NEW YORK (Reuters Health) – Duloxetine can be helpful in cancer patients who experience painful neuropathy as a sequela of treatment with neurotoxic antineoplastic agents, according to a new study. “To our knowledge, the current study is the first large phase 3 trial to elucidate an effective intervention for painful chemotherapy-induced peripheral neuropathy caused by platinum and taxane agents (mainly paclitaxel or oxaliplatin),” the researchers report. They explain in their paper in the April 3 issue of JAMA that up to 40% of patients with cancer treated with taxanes, platinums, vinca alkaloids, or bortezomib develop painful peripheral neuropathy, which can persist for years and significantly decrease function and quality of life. Noting that duloxetine is effective for painful diabetic neuropathy, Dr. Ellen M. Lavoie Smith, with the University of Michigan School of Nursing, Ann Arbor, and colleagues conducted a randomized crossover trial of duloxetine versus placebo in 231 patients with chemotherapy-induced peripheral neuropathic pain levels of at least 4 on a 0-10 scale. Treatment started with 30 mg/day duloxetine or placebo for 1 week, followed by 60 mg/day duloxetine or placebo for 4 more weeks. Patients were randomly assigned to receive duloxetine followed by placebo or vice versa. During the initial treatment period, mean pain scores declined by 1.06 points in the duloxetine group versus 0.34 points in the placebo group (mean difference 0.71), according to the report. In the second treatment period after a 2-week washout, mean pain scores dropped by 1.42 points among patients switched to duloxetine from placebo compared to a decrease of 0.41 points for those who were switched to placebo – a mean difference of 1.01. Some decrease in pain was reported by 59% of patients initially receiving duloxetine compared to 38% of those initially given placebo, the investigators report. They also observed that patients treated with oxaliplatin benefited more from duloxetine than those who received taxanes. The mean difference in the reduction in pain score with duloxetine versus placebo was 1.06 in the platinum group, compared to just 0.19 for the taxane group. Summing up, Dr. Lavoie Smith and colleagues conclude, “Among patients with painful chemotherapy-induced peripheral neuropathy, the use of duloxetine compared with placebo for 5 weeks resulted in a greater reduction in pain.” SOURCE: Effect of Duloxetine on Pain, Function, and Quality of Life Among Patients With Chemotherapy-Induced Painful Peripheral Neuropathy JAMA 2013;309:1359-1367.