May 2014
J Clin Oncol. 2014 Apr 14. [Epub ahead of print]
Hershman DL, Lacchetti C, Dworkin RH, Lavoie Smith EM, Bleeker J, Cavaletti G, Chauhan C, Gavin P, Lavino A, Lustberg MB, Paice J, Schneider B, Smith ML, Smith T, Terstriep S, Wagner-Johnston N, Bak K, Loprinzi CL.
A systematic literature review of randomized controlled trials (RCTs) formed the basis of this evidence-based guidance on prevention and treatment of chemotherapy-induced peripheral neuropathies (CIPN) in adult cancer survivors. From the 1252 articles identified, 48 RCTs met the inclusion criteria. Overall they were small with mixed populations, often having insufficient sample sizes to detect differences in outcomes. The risk of bias was low to moderate for all but five of the included trials. Most studies were not directly comparable because of different outcomes, measurements, and instruments used at different time points. From the limited high-quality evidence, there were no recommendations for clinical practice to prevent of CIPN (other than decreasing the causative drug).
Based on the evidence, duloxetine was given a moderate recommendation for the treatment of CIPN. Although there is some evidence for the use of venlafaxine, these were not strong enough to recommend its use. Studies were inconclusive for tricyclic antidepressants, gabapentin, and a topical gel containing baclofen, amitriptyline and ketamine, but based on effectiveness in neuropathic pain due to other aetiologies, the guidance was that these agents could be trialled. Recommendationsare made against several agents for the prevention of CIPN, including amifostine, amitriptyline, nimodipine, retinoic acid and vitamin E; and against the use of lamotrigine for the treatment of CIPN.
Prepared by Jason Boland