A large group of clinical experts working in facilities across the United States conducted a systematic literature review of evidence-based prevention and treatment approaches for the management of chemotherapy-induced peripheral neuropathies (CIPN). Their goal was to develop an evidence-based American Society of Clinical Oncology clinical practice guideline.
A search of randomized clinical trials of adult patients found 48 that met eligibility criteria. Most studies were small and heterogeneous, and many had insufficient sample sizes to detect clinically significant differences in outcomes. Primary outcomes varied across the trials, and many studies were not directly comparable because of different outcomes, measurements, and instruments that were used at different time points.
Because of the lack of high-quality consistent evidence, the group could not recommend any agents for the prevention of CIPN. The best available data support a moderate recommendation of treatment of existing CIPN with duloxetine. CIPN trials are inconclusive about the effectiveness of tricyclic antidepressants (such as nortriptyline), gabapentin, and a compounded topical gel containing baclofen, amitriptyline HCL, and ketamine in treating CIPN; however, the group noted that these agents may be offered on the basis of data supporting their utility in other neuropathic pain conditions and recommended further research on using these agents to treat CIPN.
Hershman DL, Lacchetti C, Dworking DH, et al. Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol, published online before print April 14, 2014, doi: 10.1200/JCO.2013.54.0914.