Pharmacological Treatment of Established Chemotherapy-Induced Peripheral Neuropathy

Pharmacological treatment of chemotherapy-induced peripheral neuropathy (CIPN) is still in its infancy and available options are limited. Both American Society of Clinical Oncology (ASCO) and European Society of Medical Oncology-European Oncology Nursing Society-European Association of Neuro-Oncology (ESMO-EONS-EANO) guidelines recommend the use of duloxetine for treatment of CIPN. The ESMO-EONS-EANO suggest gabapentinoids (pregabalin and gabapentin), tricyclic antidepressants, and opioids may be considered as an option to relieve neuropathic pain where duloxetine cannot be used. The National Comprehensive Cancer Network (NCCN) guidelines do not address CIPN specifically, but consider gabapentinoids (pregabalin and gabapentin) first-line options for cancer-related neuropathic pain. Currently, none of these guidelines recommend the use of any supplements but they recommend against use of acetyl-l-carnitine due to harm seen in preventions studies. The ESMO guidelines also recommend use of topical menthol but recommend against the use of topical ketamine and amitriptyline. Despite limited options currently available, multiple studies are ongoing and further treatment choices may become available in the future.