Pharmacotherapy options for managing chemotherapy-induced peripheral neurotoxicity

ABSTRACT

Introduction: Prevention and treatment of chemotherapy-induced peripheral neurotoxicity (CIPN) are clinically-relevant unmet needs. Despite extensive efforts at the preclinical and clinical levels, no effective pharmacological interventions are available, and this unsatisfactory situation reflects a combination of methodological issues and a lack of effectiveness of the tested drugs.

Areas covered: This non-systematic, but unbiased review is based on published papers available in PubMed and screened using the broad search string [chemotherapy (and) neuropathy (and) treatment] to analyze the reported data. Subsequently, the same search was performed in ClinicalTrials.gov to assess the trend of new clinical studies.

Expert opinion: From the analysis of the most recently published clinical studies and of the ongoing registered trials it seems that drug-based treatment attempts are being overwhelmed by non-pharmacological studies, in most cases based on weak supporting hypothesis. Among the possible strategies important to restore a prominent role for drug-based clinical trials, increased knowledge on CIPN pathophysiology, more effective translation of preclinical results into clinical setting, improvement in CIPN assessment and the identification of subjects at high-risk for more severe CIPN are important areas to concentrate investigational efforts.

KEYWORDS:

• Chemotherapy
• neuropathy
• prevention
• treatment

Article highlights

• Chemotherapy-Induced Peripheral Neurotoxicity (CIPN) treatment is a clinically-relevant, unmet need

• There is not a general consensus regarding the optimal way to assess CIPN occurrence and severity

• Recently, the number of non-pharmacological trials is increasing while conventional, drug-based trials are very few

• This effect is probably not only related to a lack of efficacy, but also to sub-optimal clinical investigation

• Reflection on possible new, different endpoints and study design in CIPN prevention trials is warranted

This box summarizes key points contained in the article.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has received funding from a Associazione Italiana per la Ricerca sul Cancro (AIRC) grant (Progetto IG 2016 id.18631)