It is my understanding that the based on the expert panel that convened that there were no recommendations made for CIPN prevention.and that the drug that had the strongest support for use in treatment of CIPN is duloxetine. I read that when they were evaluating the literature for supporting data that it was determined that from a neurological standpoint that the MOA for some of the drugs being considered for CIPN were either unknown or that current practices had been based on some animal studies. Additional research is needed and physicians are encouraged to talk to their patients about clinical trials.
Emre - To my knowledge they have not; based on the best current evidence, there are several therapies that have some evidence supporting their use though:
Duloxetine (Cymbalta): One possible treatment for CIPN that is getting a lot of attention recently is is duloxetine (Cymbalta). Results of recent, well-designed randomized clinical trial showed a small but statistically significant reduction in neuropathic pain for patients receiving 60 mg of daily duloxetine compared to placebo. While the study included a relatively large cohort of patients receiving taxanes, the data suggest that Cymbalta may work better for patients who received platinating agents. That said, the data was strong enough to get a recommendation from the most recent clinical practice guideline on CIPN (Hershman et al. 2014).
Neurontin (Gabapentin)/Lyrica (Pregabalin): A second therapy that may be effective for mitagating CIPN is Neurontin (gabapentin) or Lyrica (pregabalin). Some patients see a reduction in painful/irritating CIPN symptoms with these drugs, but often the issue is that the doses needed to achieve these results come with side-effects. A pharmacy resident told me that in the hospital from which he came, to help get around this, some of the pharmacists had created a topical cream with Neurontin that allowed the medication to target the nerves in the fingers/toes that were most affected and minimize other side-effects. This may be something to explore.
Topical Gel with Baclofen, Amitriptyline, and Ketamine: The third option that you and you team may want to consider is a gel combining the pain-reliever/anesthetic ketamine 20 mg, amitriptyline HCL 40 mg (a tricyclic anti-depressant), and baclofen 10 mg (a muscle relaxer/anti-spasmodic). Back in 2011, results of an early trial with 208 patients suggested that the gel might improve CIPN, (and most relevant to you) and decrease the severity of burning pain in the hands better than placebo. Unfortunately, results of more recent (2014) Phase III study with 462 patients found no improvement in CIPN symptoms over six weeks in patients receiving the gel, but the authors only used a gel with ketamine and amitriptyline (no baclofen), so it's possible that the baclofen has to be part of the gel. It's also important to keep in mind that originally, clinicians were using higher doses for the ingredients than what the FDA would allow for the 2011 study, so it's possible higher doses would be more effective.
Scrambler Therapy: A final promising approach to mitigating the painful symptoms associated with CIPN involves direct elelectro- cutaneoustimulation of sensory nerves (known as ‘scrambler therapy’). The technique involves the use of uses a multiprocessor apparatus that transmits low frequency signals to the patient’s nerves. The processing unit uses a non-linear algorithm to select the effectively ‘scrambling’ the incoming pain signals to the central nervous system.
In 2010, Smith et al out of Masey Cancer Center in Virginia tested a brand of scrambler, the MC5-A Calmare®, in 18 participants (14 women), of which 50% (n=7) were women with breast cancer that had received taxanes. Participants in the study received scrambler therapy for 60 minutes a day for 10 days (excluding weekends). Results of the study showed a 58% reduction in self-reported pain (5.81±1.11 pre-treatment vs. 2.38±1.82 at the end of 10 days (P