Treatment of Platinum-Based Chemotherapy-Induced Peripheral Neuropathy

First-Line Treatment

The American Society of Clinical Oncology recommends duloxetine as the first-line treatment for platinum-based chemotherapy-induced peripheral neuropathy, with the strongest evidence showing it is more effective for platinum-induced neuropathy than for taxane-induced neuropathy 1, 2
Duloxetine should be started at 30 mg daily for the first week, then increased to 60 mg daily for ongoing treatment, with Level I, Grade B evidence for treating painful CIPN 1, 2, 3

The American Society of Clinical Oncology suggests pregabalin or gabapentin as second-line options, though evidence is weaker than for duloxetine 1, 2
Nortriptyline is a reasonable option based on efficacy in other neuropathic pain conditions, with a target maximum dose of 100 mg/day 1
Venlafaxine has shown effectiveness in a small randomized trial with Level II, Grade C evidence 1

A compounded gel containing baclofen, amitriptyline, and ketamine has shown improvement on CIPN-20 scores, especially the motor subscale, after 4 weeks, with Level II, Grade C evidence 1, 2
1% menthol cream applied twice daily to affected areas and corresponding spinal dermatomal regions has improved pain scores after 4-6 weeks, with Level III, Grade B evidence 1, 2
8% capsaicin patches have established efficacy for other neuropathic pain forms, with Level I, Grade C evidence for general neuropathic pain and Level III, Grade C for CIPN 1, 2

Opioids should only be used as a last resort when other treatments have failed, with tramadol 200-400 mg in divided doses having established efficacy for other neuropathic pain forms, and strong opioids at the smallest effective dose may relieve neuropathic pain 1, 2

NSAIDs and glucocorticoids have no supporting data for CIPN treatment, and vitamin B12 is inferior to duloxetine 1, 2
Acetyl-L-carnitine should be avoided as it may worsen neuropathy over time 8, 6
No agents are recommended for preventing platinum-induced neuropathy, and calcium/magnesium infusions, venlafaxine, and other preventive strategies lack sufficient evidence or have concerns about reducing chemotherapy efficacy 8, 6, 7

Exercise therapy, such as home-based muscle strengthening and balance exercises, may provide benefit with significant reduction in neuropathic pain scores, though larger studies are needed 4
Acupuncture has insufficient evidence for routine recommendation outside clinical trials 8, 6, 4