A Pilot Study of Acupuncture in Treating Bortezomib-Induced Peripheral Neuropathy in Patients With Multiple Myeloma

Abstract

Background Peripheral neuropathy is the dose limiting toxicity of bortezomib in patients with multiple myeloma (MM). Objectives To examine the safety, feasibility and efficacy of acupuncture in reducing bortezomib-induced peripheral neuropathy (BIPN) symptoms. Methods Patients with MM experiencing persistent BIPN ≥grade 2 despite adequate medical intervention and discontinuation of bortezomib received 10 acupuncture treatments for 10 weeks (2×/week for 2 weeks, 1×/week for 4 weeks, and then biweekly for 4 weeks). Responses were assessed by the Clinical Total Neuropathy Score (TNSc), Functional Assessment of Cancer Therapy/Gynecologic Oncology Group–Neurotoxicity (FACT/GOG-Ntx) questionnaire, and the Neuropathy Pain Scale (NPS). Repeated-measures analysis of variance was used to test for monotonic decline in scores on each of the measures. Serial serum levels of proinflammatory and neurotrophic cytokines were obtained at baseline and weeks 1, 2, 4, 8, and 14. Results Twenty-seven patients with MM were enrolled in the trial. There were no adverse events associated with the acupuncture treatments. TNSc data were deemed invalid and therefore were not reported. At weeks 10 and 14, FACT/GOG-Ntx and NPS showed significant reduction suggesting decreased pain, and improved function (P values were <.0001 for both FACT/GOG-Ntx and NPS at weeks 10 and 14). However, nerve conduction studies did not significantly change between baseline assessment and end of study. There was no correlation in serum cytokines for responders versus none responders. Conclusions Acupuncture is safe, feasible and produces subjective improvements in patients’ symptoms. A follow-up randomized controlled trial is warranted.

Natural products and complementary therapies for chemotherapy-induced peripheral neuropathy: A systematic review

“…In five of six patients treated with acupuncture, mean NCV significantly improved after 6 months. In another pilot study by Bao et al [66], 27 multiple myeloma patients with moderate to severe bortezomib-induced peripheral neuropathy experienced significantly reduced neuropathic pain and improved functioning following 10 weeks of acupuncture treatment (twice weekly for 2 weeks, once weekly for 4 weeks, and then biweekly for 4 weeks). Another single-arm study by Garcia et al [67] demonstrated that electroacupuncture was safe and possibly effective in treating thalidomide/bortezomib-induced peripheral neuropathy in 19 multiple myeloma patients with significant improvements in Functional Assessment of Cancer therapy-neurotoxicity score after 9 weeks treatment.…”

The Efficacy of Acupuncture in Chemotherapy-Induced Peripheral Neuropathy: Systematic Review and Meta-Analysis

“…Zhang et al 34 found electroacupuncture superior to acupuncture in terms of symptom relief and quality of life improvement in treating bortezomib-related neuropathy. Others found a positive effect for bortezomib-induced neuropathy 33,38,39 but a negative effect for taxane used for breast cancer. 32 Despite these findings, the limited number of studies prevents drawing any definite conclusions about the efficacy of acupuncture.…”

Randomized sham-controlled pilot trial of weekly electro-acupuncture for the prevention of taxane-induced peripheral neuropathy in women with early stage breast cancer

“…In a recent single arm trial (n=27), Bao et al . reported that 10-weeks of acupuncture was significantly associated with reducing pain and improving neuropathy symptoms in multiple myeloma patients with bortezomib-induced peripheral neuropathy [33]. A randomized controlled trial among patients with paclitaxel or oxaliplatin-induced peripheral neuropathy (n=64) showed that sensory nerve disorder was improved in 67% of patients receiving acupuncture compared to 40% of patients who received a form of vitamin B 12 [34].…”