The American Society of Clinical Oncology recommendations for the prevention and management of chemotherapy-induced peripheral neuropathy (CIPN) in survivors of adult cancers include:
- No established agents are recommended for preventing CIPN, because of the lack of high-quality, consistent evidence and a balance of benefits versus harms
- The following agents should not be offered for the prevention of CIPN: Ethyol (amifostine), Elavil (amitriptyline), calcium plus magnesium, diethyldithiocarbamate, Tationil (glutathione), Nimotop (nimodipine), Org 2766, Atralin (tretinoin), rhuLIF, and vitamin E; acetyl-L-carnitine has been associated with worse long-term outcomes for CIPN
- Treating clinicians can offer Cymbalta (duloxetine) to patients with CIPN
- Although recommendations cannot be made for tricyclic antidepressants, Neurontin (gabapentin), or topical gels containing Lioresal (baclofen), Elavil (amitriptyline), and Ketalar (ketamine) because of the lack of strong evidence, it might be reasonable to try them in select patients
Source: Hershman DL, Lacchetti C, Dworkin RH, et al. Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2014;32:1941-1967.