Table 5.
Current evidence for recommended treatment for painful chemotherapy-induced peripheral neuropathy [232, 235, 261, 371–375]
| Treatment | Author and study design | Number of patients | Antineoplastic agent | Study outcome | Guideline |
|---|---|---|---|---|---|
| Duloxetine | Yang et al. 2012 [291]: Open-label pilot study | 30 | Oxaliplatin | OIPN improved in 47.4% of participants by one grade, with 62.6% maintaining on a steady grade | ASCO, ONS, NCI |
| Smith et al. 2013 [290]: Randomised, placebo-controlled, double-blind, phase III crossover trial | 141 | Paclitaxel, oxaliplatin | Duloxetine statistically significantly reduced average pain score after 5 weeks compared to placebo (1.06 [95% CI, 0.72–1.40] vs 0.34 [95% CI, 0.01–0.66]; p = 0.003) | ||
| Hirayama et al. 2015 [292]: Randomised, vitamin B12-controlled, open-label crossover pilot trial | 32 | Oxaliplatin, paclitaxel, vincristine and bortezomib | Duloxetine changed pain scores pain (p = 0.04) and numbness (p = 0.03) compared to placebo | ||
| Otake et al. 2015 [376]: Retrospective cohort study | 25 | Paclitaxel, carboplatin, epirubicin | Duloxetine improved CIPN symptoms in 56% of participants | ||
| Farshchian et al. 2018 [294]: Randomised, placebo-controlled, double-blind trial | 156 | Taxane and platinum | Both duloxetine and venlafaxine reduced neuropathic pain and CIPN grade at week 4 compared to controls (p < 0.05). Duloxetine was more effective compared to venlafaxine (p < 0.05) | ||
| Anti-depressants | Kus et al. 2016 [296]: Retrospective case–control study | 199 | Taxanes, platinums | An improvement of 75% in pain score was reported in 53.5%, 58.3% and 45.2% in the first three visits compared to 0% in the control group (p < 0.001) | ESMO, NCCN |
|
Özdoǧan et al. 2004 [377]: Pilot study |
12 | Platinums, vinca alkaloids, 5-FU, etoposide | Reduced pain scores were statistically significant compared to baseline (p ≤ 0.001). Increase in drowsiness reported (p = 0.041) | ||
| Durand et al. 2005 [378]: Case study | 2 | Oxaliplatin | Anecdotal functional improvements reported | ||
| Durand et al. 2012 [295]: Randomised, double-blind, placebo-controlled phase III trial | 42 | Oxaliplatin | Pain relief reported at a higher frequency in participants treated with venlafaxine compared to controls (31.3% vs 5.3%; p = 0.03) | ||
| Hammack et al. 2002 [284]: Randomised, double-blind, placebo-controlled, crossover trial | 51 | Cisplatin | No significant impact on CiSPN pain or paraesthesia severity from baseline | ||
| Kautio et al. 2008 [285]: Randomised, double-blind, placebo-controlled trial | 33 | Vinca alkaloids, platinums and taxanes | No significant impact on CIPN pain | ||
| Gabapentinoids | Mishra et al. 2012 [279]: Prospective, randomised, double-blind, placebo-controlled trial | 120 | - | Number of participants requiring morphine was significantly lower in the amitriptyline, gabapentin and pregabalin treatment groups compared to placebo (56.7%, 33.3% and 16.7% vs 100%). Pregabalin appeared to outperform gabapentin in reducing lancinating pain (p = 0.026) and dysaesthesia (p = 0.021) | ESMO, ASCO, NCCN |
| Rao et al. 2007 [282]: Randomised, double-blind, placebo-controlled, crossover, phase III trial | 84 | Paclitaxel, docetaxel, carboplatin, cisplatin, oxaliplatin, vincristine or vinblastine | No benefit identified in reducing pain scores in participants with CIPN | ||
| Tsavaris et al. 2008 [280]: Pilot study | 110 | Docetaxel, paclitaxel, vinorelbine, oxaliplatin, | Approximately half of participants had no response to gabapentin therapy, whilst the other half had a decrease in chemotherapy dose self-reported to be managed by gabapentin pharmacotherapy | ||
| Magnowska et al. 2018 [281]: Prospective study | 61 | Paclitaxel, carboplatin | Participants receiving gabapentin report improved symptoms (p = 0.027), pain (p = 0.027 and neurological deficit (p = 0.019) | ||
| Saif et al. 2010 [379]: Prospective study | 23 | Pregabalin pharmacotherapy improved OIPN severity by 1–2 grades in 48% of participants | |||
| Opioids | Cartoni et al. 2012 [277]: Pilot study | 46 | Bortezomib | Reduction in the intensity and frequency of pain reported in 47.8% of participants after 2 weeks compared to baseline (mean numeric rating scale = 3.65; p < 0.01) | ESMO, NCCN |
| Kim et al. 2018 (276): Multicentre, interventional, single-arm phase IV study | 66 | Taxanes, epothilones platinums, bortezomib, thalidomide, vinca alkaloid | A 21.4% reduction in pain score in participants at week 4 (1.29 ± 1.84; p < 0.0001 |
ASCO American Society of Clinical Oncology, ESMO European Society for Medical Oncology, ONS Oncology Nursing Society, NCI National Cancer Institute, NCCN National Comprehensive Cancer Network