From the Guidelines
Duloxetine is the most effective treatment for neuropathic pain caused by cisplatin chemotherapy, with a recommended dose of 30 mg/day for 1 week, then 60 mg/day. This is based on the highest quality evidence from recent studies, including a large randomized trial showing a moderate clinical benefit in patients with painful chemotherapy-induced peripheral neuropathy (CIPN) 1. The effect of duloxetine treatment has been shown to be more pronounced in CIPN due to platinum-based therapies, such as cisplatin, than in taxanes.
Some key points to consider when treating neuropathic pain caused by cisplatin chemotherapy include:
- Duloxetine has the strongest evidence for efficacy in treating CIPN, with a level I recommendation 1
- Other options, such as venlafaxine, pregabalin, and tricyclic antidepressants, may be considered for patients who do not respond to duloxetine, but have less robust evidence supporting their use 1
- Topical treatments, such as low-concentration menthol cream, may provide localized relief with minimal systemic effects 1
- Opioids may be used as a salvage option, but have limited evidence supporting their use specifically for CIPN 1
It is essential to individualize treatment based on pain severity, other medications, and patient-specific factors, and to monitor patients closely for efficacy and potential side effects. Early pain management is crucial, and treatment should be initiated as soon as possible to reduce the risk of chronic neuropathic pain.
From the Research
Treatment Options for Neuropathy Caused by Cis-Platinum
- The most frequently suggested drugs for neuropathic pain are amitriptyline, duloxetine, gabapentin, and pregabalin 2.
- First-line drugs proposed for neuropathic pain include tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, pregabalin, and gabapentin 3.
- Duloxetine was found effective in a single phase III intervention study for symptomatic treatment of platinum-induced peripheral neurotoxicity (PIPN) 4.
- Gabapentinoids, such as gabapentin and pregabalin, target the voltage-dependent calcium channels α2δ-1 subunit, inhibiting calcium currents and decreasing excitatory transmitter release and spinal sensitization 5.
Specific Considerations for Cis-Platinum Induced Neuropathy
- Platinum-induced peripheral neurotoxicity (PIPN) is a common side effect of platinum-based chemotherapy, and cisplatin can cause ototoxicity, particularly in children 4.
- There are currently no neuroprotective strategies to reduce the risk of PIPN, and symptomatic treatment is limited 4.
- Duloxetine is a recommended treatment for PIPN, but other options such as gabapentin and pregabalin may also be considered based on their efficacy in treating neuropathic pain 2, 3, 5, 6.