Duloxetine is effective in alleviating chemotherapy-induced peripheral neuropathy (CIPN) in patients with advanced cancer, according to a study presented here at the 2017 ASCO Palliative Care in Oncology Symposium.
“Duloxetine reduced pain in patients with CIPN, significantly in most cases,” said Sang Mi Ro, MD, Youido St. Mary’s Hospital, Medical College, Catholic University, Seoul, South Korea. “The safety and tolerability were consistent with earlier data on long-term use in practice.”
The results from the 27-patient study fill in a gap in knowledge about the long-term efficacy and safety of duloxetine.
The primary disease of the patients in the study included breast/lung cancer (29.6%), gastrointestinal cancer (22.2%), genitourinary cancer (22.2%), lymphoma (14.8%), and other types for 3 (11.1%) patients. The majority of patients (n = 23) had stage IV disease.
Of the patients, 24 received neurotoxic chemotherapeutic agents. Concurrent medication use included gabapentin, pregabalin, and oxycodone/naloxone.
Duloxetine was given at a dose of 30 mg/day for the first week and 60 mg/day from the second week of treatment onward. Treatment was continued until toxicity became unacceptable, the patient died, or treatment was halted for some other reason based on a decision from the patient or physician.
During the treatment period (mean, 29 weeks; range 1-130 weeks), 25 (92.5%) of the 27 patients displayed a significant duloxetine-mediated reduction in their pain intensity from baseline. The mean decrease in the average pain score was 2.85 (P < .001). The median duration of the response was 19 weeks (range, 4-99 weeks). The best response tended to be obtained after 7 weeks of treatment, with response maintained for about 19 weeks.
Treatment-related adverse events most often included nausea (17.2%), vomiting (3.4%), and dizziness (6.8%). Somnolence, insomnia/constipation, and urinary retention/rash occurred in 1 patient each. Eleven (40.7%) patients discontinued treatment due to other reasons that included patient/physician decision, poor compliance, loss to follow-up, or progression of disease.
“Quality of life in the survivorship of patients with cancer is becoming one of the important issues with a development of systemic anticancer treatment,” said Dr. Ro. “About 40% of the patients who receive chemotherapeutic agents having neuropathic potential suffer from painful CIPN.”
[Presentation title: Long Term Efficacy and Safety of Duloxetine in the Management of Painful Chemotherapy Induced Peripheral Neuropathy. Abstract 236]