Chemotherapy-induced Peripheral Neuropathy Guidelines 

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 and were updated in 2020. ^{[1, 2]} The ONS reaffirmed its 2007 guidelines in 2014. ^[3]

Prevention

Due to lack of high-quality, consistent evidence, the ASCO guidelines do not recommend any agents for prevention of CIPN. The guidelines strongly recommend that clinicians should not offer, and should discourage use of, acetyl-l-carnitine for the prevention of CIPN in patients with cancer. The guidelines also include a moderate recommendation against offering the following agents for the prevention of CIPN ^[2] :

• All-trans retinoic acid
• Amifostine
• Amitriptyline
• Calcium magnesium
• Calmangafodipir
• Cannabinoids
• Carbamazepine
• l-carnosine
• Diethyldithiocarbamate (DDTC)
• Gabapentin/pregabalin
• Glutamate
• Glutathione (GSH) for patients receiving paclitaxel/carboplatin chemotherapy
• Goshajinkigan (GJG)
• Metformin
• Minocycline
• N-acetylcysteine
• Nimodipine
• Omega-3 fatty acids
• Org 2766
• Oxcarbazepine
• Recombinant human leukemia inhibitory factor
• Venlafaxine
• Vitamin B
• Vitamin E

ASCO advises that outside the context of a clinical trial, no recommendations can be made on the use of the following for the prevention of CIPN:

• Acupuncture
• Cryotherapy
• Compression therapy
• Exercise therapy
• Ganglioside-monosialic acid (GM-1)

Treatment

The ASCO guidelines recommend duloxetine to treat painful CIPN. The guidelines advise that outside the context of a clinical trial, no recommendations can be made on the use of the following for the treatment of CIPN:

• Exercise therapy
• Acupuncture
• Scrambler therapy
• Gabapentin/pregabalin
• Topical gel treatment containing baclofen, amitriptyline HCL, plus/minus ketamine
• Tricyclic antidepressants
• Oral cannabinoids

ASCO notes that although preliminary evidence suggests that exercise, acupuncture, and scrambler therapy offer potential benefit, larger sample-sized definitive studies are needed to confirm efficacy and clarify risks.

The ONS guidelines include the following recommendations for treatment of chemotherapy-induced peripheral neuropathy ^[3] :

• 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

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.