Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update
- Study type
- Clinical guideline
- Study name
- ASCO CIPN 2020
- Design
- Clinical practice guideline update based on a targeted systematic literature review by an expert panel
- Sample size
- 257 new references identified; 87 publications reviewed in full text
- Source
- JCO · 2020
In plain words
Some chemotherapy drugs can damage the nerves in the hands and feet and cause numbness, tingling or pain. According to this guideline, no medicine is yet recommended to prevent this side effect, and acetyl-L-carnitine should not be taken for this purpose. If the side effect becomes so severe that it is hard to bear or gets in the way of daily life, the doctor may delay or lower the chemotherapy dose, switch the drug or stop treatment. For pain caused by this nerve damage, duloxetine is the only medicine with good evidence, although its benefit is limited.
Key points
Key guideline recommendations
- Level of evidence and strength of recommendation in the full guideline
No agent is recommended for the prevention of chemotherapy-induced peripheral neuropathy (CIPN).
- Level of evidence and strength of recommendation in the full guideline
Acetyl-L-carnitine for the prevention of CIPN in patients with cancer should be discouraged (not recommended).
- Level of evidence and strength of recommendation in the full guideline
Clinicians should assess the appropriateness of dose delay, dose reduction, substitution or discontinuation of chemotherapy in patients who develop intolerable neuropathy and/or functional impairment.
- Level of evidence and strength of recommendation in the full guideline
Duloxetine is the only agent with appropriate evidence to support its use in patients with established painful CIPN; however, the extent of its benefit is limited.
Study population
Survivors of adult cancers who have, or are at risk of, chemotherapy-induced peripheral neuropathy (CIPN).
Endpoints
Rather than a trial endpoint, this guideline reviewed the evidence on the prevention of CIPN and the treatment of established CIPN. Details of the assessment criteria are given in the full guideline.
Safety and side effects
The abstract gives no detailed information on adverse events. It notes only that the benefit of duloxetine is limited.
Clinical significance and place in guidelines
This update confirms the previous recommendation that no preventive agent is recommended for CIPN and that acetyl-L-carnitine should not be used for prevention. In practice, neuropathy should be monitored, and modification or discontinuation of chemotherapy considered in the event of intolerable neuropathy or functional impairment. Duloxetine is the only option with sufficient evidence for painful CIPN, but with limited benefit. The level of evidence and strength of each recommendation should be checked in the full guideline.
Limitations
The abstract states no specific limitations. It specifies only that the benefit of duloxetine is limited and that no preventive agent has sufficient evidence. Details of the quality of evidence are given in the full guideline.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.