American Society of Clinical Oncology
Prevention And Management Of Chemotherapy-Induced Peripheral Neuropathy In Survivors Of Adult Cancers
This guideline holds 7 recommendations, 86 references and 3 tables.
Summary
Chemotherapy-induced neuropathy is a serious clinical problem caused by cytotoxic drugs like taxanes and platinums. Symptoms can acute or chronic, causing marked effects on the quality of life and potentially limiting cancer treatments.
Key takeaways
No agents are recommended for the prevention of CIPN.
Acetyl-L-carnitine use is discouraged for CIPN prevention.
Clinicians should assess whether to delay, reduce, substitute, or stop chemotherapy for patients developing intolerable neuropathy.
Duloxetine is the only agent with appropriate evidence recommended for treating established painful CIPN.
What is new in this version
The updated guideline no longer provides promising commentary regarding venlafaxine as a preventative agent due to longer follow-up data. Acetyl-L-carnitine is now explicitly recommended against for the treatment of established chemotherapy-induced neuropathy. There is also waning enthusiasm for tricyclic antidepressants, gabapentinoids, and a topical gel treatment containing baclofen, amitriptyline, and ketamine due to a lack of new supporting data or negative trial results.
Recommendations
Prevention of chemotherapy-induced peripheral neuropathy
Clinicians should assess the risks and benefits of agents known to cause CIPN among patients with underlying neuropathy and with conditions that predispose to neuropathy such as diabetes and/or a family or personal history of hereditary peripheral neuropathy.
Population: Patients with underlying neuropathy and with conditions that predispose to neuropathyWhen: Chemotherapy-Induced Peripheral Neuropathy (CIPN)
Clinicians should not offer, and should discourage use of, acetyl-L-carnitine for the prevention of CIPN in patients with cancer.
Population: Patients with cancerWhen: Chemotherapy-Induced Peripheral Neuropathy (CIPN)
Outside the context of a clinical trial, no recommendations can be made on the use of the following interventions for the prevention of CIPN: Acupuncture, Cryotherapy, Compression therapy, Exercise therapy, Ganglioside-monosialic acid (GM-1).
Population: Patients with cancerWhen: Chemotherapy-Induced Peripheral Neuropathy (CIPN)
Clinicians should not offer the following agents for the prevention of CIPN to patients with cancer undergoing treatment with neurotoxic agents: 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.
Population: Patients with cancer undergoing treatment with neurotoxic agentsWhen: Chemotherapy-Induced Peripheral Neuropathy (CIPN)
Treatment of chemotherapy-induced peripheral neuropathy that develops while patients are receiving neurotoxic chemotherapy
Clinicians should assess, and discuss with patients, the appropriateness of dose delaying, dose reduction, or stopping chemotherapy (or substituting with agents that do not cause CIPN) in patients who develop intolerable neuropathy and/or functional nerve impairment.
Population: Patients receiving neurotoxic chemotherapy who develop intolerable neuropathy and/or functional nerve impairmentWhen: Chemotherapy-Induced Peripheral Neuropathy (CIPN)
Treatment of chemotherapy-induced peripheral neuropathy for patients who have completed neurotoxic chemotherapy
For patients with cancer experiencing painful CIPN, clinicians may offer duloxetine.
Population: Patients with cancer experiencing painful CIPNWhen: Chemotherapy-Induced Peripheral Neuropathy (CIPN)
Outside the context of a clinical trial, no recommendations can be made on the use of the following interventions 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.
Population: Patients with cancerWhen: Chemotherapy-Induced Peripheral Neuropathy (CIPN)
