From the Guidelines
The management of oxaliplatin-induced peripheral neuropathy primarily involves dose modification, temporary interruption, or discontinuation of oxaliplatin when symptoms become severe, and for symptomatic relief, duloxetine at 30-60 mg daily is the most evidence-supported medication, as recommended by the ASCO guideline update 1. The key considerations in managing oxaliplatin-induced neuropathy include:
- Dose modification or temporary interruption of oxaliplatin for severe symptoms
- Careful monitoring for mild to moderate neuropathy (grade 1-2)
- Prophylactic measures such as calcium and magnesium infusions, although evidence for their effectiveness is mixed
- Symptomatic relief with duloxetine, which has been shown to decrease CIPN pain and non-painful CIPN symptoms 1 Other agents that may be considered for symptomatic relief include:
- Gabapentin, although the evidence for its effectiveness is limited and inconclusive 1
- Pregabalin, which has been shown to be ineffective in preventing CIPN in several randomized placebo-controlled trials 1
- Tricyclic antidepressants like amitriptyline, although their use is not commonly recommended due to lack of established benefit and unfavorable side effects 1 Non-pharmacological approaches such as avoiding cold exposure, wearing gloves, and avoiding cold beverages may also help alleviate symptoms. Regular assessment using validated tools and patient education on the potential for neuropathy are essential components of management. It is essential to prioritize the use of duloxetine, as it is the most evidence-supported medication for symptomatic relief, and to consider the potential benefits and limitations of other agents and non-pharmacological approaches in the context of individual patient needs and preferences.
From the FDA Drug Label
Oxaliplatin can cause acute and delayed neuropathy. Reduce the dose or permanently discontinue oxaliplatin for persistent neurosensory reactions based on the severity of the adverse reaction [see Dosage and Administration (2. 2)]. Acute neuropathy typically presents as a reversible, primarily peripheral sensory neuropathy that occurs within hours or 2 days following a dose, resolves within 14 days, and frequently recurs with further dosing Delayed neuropathy typically presents as a persistent (greater than 14 days), primarily peripheral sensory neuropathy that is usually characterized by paresthesias, dysesthesias, and hypoesthesias, but may also include deficits in proprioception that can interfere with daily activities
The management of oxaliplatin-induced peripheral neuropathy involves:
- Reducing the dose of oxaliplatin for persistent neurosensory reactions based on the severity of the adverse reaction
- Permanently discontinuing oxaliplatin for severe or persistent neuropathy
- Avoiding topical application of ice, as cold temperature can exacerbate acute neurological symptoms The decision to reduce the dose or discontinue oxaliplatin should be based on the severity of the neuropathy and the individual patient's response to treatment 2.
From the Research
Management of Oxaliplatin-Induced Peripheral Neuropathy
- The management of oxaliplatin-induced peripheral neuropathy includes preventive measures such as administration of calcium and magnesium solutions, gabapentin, carbamazepine, amifostine, and glutathione 3.
- Treatment measures include calcium and magnesium solutions, gabapentin, and alpha-lipoic acid 3.
- Oral calcium supplements have also been shown to be effective in treating and preventing oxaliplatin-induced neurotoxicity 4.
- Duloxetine has been evaluated as a potential prophylactic agent for oxaliplatin-induced peripheral neuropathy, with studies showing that it can prevent worsening of paresthesia and peripheral sensory neuropathy 5.
- Predictors of duloxetine response in patients with oxaliplatin-induced painful chemotherapy-induced peripheral neuropathy include higher baseline emotional functioning 6.
Treatment Options
- Calcium and magnesium solutions: effective in treating and reducing the severity of neuropathic symptoms 3, 4.
- Gabapentin: used as a preventive measure and treatment for oxaliplatin-induced peripheral neuropathy 3.
- Alpha-lipoic acid: used as a treatment for oxaliplatin-induced peripheral neuropathy 3.
- Duloxetine: evaluated as a potential prophylactic agent for oxaliplatin-induced peripheral neuropathy, with promising results 5, 6.
Key Findings
- Oxaliplatin-induced peripheral neuropathy is a common adverse effect of oxaliplatin treatment, with two forms: acute and chronic 3, 7.
- The incidence of acute oxaliplatin-induced neuropathy is high, with prevalence ranging from 4-98% 7.
- Chronic neuropathy is cumulative and dose-limiting, with a significant impact on patient quality of life 3, 7.
- Further studies are needed to determine the best way to prevent and treat oxaliplatin-induced peripheral neuropathy 3, 7, 5.