Drug treatment for chemotherapy-induced peripheral neuropathy in patients with pancreatic cancer

Pancreatic cancer (PC) is a lethal disease where most tumors are too advanced at diagnosis for resection, leaving chemotherapy as the mainstay of treatment. Although the prognosis of unresectable PC is poor, it has been dramatically improved by new chemotherapy treatments, such as the combination of 5-fluorouracil, oxaliplatin, irinotecan, and leucovorin (FOLFIRINOX) or gemcitabine plus nab-paclitaxel. However, as oxaliplatin and paclitaxel are common neurotoxic drugs, chemotherapy-induced peripheral neuropathy (CIPN) is a common and severe adverse effect of both treatments. As there are no agents recommended in the ASCO guidelines, we review the methods used to treat CIPN caused by PC treatment. The efficacy of duloxetine was observed in a large randomized controlled trial (RCT). In addition, pregabalin was more effective than duloxetine for CIPN in two RCTs. Although duloxetine and pregabalin can be effective for CIPN, they have several side effects. Therefore, the choice between the two drugs should be determined according to effect and tolerability. Mirogabalin is also used in patients with PC and there is hope it will yield positive outcomes when treating CIPN in the future.

Automated summary

Pancreatic cancer is a deadly disease that is usually diagnosed at an advanced stage, making chemotherapy the main treatment option. New chemotherapy treatments have significantly improved the prognosis for unresectable pancreatic cancer. However, these treatments often cause chemotherapy-induced peripheral neuropathy (CIPN) as a severe adverse effect. Currently, there are no recommended agents for CIPN in the ASCO guidelines. This article reviews the methods used to treat CIPN caused by pancreatic cancer treatment, including the efficacy of duloxetine and pregabalin, and the potential use of mirogabalin in the future.