Paclitaxel widely and effectively used in chemotherapy for breast cancer. However, paclitaxel-induced peripheral neuropathy (PIPN) is a common toxicity. According to our data, grade 1/2 sensory neuropathy occurred in more than 50% of paclitaxel-treated patients and lingered in 20% of them even after 3 years. Current treatment options for CIPN are quite limited. At present, pregabalin is most commonly used for PIPN in Japan. In contrast, American Society of Clinical Oncology Clinical Practice Guideline recommends duloxetine. We examined the efficacy and adverse events of duloxetine for treating PIPN.
Twenty-six Japanese breast cancer patients suffering PIPN were examined between March 2015 and August 2015. The median age was 63 years (range = 45-79). All patients were female and treated with paclitaxel as neo-adjuvant or adjuvant chemotherapy. Duloxetine was basically started with the minimum dose of 20 mg/day when grade 2 PIPN remained after pregabalin treatment. The efficacy and adverse events of duloxetine were examined by medical records, retrospectively.
PIPN by CTCAE v4.0 was found Grade1 in 3 cases, Grade 2 in 22 cases and Grade 3 in 1 case. In 13 of 26 patients (50%), PIPN was decreased to grade 1. Adverse events were found in 11 cases; drowsiness in 6, nausea in 4, constipation in 2 and dry mouth in 1 case. Duloxetine was discontinued in 8 cases by adverse events and 6 cases by no effect.
Duloxetine was effective in paclitaxel-induced and pregablin-resistant PIPN in Japanese breast cancer patients. However, it is necessary to manage adverse events related to serotonin and norepinephrine reuptake inhibitors.
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All authors have declared no conflicts of interest.