ASCO guideline on prevention and management of chemotherapy-induced PN in cancer survivors
USA: The American Society of Clinical Oncology (ASCO) has released an updated guideline on the prevention and management of chemotherapy-induced peripheral neuropathy (CIPN) in survivors of adult cancers. The guideline is published in the Journal of Clinical Oncology.
For developing the guideline, an expert panel led by Charles L. Loprinzi, Mayo Clinic, Rochester, MN, conducted targeted systematic literature reviews to identify new studies.
The search strategy identified 257 new references, which led to a full-text review of 87 manuscripts. A total of 3 systematic reviews, 2 with meta-analyses, and 28 primary trials for the prevention of CIPN in addition to 14 primary trials related to the treatment of established CIPN are included in this update.
The following recommendations are evidence-based, informed by randomized trials, and guided by clinical experience.
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.
- Clinicians should not offer, and should discourage use of, acetyl-l-carnitine for the prevention of CIPN in patients with cancer.
- 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).
- linicians 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, and vitamin E.
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.
Treatment of chemotherapy-induced peripheral neuropathy for patients who have completed neurotoxic chemotherapy
- For patients with cancer experiencing painful CIPN, clinicians may offer duloxetine.
- 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, and oral cannabinoids.
DOI: 10.1200/JCO.20.01399 Journal of Clinical Oncology 38, no. 28 (October 01, 2020) 3325-3348.