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Unfortunately, chemotherapy-induced peripheral neuropathy cannot currently be effectively treated. The emphasis in managing this condition lies in development of neuroprotective agents, which protect the nerves from becoming injured when treatment begins. Amifostine (Ethyol) has been approved by the Food and Drug Administration (FDA) to prevent kidney damage caused by repeat doses of cisplatin in patients who have a diagnosis of ovarian cancer or non-small cell lung cancer. Other neuroprotective drugs under investigation include:

• Calcium/magnesium infusions to reduce dysesthesia associated with oxaliplatin
• Acetyl-L carnitine (ALC) significantly improved sensory and motor neuropathy in a small trial involving 25 patients on chemotherapy
• Glutamine may be effective for peripheral neuropathy symptoms associated with paclitaxel
• Glutathione looks promising for prevention of neuropathy associated with oxaliplatin
• Thiol drugs containing sulfur
• Lipoic acid (comes as an oral supplement which has been used in Europe)

Neurotrophic agents, also called nerve growth factors (NGF) are another class of drugs under investigation and they work by ensuring the survival of neurons. Limited studies have shown that blood levels of NGF decrease or disappear after administration of chemotherapy. Some clinical trials have shown that patients with diabetic neuropathy and HIV-induced neuropathy exhibited improved function of small-fiber sensory nerves and reduction of pain intensity following administration of rhNGF. Trials are ongoing. Pyrimidine isaxonine is a drug that appears to enhance regeneration of peripheral nerves but has side effects, including hepatic toxicity, which presently limits its clinical use.

Other drugs which may be effective for chemotherapy-related peripheral neuropathy include:

• Gabapentin
• Carbamazepine may be beneficial but its hepatic (liver) and hematological side effects make it less desirable for cancer patients
• Data regarding oxcarbazepine is very limited
• Lamotrigine has shown promise with indications that a significant number of patients respond favorably. It also has the advantage of no hepatic side effects and the rash (if it occurs) is considered tolerable.
• Capsaicin can be used at any time

Massage and stretching help alleviate cramps and some benefit is seen from quinine found either in tonic water or over-the-counter preparations. An effort should be made to keep the dose as low as possible due to many potential side effects including cardiac arrhythmia and thrombocytopenia (low blood platelet count). Education and counseling of the patient with chemotherapy-induced peripheral neuropathy is very important since they could be experiencing a chronic long-term change of daily functioning. Two areas that can directly impact this adjustment include physical and occupational therapy as discussed above.