Survey of the management of chemotherapy-induced peripheral neuropathy in Japan: Japanese Society of Medical Oncology

Abstract

BackgroundVarious drugs are administered for the management of chemotherapy-induced peripheral neuropathy (CIPN) in Japan. However, there have been no surveys undertaken to identify these drugs or their frequency of prescription. Therefore, we administered a questionnaire survey to the diplomates of the Subspecialty Board of Japanese Society of Medical Oncology (JSMO) to investigate the frequency of administration of different drugs for the management of CIPN in Japan.MethodsWe investigated the use of vitamin B12, antiepileptic agents such as pregabalin, duloxetine, antidepressants other than duloxetine, non-steroidal anti-inflammatory drugs (NSAIDs), opioids and the Kampo compound goshajinkigan in a questionnaire employing a three-step scale wherein A implies routine or prophylactic administration, B implies occasional administration and C implies infrequent administration.ResultsConsidering responses A and B together, the most frequently administered drugs for the treatment of numbness were antiepileptic drugs such as pregabalin (A+B=98.7%), vitamin B12 (74.7%), Kampo compounds (58.7%) and duloxetine (46.8%). The most frequently prescribed drugs for pain were NSAIDs (97.7%), followed by opioids (83.1%) and finally antiepileptic drugs (82.1%).ConclusionsVarious drugs are frequently administered for CIPN. In addition, it was found that marked differences exist between the drugs targeted on numbness and pain.

Risk factors and pharmacotherapy for chemotherapy-induced peripheral neuropathy in paclitaxel-treated female cancer survivors: A retrospective study in Japan

“…It is to be noted that all of paclitaxel-treated gynecologic cancer patients received platinum agents, while nobody of paclitaxel-treated breast cancer patients was treated with platinum agents in the present study, thereby providing a potential bias. It is also noteworthy that the total paclitaxel dose was slightly but significantly greater in gynecologic cancer patients than in breast cancer patients (see S2 Fig) . As described in the previous report from survey of the management of CIPN in Japan [21], the present study ascertained that many of female cancer patients with PIPN were prescribed with pregabalin, mecobalamin or Goshajinkigan (see Table 3) in spite of poor evidence for their effectiveness against CIPN [17,[22][23][24], while relatively few patients with PIPN received duloxetine, the only medicine that has moderate evidence for the use to treat the established CIPN [17] (see Table 3 and Fig 2). Goshajinkigan, a polyherbal medicine that legally requires a prescription to be dispensed in Japan, contains fixed proportions of 10 crude herbal extracts, i.e.…”

“…The moderate usefulness of duloxetine for treatment of CIPN in cancer patients treated with various cytotoxic chemotherapeutics including paclitaxel has also been supported by clinical trials in Japan [19,20]. Nonetheless, apart from opioids and non-steroidal anti-inflammatory drugs (NSAIDs) that are often used to treat cancer pain, vitamin B12, pregabalin and Goshajinkigan, a Chinese polyherbal medicine, in addition to duloxetine, are commonly prescribed for treatment of CIPN in Japan [21], although there is poor evidence for their effectiveness against CIPN [17,[22][23][24].…”

“…peripheral neuropathy in Japan[21]. It is noteworthy that 4 patients received duloxetine, pregabalin or mecobalamin without PIPN diagnosis (Table3).…”

Colorectal Cancer Survivors Suffering From Sensory Chemotherapy-Induced Peripheral Neuropathy Are Not a Homogenous Group: Secondary Analysis of Patients’ Profiles With Oxaliplatin-Induced Peripheral Neuropathy

“…This point underlines the expected difficulties to manage neuropathic pain in CIPN patients. Especially since recent studies in Japan ( Hirayama et al, 2016 , 2020 ), France ( Selvy et al, 2020 ; 2021a ; 2021b ) and United States ( Gewandter et al, 2020 ) have shown that oncologists do not prescribe duloxetine, or prescribe it very little, for the management of chronic pain related to CIPN. Secondly, we advise clinicians to consider particular attention to aggravating factors or factors related to the presence of severe CIPN, such as those listed above.…”

Photobiomodulation Therapy for the Management of Chemotherapy-Induced Peripheral Neuropathy: An Overview

“…Current treatment strategies for CIPN are based on symptom management and include mostly neuropathic pain medication (e.g., opioids, tricyclic antidepressants, anticonvulsants, serotonin-norepinephrine reuptake inhibitors, and nonsteroidal anti-inflammatory agents) and nutritional supplements. [20][21][22][23][24][25] Experimental treatment options consist of antioxidants (e.g., alpha-lipoic acid, glutathione, and vitamin E), substances influencing ion channels (calcium/magnesium supplementation, pregabalin, and carbamazepine), and neuroprotectors (ginkgo biloba, glutamine). 20,[22][23][24]26,27 However, results are limited and no gold standard to manage CIPN has been identified to date.…”