Prevention and treatment of chemotherapy-induced peripheral neuropathy
Prevention and treatment of chemotherapy-induced peripheral neuropathy
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DOI：
10.2146/ajhp130126
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发表时间：
2014-01-01
影响因子：
2.7
通讯作者：
Kolesar, Jill M.
中科院分区：
文献类型：
--
作者：
Piccolo, Jennifer;Kolesar, Jill M.
目的。对化疗引起的周围神经病变（CIPN）的预防和治疗进行综述。总结。许多药物，包括氨磷汀、谷胱甘肽和维生素 E，都被评估为 CIPN 的预防策略，但没有任何药物显示出疗效。钙、镁对于预防 CIPN 有效；然而，对化疗疗效降低的担忧依然存在。文拉法辛是一种血清素去甲肾上腺素再摄取抑制剂 (SNAI)，在一项随机、双盲、安慰剂对照的 III 期试验中，对每两周接受一次奥沙利铂治疗方案的患者进行了预防神经病变的评估，结果显示，与对照组相比，文拉法辛的急性神经毒性显着减轻。 CIPN 的治疗选择包括减少化疗剂量、改变化疗方案以及辅助治疗 CIPN。外用药物、三环类抗抑郁药和抗惊厥药（如普加巴林和加巴喷丁）的辅助治疗效果有限。然而，一项随机、双盲、交叉 III 期试验将度洛西汀与安慰剂对比，用于治疗紫杉醇或奥沙利铂引起的 CIPN，结果发现，无论采用何种化疗，每天接受度洛西汀 60 mg 治疗的患者比接受安慰剂的患者疼痛评分平均下降幅度更大。结论。钙镁输注和文拉法辛可有效预防 CIPN，但由于担心化疗疗效下降而未常规使用。 CIPN 的辅助治疗选择包括局部镇痛药、三环类抗抑郁药、抗惊厥药或 SNRI。度洛西汀在治疗奥沙利铂或紫杉醇诱发的 CIPN 方面比安慰剂更有效，且耐受性良好，应被视为 CIPN 的一线治疗选择。
Purpose. The prevention and treatment of chemotherapy-induced peripheral neuropathy (CIPN) are reviewed.Summary. A number of agents, including amifostine, glutathione, and vitamin E, were evaluated as prevention strategies for CIPN, with no agent demonstrating efficacy. Calcium and magnesium are effective for the prevention of CIPN; however, concerns regarding reduced chemotherapy efficacy linger. Venlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNAI), was evaluated for the prevention of neuropathy in a randomized, double-blind, placebo-controlled Phase III trial of patients receiving an oxaliplatin-based regimens every two weeks and demonstrated significantly less acute neurotoxicity compared with the control group. Treatment options for CIPN include reducing the dosage of the chemotherapy, changing the chemotherapy, and treating CIPN with adjunct therapy. Adjunct therapy with topical agents, tricyclic antidepressants, and anticonvulsants, such as pregabalin and gabapentin, have shown limited efficacy. However, a randomized, double-blind, crossover, Phase III trial of duloxetine versus placebo for the treatment of CIPN caused by paclitaxel or oxaliplatin found that patients treated with duloxetine 60 mg daily had a larger average decrease in pain score than those receiving placebo, regardless of the chemotherapy used.Conclusion. Calcium and magnesium infusions and venlafaxine are effective in preventing CIPN but are not routinely used because of concerns related to decreased chemotherapy efficacy. Adjunct treatment options for CIPN include a topical analgesic, a tricyclic antidepressant, an anticonvulsant, or an SNRI. Duloxetine is more effective than placebo in treating oxaliplatin- or paclitaxel-induced CIPN, is well tolerated, and should be considered to be a first-line treatment option for CIPN.