Trends in the Treatment of Chemotherapy-Induced Peripheral Neuropathy : PracticeUpdate

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PracticeUpdate: Dr. Loprinzi, please speak about the current treatment regimens for chemotherapy-induced peripheral neuropathy.

Dr. Loprinzi: First, I’ll say a couple of words about something that is obvious to many—chemotherapy-induced neuropathy is a big, big problem; it is one of the more prominent toxicities we have with a number of commonly used chemotherapy agents, such as the platinum agents and taxanes.
Although chemotherapy-induced neuropathy will often get better for many patients after stopping chemotherapy, it won’t for others and, for some, it can become a chronic problem that lasts for years. Mostly, we’re talking about peripheral neuropathy—stocking-and-glove numbness, tingling, with or without pain; occasionally patients can also develop some motor weakness.
We don’t have great ways of preventing the problem. Calcium and magnesium for FOLFOX neuropathy has been most actively used in clinical practice over the past decade; stay tuned for ASCO 2013, because a large trial studying this issue will be presented there, which may set the standard for whether or not this approach should continue to be used in practice.
In terms of treatment of patients with established neuropathy, the most common drugs used in clinical practice over the last decades have been the gabapentinoids—gabapentin and pregabalin. Nonetheless, only one reasonably sized, placebo-controlled, randomized controlled trial has evaluated either of these drugs—that being gabapentin—and results were convincingly negative.¹ However, gabapentinoids are still commonly used in clinical practice. It’s possible that the negative results of the gabapentin trial were just by chance and that gabapentin really does work (since it works for other neuropathy syndromes), or it could be that gabapentin helps some patients and hurts others— resulting, on average, with the trial showing no benefit. It is also possible that pregabalin helps, but this has not been established by clinical trials.........