Colon Cancer News
News in Review: Effect of Duloxetine on Neuropathy
A recent study published in the April edition of the Journal of the American Medical Association showed that duloxetine, also commonly known as the anti-depressant Cymbalta, was able to decrease pain and Chemotherapy-induced peripheral neuropathy, often abbreviated as CIPN.
We sat down with Dr. Laura Porter to hear the highlights and her take on the findings.
What is Chemotherapy-Induced Peripheral Neuropathy?
Chemotherapy-induced peripheral neuropathy, often abbreviated as CIPN, is a tingling or numbness that beings in the hands and/or feet and creeps up the arms and legs. It can also manifest as a shooting and/or burning pain or sensitivity to temperature. It can include sharp, stabbing pain, and it can make it difficult to perform normal day-to-day tasks. 
Currently, there are no known effective treatments for CIPN, as many of us are aware. About 20-40% of patients on neurotoxic chemotherapies, of which the colon-cancer fighting oxaliplatin is one, will develop CIPN.
Duloxetine: Blocking the Pain
A new clinical trial tested the use of duloxetine, commonly known as the anti-depressant Cymbalta, to decrease pain after a five week period. The study also looked at how the drug affected quality of life and other side effects.
Duloxetine has been used for peripheral neuropathy before in diabetic patients and has been shown to be effective in blocking the transmission of pain stimuli by the two key neurotransmitters serotonin and norepinephrine.
This breakthrough study was a randomized phase 3 double-blind, placebo controlled crossover trial that assessed whether a single daily dose could reduce the symptoms of CIPN. The trial included 231 patients from eight different cancer centers.
Will This New Study Bring New Hope?
The study results were promising for those of us who have been on oxaliplatin, but less promising for other treatments, such as taxanes used for breast cancer.
- The duloxetine group reported a larger decrease in average pain
- There was a decrease in pain interference of daily functioning
- Pain-related quality of life improved to a greater degree in those on duloxetine
- There were no severe or moderately-severe adverse effects reported, although several people dropped out of the trial due to moderate side effects
- 41% of people treated with duloxetine reported a decrease in numbness and tingling in feet, the same response was not observed in the hands
Larger trials need to be done, but there is hope for treatment of neuropathy. As with all medications, none are benign and all have side-effects. Unfortunately, duloxetine comes with its share of them.
The good news is that progress is being made.
2. Effect of duloxetine on Pain, Function and Quality of Life among patients with Chemotherapy-Induced Peripheral Neuropathy (CIPN). Journal of the American Medical Association. April 3, 2013.