Chemotherapy-induced peripheral neuropathy (CIPN), a frequent adverse effect in cancer patients, may find relief through topical drug combinations, according to a review presented at the 2024 Society for Integrative Oncology (SIO) Annual Conference. The research, led by Richard Lee, MD, at City of Hope, assessed the efficacy of various topical agents in managing CIPN symptoms.
Promising Topical Agents for CIPN
The systematic review identified six randomized controlled trials evaluating different topical agents. Notably, a combination of baclofen, amitriptyline, and ketamine (BAK) showed positive results in a large randomized trial involving over 200 patients. Additionally, single-agent studies involving CBD, peppermint geranium, black pepper, rosemary oil combination, and crepe ginger essential oil were examined. Crepe ginger essential oil demonstrated some initial benefit, although the study size was relatively small.
"These topical agents have the advantage of not being ingested, making them easier to use with fewer side effects," Lee noted. However, he emphasized the need for more research to fully understand the appropriateness and patient suitability for these agents.
Considerations for Topical Agent Use
While topical CBD showed benefit in one study, Lee acknowledged mixed data from other publications. He stated that further, larger randomized controlled trials are needed to determine the best agents and identify which patients would benefit most. The BAK combination, while promising, is not readily available as a premade product, limiting its immediate applicability.
Current Standards of Care and the Need for Alternatives
Currently, close monitoring and prevention are the primary strategies for managing CIPN. Duloxetine is the only medication with robust clinical evidence supporting its use for CIPN symptoms. Gabapentin is also commonly used, though with less robust data. Ongoing trials are exploring acupuncture as a potential treatment.
Implications for Oncology Nurses and Providers
Lee emphasized the importance of open communication between healthcare providers and patients regarding CIPN symptoms. He advised that patients should be informed that CIPN is often temporary and may resolve after chemotherapy cessation. For chronic cases, standard options should be considered, followed by alternative strategies like topical agents if necessary. "Many patients will usually feel better within the first 3 to 6 months. If it does become chronic, that's where we need to think about more standard options, and then potentially, if that doesn't help enough, to think about some of these other strategies, like some of the topical agents we talked about."
