Current use of drugs affecting the central nervous system for chemotherapy-induced peripheral neuropathy in cancer patients: a systematic review

• Published in: Supportive care in cancer Vol. 23; no. 2; pp. 513 - 524
• Main Authors: Chu, Sang Hui, Lee, Young Joo, Lee, Eon Sook, Geng, Yimin, Wang, Xin Shelley, Cleeland, Charles S.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2015; Springer; Springer Nature B.V
• Subjects: Amitriptyline - therapeutic use; Anticonvulsants; Anticonvulsants - therapeutic use; Antidepressants; Antidepressive Agents - therapeutic use; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Boronic Acids - adverse effects; Boronic Acids - therapeutic use; Bortezomib; Cancer; Cancer patients; Carbamazepine - analogs & derivatives; Carbamazepine - therapeutic use; Care and treatment; Central nervous system; Central Nervous System - drug effects; Chemotherapy; Cyclohexanols - therapeutic use; Drug therapy; Drugs; Duloxetine Hydrochloride; Epothilones - adverse effects; Epothilones - therapeutic use; Humans; Medicine; Medicine & Public Health; Neoplasms - drug therapy; Nervous system; Neuralgia - drug therapy; Neuropathology; Nursing; Nursing Research; Oncology; Pain Medicine; Peripheral Nervous System Diseases - chemically induced; Peripheral Nervous System Diseases - drug therapy; Pyrazines - adverse effects; Pyrazines - therapeutic use; Rehabilitation Medicine; Review Article; Taxoids - adverse effects; Taxoids - therapeutic use; Thalidomide - adverse effects; Thalidomide - therapeutic use; Thiophenes - therapeutic use; Venlafaxine Hydrochloride; Vinca Alkaloids - adverse effects; Vinca Alkaloids - therapeutic use; Anticonvulsants; Chemotherapy; Peripheral neuropathy; Antidepressants; Cancer
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-014-2408-8

Purpose
Chemotherapy-induced peripheral neuropathy (CIPN) is common among cancer patients who undergo chemotherapy with platinum analogues, taxanes, vinca alkaloids, epothilone, bortezomib, and thalidomide. The purpose of this study was to investigate the evidence of using drugs affecting the central nervous system (CNS) to alleviate CIPN in cancer patients.
Methods
A systematic literature search was conducted using the CINAHL, EMBASE, and Medline databases to identify randomized controlled clinical trials (RCTs) reported in English up to 2013. We identified ten trials of CNS-acting drugs used to treat CIPN in cancer patients and reviewed efficacy and safety of CNS-acting drugs for CIPN using a standard data collection form. The risk of bias in each RCT was also assessed.
Results
Antidepressants were used in six studies and anticonvulsants in four studies. We found positive results for amitriptyline (topical), venlafaxine, and oxcarbazepine in one study each, but the results were not sufficient to draw definite conclusions. One trial with duloxetine showed a moderate effect (effect size, 0.513,
P
 = .003) on CIPN pain relief. However, none of the results has yet been duplicated in an RCT with a large sample size.
Conclusions
Insufficient RCTs exist to confirm the efficacy of CNS agents to reduce CIPN. This study highlighted the need for and the importance of conducting well-designed RCTs to generate evidence on CIPN symptom management. Additional RCTs are warranted to accelerate the potential use of CNS drugs for CIPN in cancer patients.