Quiz

Update on Treatment and Diagnosis of Chemotherapy-Induced Peripheral Neuropathy

• Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent adverse effect of anticancer agents, which primarily affects sensory nerves and causes pain, tingling, and numbness in a symmetrical “glove and stocking” distribution.

• The pathophysiology of CIPN is complex and varies with the different classes of chemotherapy drugs. It involves multiple mechanisms, including mitochondrial toxicity and oxidative stress, DNA damage, axonal transport disruption, and ion channel remodeling in peripheral nerves.

• Patients with a more severe CIPN presentation experience a decreased quality of life physically, emotionally, and socially, and it has been associated with interfering with patients’ ability to work and a greater financial burden.

• There are currently no approved or effective agents for CIPN prevention, and duloxetine is the only medication that is an effective treatment against CIPN, but it has limited benefits.

• Other options such as tricyclic antidepressants or anti-seizure medications have been explored, but trials show mixed results, and there are no recommendations on these other therapies.

• The epidemiology of CIPN is complicated because of the many different scales used to assess CIPN, and there is no standardized approach for assessing and diagnosing CIPN.

• Assessment techniques can be divided into objective and subjective approaches, with nerve conduction studies (NCS) and quantitative sensory testing (QST) being effective objective and subjective assessments, respectively.

• Composite studies have become progressively favorable for assessing CIPN, with the most common one being the Total Neuropathy Score (TNS), which allows simultaneous assessment of graded physician-reported severity with objective sensibility measures and NCS.

• The first step in diagnosing CIPN is to exclude other potential neuropathy causes such as preexisting conditions, association with surgery, and any other factors that would come with.

• Prevention and treatment of CIPN are tremendously challenging because of the varying underlying pathophysiological causes with differing chemotherapy agents.

• There is still a need to explore and develop efficacious treatments for CIPN, and future perspectives include ion channel-targeted therapies and drugs that inhibit anticancer agent-induced Schwann cell damage as potential therapeutic agents for CIPN.

• The purpose of this review is to examine CIPN, innovative pharmacological and nonpharmacological therapy and preventive strategies for this illness, and future perspectives for this condition and its therapies.Treatment Options for Chemotherapy-Induced Peripheral Neuropathy (CIPN)

• Clinical examination is usually used to diagnose CIPN following exclusion of other potential causes, but it cannot prove the origin of abnormalities in the nervous system.

• Gabapentin and pregabalin both bind to the alpha2-delta protein and are first-line treatment options for neuropathic pain, but studies have shown that patients who respond poorly to gabapentin may experience a clinically significant improvement in pain when switching to pregabalin.

• Erythropoietin (EPO) possesses neuroprotective effects and is a seemingly ideal candidate for CIPN; however, its utilization for the treatment of CIPN is highly contraindicated and should be approached with caution as EPO is associated with tumor cell growth.

• Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce pain symptoms and the underlying inflammation associated with pain, but studies involving NSAIDs in the treatment of CIPN are limited and require further evaluation.

• Lidocaine is a sodium channel blocker that effectively relieves various causes of neuropathic pain, including CIPN. Intravenous (IV) lidocaine produced a significant, moderate long-term analgesic effect in patients with CIPN.

• Magnesium infusion has been postulated as a potential therapeutic option for CIPN, but other studies have failed to demonstrate any efficacy in using magnesium infusions to treat CIPN. Similarly, calcium infusions failed to reduce CIPN in multiple studies.

• Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) are the first and only FDA-approved drug class for treating pain caused by diabetic peripheral neuropathy. Duloxetine is often considered a first-line treatment option for CIPN.

• Tricyclic antidepressants (TCAs) have long been recognized for their use in treating neuropathic pain, but studies have found these drugs to be ineffective in treating pain associated with CIPN.

• Topical mixtures of amitriptyline and ketamine, and amitriptyline, ketamine, and baclofen have not shown significant improvement in CIPN symptoms compared to placebo.

• Capsaicin, a transient receptor potential vanilloid receptor (TRPV1) agonist, has demonstrated efficacy in treating neuropathic pain, including that associated with CIPN.

• Mangafodipir, a manganese chelate and superoxide dismutase mimetic, has provided evidence for the use in treating CIPN, where individuals experienced a significant reduction in pain.

• Non-pharmacologic interventions, such as acupuncture, massage, foot bath, and physical therapy, have produced a significant reduction in CIPN symptoms. Scrambler therapy, a noninvasive treatment strategy for CIPN, has shown promising results but requires further studies. Neurofeedback therapy is a non-invasive treatment thatAdvances in Treatment Options for Chemotherapy-Induced Peripheral Neuropathy

• Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of chemotherapy that causes pain and affects patients' quality of life.

• CIPN is difficult to treat, and there is no standardization on which assessment and diagnosis methods to use.

• The pathophysiology of CIPN is not well understood, leading to many different pharmacological and non-pharmacological agents being used in trials to find prevention and treatment methods.

• Duloxetine is currently the only recommended agent for CIPN treatment, but many other agents show promise and need further studies, such as IV lidocaine, cannabinoids, oral glutamine, cryotherapy, acupuncture, massage therapy, and exercise.

• Some therapies can increase the risk and severity of CIPN and should be avoided, including EPO and acetyl-L-carnitine (ALC).

• Non-pharmacological therapies have proven to be helpful in some patients, including integrative and behavioral approaches, acupuncture, massage therapy, and mind-body techniques.

• Glutamine is an amino acid that plays an important role in our immune system and intestinal health, but studies have not supported the efficacy of oral glutamine therapy in alleviating CIPN symptoms.

• Topical treatments have been explored, such as menthol and potential combinations, but further studies are needed.

• Scrambler therapy is a treatment that sends "non-pain" signals to replace "pain" signals perceived by the nerves, reducing the pain felt by the patient.

• Pharmacological agents being explored include MR309, a selective antagonist of the sigma 1 receptor, which has shown promise in reducing chronic neuropathic pain.

• The goal of future directions in the treatment of CIPN is to better understand the pathophysiology and find a therapy that can help treat this condition.

• Funding for research on CIPN is available, and studies are ongoing to find effective treatment options for patients.Current approaches for the prevention and treatment of chemotherapy-induced peripheral neuropathy

• Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of cancer treatment.

• CIPN is characterized by a range of symptoms, including pain, numbness, tingling, and weakness, which can affect quality of life and limit treatment options.

• There is no single effective treatment for CIPN, and current approaches are focused on prevention and symptom management.

• Prevention strategies include reducing chemotherapy dose, using neuroprotective agents, and incorporating alternative therapies such as acupuncture and exercise.

• The use of neuroprotective agents such as calcium and magnesium infusions, erythropoietin, and anticonvulsants such as gabapentin and pregabalin have shown promise in managing CIPN symptoms.

• Antidepressants such as duloxetine and venlafaxine have also been used to manage CIPN-related pain.

• The Total Neuropathy Score (TNS) is a commonly used tool for assessing the severity of CIPN symptoms.

• The National Cancer Institute-Common Toxicity Scale (NCI-CTC) is another tool used to assess the severity of CIPN symptoms, but it has limitations.

• Lidocaine, a local anesthetic, has been used to manage CIPN-related pain, but its effectiveness is still being studied.

• Magnesium and calcium infusions have been found to be effective in preventing oxaliplatin-induced sensory neurotoxicity.

• Gabapentin and pregabalin are anticonvulsants that have shown efficacy in managing neuropathic pain, including CIPN-related pain.

• More research is needed to identify effective treatments for CIPN and to better understand the underlying mechanisms of CIPN.