Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update
Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update
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DOI：
10.1200/jco.20.01399
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发表时间：
2020-10-01
影响因子：
45.3
通讯作者：
Hershman, Dawn L.
中科院分区：
文献类型：
--
作者：
Loprinzi, Charles L.;Lacchetti, Christina;Hershman, Dawn L.
目的更新ASCO关于成人癌症存活者化疗所致周围神经病变(CIPN)防治方法的指南。方法一个专家小组进行有针对性的系统文献回顾，以确定新的研究。结果检索策略确定了257篇新的参考文献，对87篇文献进行了全文回顾。本次更新共纳入3个系统评价，2个Meta分析，28个预防CIPN的初步试验，以及14个与已建立的CIPN治疗相关的初步试验。不鼓励使用乙酰化L肉碱预防癌症患者的CIPN。此外，临床医生应该评估对于出现无法耐受的神经病变和/或功能障碍的患者，推迟剂量、减少剂量、替代或停止化疗是否合适。度洛西汀是唯一有适当证据支持其用于已确定的疼痛CIPN患者的药物。尽管如此，度洛西汀的益处是有限的。
PURPOSE To update the ASCO guideline on the recommended prevention and treatment approaches in the management of chemotherapy-induced peripheral neuropathy (CIPN) in adult cancer survivors.METHODS An Expert Panel conducted targeted systematic literature reviews to identify new studies.RESULTS The search strategy identified 257 new references, which led to a full-text review of 87 manuscripts. A total of 3 systematic reviews, 2 with meta-analyses, and 28 primary trials for prevention of CIPN in addition to 14 primary trials related to treatment of established CIPN, are included in this update.RECOMMENDATIONS The identified data reconfirmed that no agents are recommended for the prevention of CIPN. The use of acetyl-l-carnitine for the prevention of CIPN in patients with cancer should be discouraged. Furthermore, clinicians should assess the appropriateness of dose delaying, dose reduction, substitutions, or stopping chemotherapy in patients who develop intolerable neuropathy and/or functional impairment. Duloxetine is the only agent that has appropriate evidence to support its use for patients with established painful CIPN. Nonetheless, the amount of benefit from duloxetine is limited.