ASCO Guideline Update. Chemo Induced Peripheral Neuropathy

Hi again everyone.
As panelists for the AUA/ASTRO/SUO clinical treatment guideline for advanced prostate cancer we went through the chemotherapy options and we remained pretty silent on what to do about peripheral neuropathy in patients receiving any form of Taxan-based or platinum-based chemotherapy (CIPN) commonly used in prostate cancer. The reason was the release of an ASCO guideline in 2017 on CIPN. In conclusion, the expert panel here found that there was no clear science on what to do to prevent or treat CIPN. Linked below and released yesterday in the ASCO Journal of Clinical Oncology is an update of that guideline that, well, still arrives at the same conclusion but more definitively defines existing medical, homeopathic, and other preventions/remedies ineffectiveness and /or lack of data.

I know for years I talked, even here, about the use of frozen gloves, pain medication, gabapentin, even acupuncture, to help deal with CIPN. The studies here used strong meta-analysis papers, some trials, and many observational papers and determined that there is no known effective prevention or therapy, with one exception, in very bad cases. The benefit even in that exception, Duloxetine, was very minimal and it has very limited cases where it helped.

While this isn't good news in prostate cancer, this finding was not prostate cancer specific. It is not good for just about any cancer receiving the agents described in this paper. Included agents used in PCa are Carboplatin, Cisplatin, docetaxel, and cabazataxel.

On one primary recommendation in that paper is to cease chemotherapy in patients where CIPN has become intolerable. In some cases, CIPN is very minimal and it even does not show up. And it should be a silver lining that most patients tolerate these side effects well. This paper can, while a bit technical, is a good educational reading on the effects of chemotherapy on nerves and nerve endings, and a pretty thorough analysis on the many agents, supplements, and even cryotherapy (frozen Gloves - FG).

https://ascopubs.org/doi/full/10.1200/jco.20.01399?fbclid=iwar2qztbmpkffwv_ogjyppbevofkxrgpkmgrjzk1-nhtqzc0tdilngyojpxy

Post Edited (Tony Crispino) : 7/15/2020 10:47:26 PM (GMT-6)

I was in the "first wave" of fellows in this country who pursued the newly adopted "early chemo plan" as soon as it became recommended, shortly after my diagnosis.

During infusion treatments, I was given ice bags for both hands & ice bags for both feet --- as a potential way to mitigate neuropathy.

I was also given a cup of chipped ice, in hopes it would preserve my sense of taste.

Fortunately, I did not experience neuropathy or loss of taste, during my series of chemotherapy infusions.

I am VERY mindful of my comrades here who have experienced neuropathy, past or present.

My hospital here still offers the "ice bag" approach during chemotherapy.

My hope is that powerfully effective antidotes and remedies will emerge to mitigate neuropathy, such as the chemotherapy components that now help lessen the fatigue and nausea that can be side effects of chemotherapy.

Here's to more research, more answers, more solutions!
CYCLONE - # Iowa State University