents such as paclitaxel, docetaxel, vinorelbine, and vinblastine, among others. Multiple studies and meta-analyses have failed to identify any drug that can prevent chemotherapy-related neuropathy. Duloxetine is the only drug that has demonstrated efficacy for the treatment of chemotherapy-related peripheral neuropathy.

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