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Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology Clinical Practice Guideline
A systematic literature review of randomised 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 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. Recommendations are 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.
Competing interests None.
Provenance and peer review Not commissioned; internally peer reviewed.