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 and were updated in 2020. [1, 2] The ONS reaffirmed its 2007 guidelines in 2014. [3]
ASCO Recommendations
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.
ONS Recommendations
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
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.