New Guidelines on Chemotherapy-Induced Peripheral Neuropathy

Dawn L. Hershman, MD; Mary E. Anderson, PhD


May 13, 2014

In This Article

Optimum Approaches to Managing CIPN

Editor's Note: The American Society of Clinical Oncology (ASCO®) issued new guidelines on the prevention and management of chemotherapy-induced peripheral neuropathy (CIPN) on April 14, 2014,[1] as reported previously on Medscape. The incidence of CIPN varies by the type of chemotherapeutic agent(s), the total dose, and such patient-related factors as race.[2,3,4,5,6] CIPN is a particularly important adverse effect because it may compromise a patient's ability to tolerate chemotherapy and become a serious, long-lasting, and even permanent debility. To provide guidance to clinicians and patients who are making decisions about CIPN, ASCO convened a multidisciplinary expert panel charged with providing evidence-based answers to the question, "What are the optimum approaches in the prevention and management of CIPNs in adult cancer survivors?"

Unfortunately, the expert consensus was that no approach exists that can be recommended for prevention. Only one agent is recommended for treatment, and that is only a moderate recommendation. However, the experts did issue moderate-to-strong recommendations against using certain agents, which has important clinical implications.

Dawn L. Hershman, MD, MS, co-chair of the guideline expert panel, spoke to Medscape about the ASCO guideline and how it affects the clinical prevention and management of CIPN. Dr. Hershman is Associate Professor of Medicine and Epidemiology, Division of Medical Oncology, Columbia University College of Physicians and Surgeons, New York, New York.

Medscape: What was it about the clinical landscape at this time that prompted ASCO to develop clinical guidelines for preventing and treating CIPN?

Dr. Hershman: ASCO has set a priority of looking into a variety of issues that affect cancer survivors, including CIPN, fatigue, and depression. CIPN is one of the most common adverse effects and is associated with many different types of cancer therapies. Although it has a significant impact on patients' quality of life, to date few treatments are available for either treating or preventing CIPN.

Medscape: The purpose of the clinical practice guidelines expert panel was to "develop evidence-based guidance" for the optimum prevention and management of CIPN. How did the committee accomplish that?

Dr. Hershman: We performed a comprehensive literature review of all the trials that have been completed looking at either the treatment or prevention of CIPN. Then we looked at the quality of the studies, and trials that were deemed to be of sufficient quality were included. Only randomized controlled trials were included. We reviewed many studies that either were nonrandomized or were observational and as such didn't meet our strict criteria for inclusion. We wanted to be able to comprehensively evaluate each study's benefits and limitations to make reasonable judgments in terms of what we should or should not be giving to patients.

Unfortunately, many of the studies are very different from each other in terms of design. Because we don't have a good understanding of the mechanism of CIPN for a variety of drugs, some of the prevention and treatment strategies that we use come from the neurologic literature, from animal studies, or from observation. Many of those studies, when rigorously tested, have not found any single agent to be of particular benefit, and many different drugs or supplements have been tested.


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