Affiliation:
1. 1Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 2 Pusan National University, Pusan, S. Korea
Abstract
Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a commonly encountered
disease entity following chemotherapy for cancer treatment. Although only duloxetine is
recommended by the American Society of Clinical Oncology (ASCO) for the treatment of CIPN in
2014, the evidence of the clinical outcome for new pharmaceutic therapies and non-pharmaceutic
treatments has not been clearly determined.
Objective: To provide a comprehensive review and evidence-based recommendations on the
treatment of CIPN.
Study Design: A systematic review of each treatment regimen in patients with CIPN.
Methods: The literature on the treatment of CIPN published from 1990 to 2017 was searched and
reviewed. The 2011 American Academy of Neurology Clinical Practice Guidelines Process Manual
was used to grade the evidence and risk of bias. We reviewed and updated the recommendations
of the ASCO in 2014, and evaluated new approaches for treating CIPN.
Results: A total of 26 treatment options in 35 studies were identified. Among these, 7 successful
RCTs, 6 failed RCTs, 18 prospective studies, and 4 retrospective studies were included. The included
studies examined not only pharmacologic therapy but also other modalities, including laser therapy,
scrambler therapy, magnetic field therapy and acupuncture, etc. Most of the included studies had
small sample sizes, and short follow-up periods. Primary outcome measures were highly variable
across the included studies. No studies were prematurely closed owing to its adverse effects.
Limitations: The limitations of this systematic review included relatively poor homogeneous,
with variations in timing of treatment, primary outcomes, and chemotherapeutic agents used.
Conclusion: The evidence is considered of moderate benefit for duloxetine. Photobiomodulation,
known as low level laser therapy, is considered of moderate benefit based on the evidence
review. Evidence did not support the use of lamotrigine and topical KA (4% ketamine and 2%
amitriptyline). The evidence for tricyclic antidepressants was inconclusive as amitriptyline showed
no benefit but nortriptyline had insufficient evidence. Further research on CIPN treatment is
needed with larger sample sizes, long-term follow-up, standardized outcome measurements, and
standardized treatment timing.
Key words: Chemotherapy-induced neuropathy, peripheral neuropathy, chemotherapy-tumor,
neuropathic pain, chronic pain, toxicology, treatment, reduction of pain, level of evidence.
Publisher
American Society of Interventional Pain Physicians
Subject
Anesthesiology and Pain Medicine
Cited by
13 articles.
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