Abstract
Peripheral neurotoxicity is a disturbing issue for cancer patients who are treated with chemotherapy. Several medications have been developed for preventing chemotherapy-induced chronic neurotoxicity (CICNT) however; their relative efficacies have not yet been studied. In this study, we conducted a network meta-analysis to give intervention recommendations. The literature was searched in a variety of databases and eligible studies were chosen based on predefined criteria. Data extraction and statistical analysis was performed, and the results are displayed using the odds ratio (OR) and corresponding 95% credible intervals (CrI) with respect to overall and severe neurotoxicity. The medications were ranked according to their surface under cumulative ranking curve values. The consistency of direct and indirect evidence was also evaluated. We found that patients with amifostine or vitamin E (VE) treatment exhibited a lower risk of overall neurotoxicity compared to those using the placebo (amifostine: OR = 0.10, 95% CrI: 0.02–0.46; VE: OR = 0.08, 95% CrI: 0.01–0.99). In regard to preventing severe neurotoxicity, glutathione and amifostine treatment appeared to be significantly more effective than the placebo (glutathione: OR = 0.19, 95% CrI: 0.04–0.64; amifostine: OR = 0.12, 95% CrI: 0.02–0.48). In summary, amifostine, VE, and glutathione treatment is considered to be effective in lowering the risk of CICNT. However, further studies which consider safety are required.
Highlights
Chemotherapy is widely used as a cancer treatment; it induces peripheral neurotoxicity in patients [1]
The efficacy outcomes we studied were based on the ability of the above drugs to decrease overall and severe neurotoxicity in chemotherapy-treated cancer patients
The overall neurotoxicity network comparison results demonstrated that amifostine and vitamin E (VE) both have significantly lower odds ratio (OR) values compared to the placebo, indicating a high efficacy
Summary
Chemotherapy is widely used as a cancer treatment; it induces peripheral neurotoxicity in patients [1]. There are two main types of neuropathy that may be induced by different kinds of chemotherapies, acute neuropathy, and chronic neuropathy [2]. Acute neuropathy normally only lasts 1 week, and it is not dose related to chemotherapeutics. Chronic neuropathy is dose-related and can lead to a more debilitating influence on patients by causing paresthesia or proprioceptive changes [3]. As acute neuropathy is reversible and does not cause severe harm to the peripheral nervous system [2, 4,5,6], more attention is given to chronic peripheral neurotoxicity.
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