- Chemotherapy-induced neuropathy (CIPN) is a serious clinical problem caused by a substantial number of cytotoxic drugs, including taxanes, platinums, vinca alkaloids, epothilones, eribulin, and bortezomib.
- No agents are recommended for the prevention of CIPN.
- Duloxetine is the only agent that has appropriate evidence to support its use, but the amount of benefit from duloxetine is limited.
- Therefore, prevention and minimizing risk are the primary objectives.
- Because patients with CIPN can have balance troubles and a higher chance of falling, it is reasonable to consider physical and/or occupational therapy approaches for patients with such CIPN-related disabilities.
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 neuropathy. (Moderate Recommendation; IC-B-L)
- Clinicians should not offer, and should discourage use of, acetyl-L-carnitine for the prevention of CIPN in cancer patients. (Strong Recommendation; EB-H-H)
- Outside the context of a clinical trial, no recommendations can be made on the use of the following interventions for the prevention of CIPN:
- Compression therapy
- Exercise therapy
- Ganglioside-monosialic acid (GM-1)
Note: While preliminary evidence suggests a potential for benefit from these interventions, larger sample-sized definitive studies are needed to confirm efficacy and clarify risks.
- Clinicians should NOT offer the following agents for the prevention of CIPN to cancer patients undergoing treatment with neurotoxic agents:
- All-trans retinoic acid
- Calcium magnesium
- Diethyldithio-carbamate (DDTC)
- Glutathione (GSH) for patients receiving paclitaxel/carboplatin chemotherapy
- Goshajinkigan (GJG)
- Omega-3 fatty acids
- Org 2766
- Vitamin B
- Vitamin E