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Published by American Society of Clinical Oncology · ASCO standard criteria (Type and Strength of recommendation, Evidence quality)
Chemotherapy-induced neuropathy is a serious clinical problem caused by cytotoxic drugs like taxanes and platinums. Symptoms can acute or chronic, causing marked effects on the quality of life and potentially limiting cancer treatments.
Key Takeaways
The updated guideline no longer provides promising commentary regarding venlafaxine as a preventative agent due to longer follow-up data. Acetyl-L-carnitine is now explicitly recommended against for the treatment of established chemotherapy-induced neuropathy. There is also waning enthusiasm for tricyclic antidepressants, gabapentinoids, and a topical gel treatment containing baclofen, amitriptyline, and ketamine due to a lack of new supporting data or negative trial results.
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 peripheral 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).
Clinicians 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, Vitamin E.
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.
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, Oral cannabinoids.
Clinical Topic
Chemotherapy-Induced Peripheral Neuropathy
Objectives
To update the ASCO guideline on the recommended prevention and treatment approaches in the management of chemotherapy-induced peripheral neuropathy (CIPN) in adult cancer survivors.
Target Patient Population
Adult cancer survivors with, or at risk for developing, chemotherapy-induced neuropathies
Diagnostic Criteria
Diagnosis generally made by clinical history (new or worsening numbness, tingling, and/or pain in hands and/or feet in patients receiving neurotoxic chemotherapy without other reason).
Target Providers
Therapeutic Area
OncologyGuideline Scope
Inclusion Criteria
Exclusion Criteria
Special Populations
System: ASCO standard criteria (Type and Strength of recommendation, Evidence quality)
Contraindications
Monitoring Guidance
Neurologic physical examinations can be used. Neurologic tests like electromyography (EMG) are not usually necessary but can be used.
Difficulty
advanced
Learning Paths