Chu Sang Hui, Lee Young Joo, Lee Eon Sook, Geng Yimin, Wang Xin Shelley, Cleeland Charles S
Department of Clinical Nursing Science, Yonsei University College of Nursing, Nursing Policy Research Institute, Biobehavioral Research Center, 50 Yonsei-ro, Seodaemun-Gu, Seoul, 120-752, South Korea,
Support Care Cancer. 2015 Feb;23(2):513-24. doi: 10.1007/s00520-014-2408-8. Epub 2014 Sep 26.
Chemotherapy-induced peripheral neuropathy (CIPN) is common among cancer patients who undergo chemotherapy with platinum analogues, taxanes, vinca alkaloids, epothilone, bortezomib, and thalidomide. The purpose of this study was to investigate the evidence of using drugs affecting the central nervous system (CNS) to alleviate CIPN in cancer patients.
A systematic literature search was conducted using the CINAHL, EMBASE, and Medline databases to identify randomized controlled clinical trials (RCTs) reported in English up to 2013. We identified ten trials of CNS-acting drugs used to treat CIPN in cancer patients and reviewed efficacy and safety of CNS-acting drugs for CIPN using a standard data collection form. The risk of bias in each RCT was also assessed.
Antidepressants were used in six studies and anticonvulsants in four studies. We found positive results for amitriptyline (topical), venlafaxine, and oxcarbazepine in one study each, but the results were not sufficient to draw definite conclusions. One trial with duloxetine showed a moderate effect (effect size, 0.513, P = .003) on CIPN pain relief. However, none of the results has yet been duplicated in an RCT with a large sample size.
Insufficient RCTs exist to confirm the efficacy of CNS agents to reduce CIPN. This study highlighted the need for and the importance of conducting well-designed RCTs to generate evidence on CIPN symptom management. Additional RCTs are warranted to accelerate the potential use of CNS drugs for CIPN in cancer patients.
化疗引起的周围神经病变（CIPN）在接受铂类类似物、紫杉烷类、长春花生物碱、埃坡霉素、硼替佐米和沙利度胺化疗的癌症患者中很常见。本研究的目的是调查使用影响中枢神经系统（CNS）的药物来缓解癌症患者CIPN的证据。
使用CINAHL、EMBASE和Medline数据库进行系统的文献检索，以识别截至2013年以英文报道的随机对照临床试验（RCT）。我们确定了十项用于治疗癌症患者CIPN的中枢神经系统作用药物试验，并使用标准数据收集表回顾了中枢神经系统作用药物治疗CIPN的疗效和安全性。还评估了每项RCT的偏倚风险。
六项研究使用了抗抑郁药，四项研究使用了抗惊厥药。我们分别在一项研究中发现阿米替林（局部用药）、文拉法辛和奥卡西平有阳性结果，但结果不足以得出明确结论。一项使用度洛西汀的试验显示对CIPN疼痛缓解有中度效果（效应量，0.513，P = 0.003）。然而，在大样本量的RCT中尚未重复这些结果。
现有RCT不足以证实中枢神经系统药物减少CIPN的疗效。本研究强调了进行设计良好的RCT以产生CIPN症状管理证据的必要性和重要性。需要更多的RCT来加速中枢神经系统药物在癌症患者CIPN中的潜在应用。
