Hi again everyone.
As panelists for the AUA/ASTRO/SUO clinical treatment guideline for advanced prostate cancer we went through the chemotherapy options and we remained pretty silent on what to do about
peripheral neuropathy in patients receiving any form of Taxan-based or platinum-based chemotherapy (CIPN) commonly used in prostate cancer. The reason was the release of an ASCO guideline in 2017 on CIPN. In conclusion, the expert panel here found that there was no clear science on what to do to prevent or treat CIPN. Linked below and released yesterday in the ASCO Journal of Clinical Oncology is an update of that guideline that, well, still arrives at the same conclusion but more definitively defines existing medical, homeopathic, and other preventions/remedies ineffectiveness and /or lack of data.
I know for years I talked, even here, about
the use of frozen gloves, pain medication, gabapentin, even acupuncture, to help deal with CIPN. The studies here used strong meta-analysis papers, some trials, and many observational papers and determined that there is no known effective prevention or therapy, with one exception, in very bad cases. The benefit even in that exception, Duloxetine, was very minimal and it has very limited cases where it helped.
While this isn't good news in prostate cancer, this finding was not prostate cancer specific. It is not good for just about
any cancer receiving the agents described in this paper. Included agents used in PCa are Carboplatin, Cisplatin, docetaxel, and cabazataxel.
On one primary recommendation in that paper is to cease chemotherapy in patients where CIPN has become intolerable. In some cases, CIPN is very minimal and it even does not show up. And it should be a silver lining that most patients tolerate these side effects well. This paper can, while a bit technical, is a good educational reading on the effects of chemotherapy on nerves and nerve endings, and a pretty thorough analysis on the many agents, supplements, and even cryotherapy (frozen Gloves - FG).https://ascopubs.org/doi/full/10.1200/jco.20.01399?fbclid=iwar2qztbmpkffwv_ogjyppbevofkxrgpkmgrjzk1-nhtqzc0tdilngyojpxy
Post Edited (Tony Crispino) : 7/15/2020 10:47:26 PM (GMT-6)