Efficacy of gabapentin in the management of chemotherapy-induced peripheral neuropathy - A phase 3 randomized, double-blind, placebo-controlled, crossover trial (NOOC3)

BACKGROUND. The antiepileptic agent, gabapentin, has been demonstrated to relieve symptoms of peripheral neuropathy due to various etiologies. On the basis of these data, a multicenter, double-blind, placebo-controlled, crossover, randomized trial was conducted to evaluate the effect of gabapentin on symptoms of chemotherapy-induced peripheral neuropathy (CIPN). METHODS. Patients with symptomatic CIPN who complained of 'average' daily pain scores of either 1) >= 4 on a 0-10 numerical rating scale (NRS); or 2) >= 1 on the 0-3 Eastern Cooperative Oncology (Group neuropathy scale (ENS) were eligible (higher numbers indicate greater severity of symptoms in both scales). Patients were randomized to receive gabapentin (target dose, 2700 mg) or placebo for 6 weeks. Crossover occurred after a 2-week washout period. CIPN-related symptoms were evaluated weekly by questionnaires. Statistical methods followed established methods for crossover designs, including Student t tests to compare average intrapatient differences between treatments and linear models to adjust for potential concomitant covariates. RESULTS. There were 115 patients who were randomly assigned to the treatment or control arm. Both groups were well matched by symptoms at study entry. Changes in symptom severity were statistically similar between the 2 groups during the study Adverse events were mild and similar in both groups. CONCLUSIONS. This trial failed to demonstrate any benefit to using gabapentin to treat symptoms caused by CIPN.