Efficacy of gabapentin in the management of chemotherapy‐induced peripheral neuropathy

Rao, Ravi A.; Michalak, John C.; Sloan, Jeff A.; Loprinzi, Charles L.; Soori, Gamini S.; Nikcevich, Daniel A.; Warner, David O.; Novotny, Paul J.; Kutteh, Leila A.; Wong, Gilbert Y.

doi:10.1002/cncr.23008

Cited by 304 publications

(96 citation statements)

References 30 publications

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“…The therapeutic action of Gabapentin on neuropathic pain is thought to involve voltage-gated calcium channels. Studies have failed to demonstrate the benefit of gabapentin in the treatment of CIPN-related symptoms [52, 77]. A related drug, pregabalin, is often used to treat adults with CIPNs.…”

Section: Reviewmentioning

confidence: 99%

Chemotherapy-induced Peripheral Neuropathy in Pediatric Cancer Patients

Moore¹,

Groninger²

2013

Cureus

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Chemotherapy-induced peripheral neuropathies (CIPNs) are an increasingly common neuropathic and pain syndrome in adult and pediatric cancer patients and survivors [1–69]. However, symptoms associated with CIPNs are often undiagnosed, under-assessed, and communications problems between clinicians, family members, and patients have been observed [70–73]. Less is known about the prevalence and impact of CIPNs on pediatric cancer populations [70–71]. This article aims to provide a brief understanding of CIPNs in pediatric populations, and to review the evidence for both its prevention and treatment.

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Section: Reviewmentioning

confidence: 99%

Chemotherapy-induced Peripheral Neuropathy in Pediatric Cancer Patients

Moore¹,

Groninger²

2013

Cureus

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“…6 While some of these therapies provide modest improvements in neurological function, in most instances, these agents are associated with additional negative side effects for cancer patients, including cardiac conduction defects and increased chemotherapy resistance. [7][8][9] Thus, other interventions that address the symptoms of CIPN should be considered. One intervention that has the potential of preventing or alleviating CIPN is exercise rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Ten weeks of home-based exercise attenuates symptoms of chemotherapy-induced peripheral neuropathy in breast cancer patients

et al. 2013

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“…While some studies have tested a prophylactic approach to OXA‐induced neuropathy by administering drugs before chemotherapy was started [10], [11], [13], [14], [15], others have focused on patients already with OXAIPN [12], [16], [17] and already presenting with neuropathic symptoms [18], thus performing a formal treatment trial rather than a preemptive or prophylactic approach. The bulk of evidence is negative for both scenarios [12], [14], [19], [20], with rare exceptions [17], [21]. Importantly, the large majority of studies have not used validated pain measurement tools [10], [11], [13], [14], [16], [19], [22], [23], while most have used the common terminology criteria (CTC) adverse events grading system as the primary outcome measurement.…”

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confidence: 99%

“…While this choice is sound and supported by robust evidence [24], it must be kept in mind that most patients with OXAIPN have small‐fiber‐predominant polyneuropathy [1], which has as its main symptom neuropathic pain. However, pain itself (i.e., visual analog scale (VAS), BPI) or neuropathic pain symptoms (i.e., NPSI) have rarely been used as a primary outcome in studies on OXAIPN, and only a few have used validated pain scales or questionnaires at all [12], [20], [21], [25]. Also, neuropathic symptoms have only rarely been evaluated [17], [26].…”

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confidence: 99%

Pregabalin for the Prevention of Oxaliplatin-Induced Painful Neuropathy: A Randomized, Double-Blind Trial

et al. 2017

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Lessons Learned. Pregabalin is a medication that can decrease neuronal hyperexcitability, relieve neuropathic pain, and reach stable plasma levels after a titration period of only a few days.Its use during oxaliplatin infusions was not able to decrease the incidence of chronic, oxalipaltin‐related neuropathic pain, compared with placebo.Background.Patients with colorectal cancer (CRC) receiving oxaliplatin (OXA) develop acute and chronic painful oxaliplatin‐induced peripheral neuropathy (OXAIPN). Acute and chronic OXA‐related neuropathies have different pathophysiological bases, but both lead to a common phenomenon: central sensitization (CS) of nociceptive neuronal networks, leading to increased sensitivity (hyperlgesia, allodynia) in the somatosensory system, the common ground of chronic neuropathic pain. Because CS is related to increased risk of painful OXAIPN, we hypothesized that preemptive use of the anti‐hyperalgesic drug pregabaline (known to decrease CS) during OXA infusions would decrease the incidence of chronic OXAIPN.Methods.Pain‐free, chemotherapy‐naïve CRC patients receiving at least one cycle of modified‐FLOX [5‐FU(500 mg/m2)+leucovorin(20 mg/m2)/week for] 6 weeks+oxaliplatin(85 mg/m2) at weeks 1‐3‐5 every 8 weeks] were randomized (1:1) into the study. Patients received either pregabalin or placebo for 3 days before and 3 days after each OXA infusion and were followed for up to 6 months. Clinical assessments were performed at baseline, at the end of chemotherapy, and after the follow‐up period. The main outcome was average pain at the last visit assessed by the visual analogic scale (0–10) item of the Brief Pain Inventory (BPI). Secondary endpoints were presence of neuropathic pain according to the Douleur Neuropathique‐4 (DN‐4), pain dimensions (short‐ form McGill Pain Questionnaire [MPQ]), Neuropathic Pain Symptom Inventory (NPSI), and changes in nerve conduction studies (NCS) and side effect profile.Results.One hundred ninety‐nine patients (57.0 ± 10.7 years old, 98 female, 101 male) were randomized. Data from 56 patients were not included in the analyses (as they did not receive at least one full cycle of modified FLOX). Data from 78 patients in the pregabalin group and 65 patients in the placebo group were retained for analyses. At the last visit, pain intensity in the pregabalin group was 1.03 (95% confidence interval [CI] = 0.79–1.26), and 0.85 (95% CI = 0.64–1.06) in the placebo group, which did not reach significance. Scores from the BPI, MPQ, DN‐4, NPSI, and NCS and side‐effect profiles and incidence of death did not differ between groups. Quality of life (QoL) score did not differ between groups (placebo = 76.9 ± 23.1, pregabalin group 79.4 ± 20.6). Mood scores were not significantly different between groups (placebo 9.7 [8.1–11.2]; pregabalin 6.8 [5.6–8.0]).Conclusion.The preemptive use of pregabalin during OXA infusions was safe, but did not decrease the incidence of chronic pain related to OXAIPN.

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Efficacy of gabapentin in the management of chemotherapy‐induced peripheral neuropathy

Abstract: This trial failed to demonstrate any benefit to using gabapentin to treat symptoms caused by CIPN.

Cited by 304 publications

References 30 publications

Chemotherapy-induced Peripheral Neuropathy in Pediatric Cancer Patients

Chemotherapy-induced Peripheral Neuropathy in Pediatric Cancer Patients

Ten weeks of home-based exercise attenuates symptoms of chemotherapy-induced peripheral neuropathy in breast cancer patients

Pregabalin for the Prevention of Oxaliplatin-Induced Painful Neuropathy: A Randomized, Double-Blind Trial

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