Chemotherapy-induced peripheral neuropathy (CIPN): current therapies and topical treatment option with high-concentration capsaicin

Main idea: Chemotherapy-induced peripheral neuropathy represents a major concern in cancer therapy. There is limited evidence-based data available for prophylaxis and treatment of this condition. Early start of functional exercises during chemotherapy is recommended. Existing data on pharmaceutical treatment of chemotherapy-induced peripheral neuropathy allow weak recommendations for duloxetine. Given the paucity of available alternative treatment strategies and extrapolating efficacy data from other neuropathic pain conditions, certain antidepressants (amitriptyline), and anticonvulsants (gabapentin, pregabalin) may be considered. If appropriate, opioids may be used based on the clinician’s experience. Systemic treatments are associated with a typical tolerability profile and carry the risk of drug interactions. Study results from open-label trials provide evidence for successful topical treatment of chemotherapy-induced peripheral neuropathy with capsaicin 179 mg patch. The patch provides a significant reduction of chemotherapy-induced peripheral neuropathy-related pain and symptoms as shown in the literature for other neuropathic disorders while displaying low rates of side effects. In particular, systemic side effects and drug interactions can be reduced or avoided. Also, recent data point to promising disease-modifying effects of the capsaicin patch.

Abstract: Chemotherapy-induced peripheral neuropathy represents a major concern in cancer therapy. There is limited evidence-based data available for prophylaxis and treatment of this condition. Early start of functional exercises during chemotherapy is recommended. Existing data on pharmaceutical treatment of chemotherapy-induced peripheral neuropathy allow weak recommendations for duloxetine. Given the paucity of available alternative treatment strategies and extrapolating efficacy data from other neuropathic pain conditions, certain antidepressants (amitriptyline), and anticonvulsants (gabapentin, pregabalin) may be considered. If appropriate, opioids may be used based on the clinician’s experience. Systemic treatments are associated with a typical tolerability profile and carry the risk of drug interactions. Study results from open-label trials provide evidence for successful topical treatment of chemotherapy-induced peripheral neuropathy with capsaicin 179 mg patch. The patch provides a significant reduction of chemotherapy-induced peripheral neuropathy-related pain and symptoms as shown in the literature for other neuropathic disorders while displaying low rates of side effects. In particular, systemic side effects and drug interactions can be reduced or avoided. Also, recent data point to promising disease-modifying effects of the capsaicin patch. Cancer diagnosis and treatment are drastic events for patients and their families. Besides the psychological aspects of the disease, patients are often affected by severe side effects related to cancer itself or as a result of therapeutic interventions. Particularly, chemotherapy-induced peripheral neuropathy (CIPN) is the most prevalent neurological complication of oral or intravenous chemotherapy. The disorder may require a dose reduction of chemotherapy and is accompanied by multiple symptoms with a long-term functional impairment affecting quality of life (QoL), e.g., sensory and functional deteriorations as well as severe pain. Although CIPN may reverse or improve after the termination of the causative chemotherapy, approximately 30-40% of patients are faced with chronicity of the symptoms. Due to the advantages in cancer diagnosis and treatments, survival rates of cancer patients rise and CIPN may occur even more frequently in the future. In this review, we summarize current recommendations of leading national and international societies regarding prevention and treatment options in CIPN. A special focus will be placed on current evidence for topical treatment of CIPN with high-dose capsaicin. Finally, an algorithm for CIPN treatment in clinical practice is provided, including both pharmacologic and non-pharmacologic modalities based on the clinical presentation.