Therapy for Chemotherapy-Induced Peripheral Neuropathy

ArticleinJAMA The Journal of the American Medical Association 310(5):537 · August 2013with6 Reads
DOI: 10.1001/jama.2013.7902
To the Editor Dr Smith and colleagues1 concluded that “among patients with painful chemotherapy-induced peripheral neuropathy, the use of duloxetine compared with placebo for 5 weeks resulted in a greater reduction in pain.”The overall strength of effect underpinning this conclusion, however, is relatively small, despite reaching statistical significance. The authors most clearly demonstrated this in Figure 2 in the article, which shows closely approximated or overlapping confidence intervals in both the initial and crossover treatment periods.
  • [Show abstract] [Hide abstract] ABSTRACT: The antiepileptic agent, gabapentin, has been demonstrated to relieve symptoms of peripheral neuropathy due to various etiologies. On the basis of these data, a multicenter, double-blind, placebo-controlled, crossover, randomized trial was conducted to evaluate the effect of gabapentin on symptoms of chemotherapy-induced peripheral neuropathy (CIPN). Patients with symptomatic CIPN who complained of 'average' daily pain scores of either 1) >/=4 on a 0-10 numerical rating scale (NRS); or 2) >/=1 on the 0-3 Eastern Cooperative Oncology Group neuropathy scale (ENS) were eligible (higher numbers indicate greater severity of symptoms in both scales). Patients were randomized to receive gabapentin (target dose, 2700 mg) or placebo for 6 weeks. Crossover occurred after a 2-week washout period. CIPN-related symptoms were evaluated weekly by questionnaires. Statistical methods followed established methods for crossover designs, including Student t tests to compare average intrapatient differences between treatments and linear models to adjust for potential concomitant covariates. There were 115 patients who were randomly assigned to the treatment or control arm. Both groups were well matched by symptoms at study entry. Changes in symptom severity were statistically similar between the 2 groups during the study. Adverse events were mild and similar in both groups. This trial failed to demonstrate any benefit to using gabapentin to treat symptoms caused by CIPN.
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  • [Show abstract] [Hide abstract] ABSTRACT: According to the Chinese, European, Iranian and Indian traditional medicines, oleo gum resin of Ferula assa-foetida (asafoetida) has therapeutic effects on different kinds of diseases. Some of these effects are related to the diseases of nervous system such as hysteresis and convulsion. In recent studies, some anti-epileptic and neuroprotective roles were also considered for it and we examined its possible role on treatment of peripheral neuropathy. In vitro studies were carried out to identify the response of isolated sciatic nerves to different concentrations of oleo gum resin of asafoetida solved in Lock's solution. Then, in vivo studies were conducted to evaluate its effect on amelioration of peripheral neuropathy in mice. Peripheral neuropathy was induced by intraperiotoneal injection of high doses of pyridoxine in adult Balb/c male mice. Tail flick tests were performed to identify the incidence of neuropathy in animals. After 10 days treatment with asafetida, the efficiency of treatment was assessed by behavioral, electrophysiological and histological studies. In vitro experiments confirmed that incubating the nerves in aqueous extract of oleo gum rein of asafoetida increased the amplitude and decreased the latent period of nerve compound action potential (CAP). Nerve conduction velocity (NCV) and amplitude of CAP also improved in asafoetida treated animals. Histological and behavioral studies showed that asafoetida was able to facilitate the healing process in peripheral nerves. In vitro experiments showed that asafoetida is a nerve stimulant and its administration in neuropathic mice exerted neuroprotecting effects through stimulating axonal regeneration and remyelination and decrement of lymphocyte infiltration.
    Article · Apr 2014
  • [Show abstract] [Hide abstract] ABSTRACT: Purpose We investigated how treatment-induced neuropathic symptoms are associated with patients' quality of life (QOL) and clinician-reported difficulty in caring for patients. Methods Data were obtained from 3,106 outpatients with colorectal, breast, lung, or prostate cancer on numbness/ tingling (N/T), neuropathic pain, and QOL. Clinicians report-ed the degree of difficulty in caring for patients' physical and psychological symptoms. Results For all patients, moderate to severe N/T was associat-ed with poor QOL (OR=1.82, 95 % CI=1.47–2.26, P<0.001) but neuropathic pain was not (OR=1.31, 95 % CI=0.94–1.83, P=0.114). Moderate to severe N/T and neuropathic pain were associated with increased care difficulty (OR=1.49, 95 % CI= 1.27–1.74, P<0.001 for N/T, and OR=1.46, 95 % CI=1.15– 1.84, P=0.002 for neuropathic pain). The association of neu-ropathic pain with care difficulty was most significant in patients with colorectal cancer (CRC) (OR=2.32, 95 % CI= 1.41–3.83, P = 0.001). Baseline neuropathic pain was associated with declining QOL in CRC patients (OR=2.08, 95 % CI=1.21–3.58, P=0.008). Conclusions Clinicians may experience increased care diffi-culty for patients of all cancer types with moderate to severe N/T or neuropathic pain; care difficulty due to neuropathic pain may be higher for CRC patients. Nearly half the patients of all cancer types with moderate to severe N/T may expect poor short-term QOL; CRC—but not other—patients with baseline neuropathic pain are likely to experience declining QOL. Implications for Cancer Survivors About half of patients with moderate to severe N/T (any cancer type) may expect poor QOL in the short term; CRC patients with baseline neuropath-ic pain in particular may experience declining QOL.
    Full-text · Article · Jul 2014