Format

Send to

Choose Destination
Support Care Cancer. 2019 Aug;27(8):3053-3059. doi: 10.1007/s00520-018-4618-y. Epub 2019 Jan 4.

High concentration of topical amitriptyline for treating chemotherapy-induced neuropathies.

Rossignol J1,2,3,4, Cozzi B2,5,6, Liebaert F7, Hatton S5, Viallard ML2,5,6, Hermine O1,2,3,4, Greco C8,9,10,11.

Author information

1
Department of Hematology, Assistance Publique Hôpitaux de Paris (APHP), Necker-enfants malades Hospital, Paris, France.
2
University Paris Descartes, Paris, France.
3
Inserm Unité 1163, Institut Imagine, Paris, France.
4
Centre National de la Recherche Scientifique ERL8654, Paris, France.
5
Department of neonatal, pediatric and adult pain and palliative medicine unit, Assistance Publique Hôpitaux de Paris (APHP), Necker-enfants malades Hospital, 149 Rue de Sèvres, 75015, Paris, France.
6
Laboratoire d'éthique médicale EA 4569, Paris, France.
7
Laboratoires Mayoly Spindler, Chatou, France.
8
University Paris Descartes, Paris, France. celine.greco@inserm.fr.
9
Department of neonatal, pediatric and adult pain and palliative medicine unit, Assistance Publique Hôpitaux de Paris (APHP), Necker-enfants malades Hospital, 149 Rue de Sèvres, 75015, Paris, France. celine.greco@inserm.fr.
10
Laboratoire d'éthique médicale EA 4569, Paris, France. celine.greco@inserm.fr.
11
Inserm UMRS 935, Villejuif, France. celine.greco@inserm.fr.

Abstract

PURPOSE:

Chemotherapy-induced peripheral neuropathy (CIPN) is a devastating pain condition of cancer therapy that may force chemotherapy dose reduction or discontinuation. Since treatment options for CIPN are quite limited, we investigated the effect of 10% amitriptyline cream on neuropathic pain.

PATIENTS AND METHODS:

This pilot study enrolled patients with hematological or solid tumors presenting hands and feet CIPN (for less than 1 month without previous treatment for CIPN [Group 1]; for more than 1 month with previous treatment [Group 2]). Patients applied 10% amitriptyline cream twice a day. Pain intensity was evaluated at 1, 2, and 4 weeks then monthly up to 1 year. The primary endpoint was change from baseline to 4-week treatment in median pain score assessed by visual analogue scale (VAS).

RESULTS:

Overall, 44 patients were enrolled. Median (range) age was 67 (46-80) years, 34% were female. The majority (88.6%) had hematological malignancies, and the most commonly used chemotherapeutic agents were bortezomib and oxaliplatin. The median (range) VAS pain score decreased from 7 (4-9) at baseline to 2 (0-4) after 4-week topical treatment. No difference was seen between Group 1 and Group 2. Reduced initial chemotherapy doses in 11 patients as well as chemotherapy discontinued in 5 patients at baseline were resumed after treatment with 10% amitriptyline cream.

CONCLUSION:

Considering the limited efficacy of conventional systemic treatments in CIPN and their safety profile, 10% topical amitriptyline appears to be a good candidate for first-line CIPN therapy, allowing continuation of chemotherapy at effective doses. The results are worth to be confirmed in a placebo-controlled clinical trial.

KEYWORDS:

Amitriptyline cream; CIPN; Neuropathy; Pain; Supportive care

PMID:
30607681
DOI:
10.1007/s00520-018-4618-y
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center