Roxanne Nelson

October 21, 2013

VANCOUVER, Canada ― Acupuncture may be able to reduce neuropathy associated with the use of bortezomib (Velcade, Millennium Pharmaceuticals, Inc.) in multiple myeloma patients, suggest new data. The results are early, but patients treated with acupuncture appeared to experience both subjective and objective improvements in symptoms.

"Acupuncture is feasible and safe for treating multiple myeloma patients with persistent and moderate pain due to bortezomib-induced peripheral neuropathy [BIPN],” said Ting Bao, MD, an assistant professor of medicine at the University of Maryland, in Baltimore. She noted that all patients appeared to have decreased pain and improved function, as evidenced by improved scores on standardized measures.

Dr. Bao presented her results here at the 10th International Conference of the Society for Integrative Oncology (SIO).

Bortezomib is an effective treatment for multiple myeloma, but its use can cause sensory neuropathy, which can limit dose and duration of treatment, she explained. "Peripheral neuropathy is one of the most common and severe toxicities, and treatment is limited to symptom management."

Symptoms are often difficult to manage, and available treatment options frequently do not provide total relief and can cause adverse effects. Conversely, Dr. Bao pointed out, acupuncture has no side effects, and several studies have demonstrated the efficacy of acupuncture in treating peripheral neuropathy.

"As such, we hypothesized that acupuncture was a safe, feasible, and effective approach to treating BIPN, and that it works through modulating serum cytokines," Dr. Bao said. "So as a first step in testing this hypothesis, we designed a single-arm, single-institution study."

Safe and Feasible

For their pilot study, Dr. Bao and colleagues enrolled 27 patients with multiple myeloma who were experiencing persistent bortezomib-induced peripheral neuropathy of grade 2 or greater, despite receiving adequate medical intervention, and who were no longer using the agent.

All patients in the cohort received 10 acupuncture treatments for 10 weeks (2x/week for 2 weeks, 1x/week for 4 weeks, and then biweekly for 4 weeks), and their responses to treatment were evaluated with the Clinical Total Neuropathy Score (TNSc), the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group–Neurotoxicity (FACT/GOG-Ntx) questionnaire, and the Neuropathy Pain Scale (NPS).

The TNSc was evaluated by a trained research nurse using both subjective and objective measurements. The researchers also obtained serial serum levels of proinflammatory and neurotrophic cytokines at baseline and at weeks 1, 2, 4, 8, and 14.

Dr. Bao explained that all of the patients had grade 3 to 4 neuropathy, and the median time after discontinuing bortezomib was 19 months, making spontaneous recovery not very feasible. "Neuropathy was already affecting their daily activity," she said.

At weeks 10 and 14, TNSc, FACT/GOG-Ntx, and NPS all showed significant reduction, suggesting decreased pain, improved function, and improved objective neuropathy measurement (P-values were 0.02 and 0.03 for TNSc at weeks 10 and 14, respectively, and <.0001 for both FACT/GOG-Ntx and NPS at weeks 10 and 14).

Mechanism Unclear

However, results of nerve conduction studies did not significantly change between baseline assessment and end of study. "Fifteen patients had nerve conduction studies before and after acupuncture," said Dr. Bao. "The majority did not show change."

"Disappointingly, there was no correlation between symptom reduction and nerve conduction studies," she continued. "And more disappointingly, 12 serum biomarkers did not show any significant change over time. So the mechanism remains unclear."

Dr. Bao concluded that even though the mechanism of action still remains unclear, acupuncture is safe, feasible, and may be able to reduce pain and improve function, and that they are planning a follow-up randomized trial.

"These results were very promising, and the next step will be to look at a randomized controlled trial, and that will ultimately be the next step to see if acupuncture is effective in treating bortezomib-induced neuropathy," said Richard Lee, MD, assistant professor of general oncology at the University of Texas MD Anderson Cancer Center in Houston.

Acupuncture may also be useful in treating other types of neuropathy, said Dr. Lee, who was approached by Medscape Medical News for an independent comment. "This is a very active area of investigation. Our group at MD Anderson, Dr. Bao’s group, and others are looking at peripheral neuropathy."

"There are many different types of chemotherapy that can cause neuropathy, such as platinum-based agents and taxanes," he continued. "Whether or not this type of treatment is universal for all types of chemotherapy, we don't know. We really need further studies to investigate its use with other agents."

Dr. Bao has disclosed no relevant financial relationships.

10th International Conference of the Society for Integrative Oncology (SIO). Abstract 40, presented October 20, 2013.


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