Albers, J.W., Chaudhry, V., Cavaletti, G., & Donehower, R.C. (2014). Interventions for preventing neuropathy caused by cisplatin and related compounds. Cochrane Database of Systematic Reviews, 3, CD005228.

DOI Link

Purpose

STUDY PURPOSE: To examine the efficacy of chemoprotective agents to prevent or limit neurotoxic side effects of cisplatin and related chemotherapy agents

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: CENTRAL, MEDLINE, LILACS, CINAHL to February 2013
 
INCLUSION CRITERIA: Randomized or quasicontrolled trials comparing treatment to placebo, no treatment, or other treatments; patients undergoing platinum-based chemotherapy
 
EXCLUSION CRITERIA: Not specified

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 420
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Risk of bias assessment

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 20 
  • TOTAL PATIENTS INCLUDED IN REVIEW = 2459
  • SAMPLE RANGE ACROSS STUDIES: 18–755
  • KEY SAMPLE CHARACTERISTICS: Varied tumor types receiving platinum-based chemotherapy

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results

Amifostine (seven trials): Three trials used in the meta-analysis (74 patients total) showed a lower prevalence of grade 1 (odds ratio [OR] = 0.26, p = 0.002) toxicity in favor of amifostine. Amifostine infusions were associated with hypotension. Calcium and magnesium (3 trials, 76 patients): Analysis showed no statistically significant overall effect for sensory neuropathy in individuals with neuropathy of at least grade 2. Glutathione (seven trials): For three trials in the meta-analysis (48 patients), there was a significant overall positive effect (OR = 0.29, p = 0.02) among patients with at least grade 2 neuropathy. ORG 2766 (four trials): Analysis showed no significant differences between groups for vibration perception tests at three to five months. Other interventions reviewed included vitamin E, diethyldithiocarbamate, oxcarbazepine, and retinoic acid.

Conclusions

There is insufficient high quality evidence to show that any agent is protective against platinum-induced neuropathy. There is some suggestion that amifostine, glutathione, and calcium and magnesium may have some effect.

Limitations

  • Limited number of studies included
  • Low sample sizes
  • There were few studies per intervention, and very few studies with small sample were included in the meta-analyses.

Nursing Implications

There is insufficient evidence to show that any agent is truly effective in protecting against neurotoxic effects of platinum-based chemotherapy. There is a continued need for well designed research using appropriate objective as well as subjective measures of neuropathy.

Legacy ID

6496