March 28, 2023

“A phase III study found that duloxetine (Cymbalta) is effective in treating painful chemotherapy-induced peripheral neuropathy—a finding that will likely change oncology practice and offers an important new quality of life solution for patients. Duloxetine is currently approved for the treatment of depression and painful diabetic peripheral neuropathy,” according to a news release. For related story, visit

This is patrice wendling at the american society of clinical oncology speaking with dr. ellen smith who’s done some research into the use of duloxetine for a very common side effect of chemotherapy peripheral neuropathy what is the mechanism of action do you think that’s working here these patients were not depressed so it wasn’t simply that they were feeling

Better and the dose i believe was subclinical for depression that’s correct we actually excluded patients who were depressed the mechanism of action is that duloxetine increases the amount of to pain inhibiting neurotransmitters in the brain serotonin and norepinephrine so this is then a brain function not really nerve that’s doing the response yes and this this

Is a really very interesting because there now has been increasing evidence to suggest that patients that have chronic pain conditions like painful neuropathy fibromyalgia osteoarthritis actually may not have in every circumstance evidence of peripheral injury but yet continue to have pain and so we believe that these patients actually are continuing to have pain

Because of abnormalities in the central nervous system that have to do with how we process pain 11% did actually see an increase in their pain what might be going on there with the treatment it’s hard to say pain is a very complicated thing to study there are many things that influence it and psychosocial issues cognitive issues cultural issues and so it’s hard to

Say i think again there may be patients who are more likely to respond to these kinds of drugs maybe because their central nervous system isn’t really working normally and so is that the difference why is that the reason why some people respond and others don’t that’s what we still need to work on to determine now these patients were treated for only four weeks

Would you maintain them on these drugs absolutely again based on the results that show that our side effect incidence was very low this would then suggest that patient could continue to take the drug there’s one caveat related to that in other studies where this drug was used to treat diabetic neuropathy these studies had patients take the drug for 12 weeks and

So it is possible that if you’re on the paid on the drug for a prolonged period of time you may then be more likely to develop side effects over time so again that’s unclear at this point there are other drugs that have obviously been used tricyclics there are other sort of serotonin norepinephrine inhibitors how was the advantage to duloxetine in this regard the

Advantage is that really for the first time we have some clear evidence to suggest that it works the side effects are much less than side effects that patients experience from tricyclics there are other serotonin norepinephrine inhibitors and there are studies ongoing that are looking to see whether these drugs are effective as well the main benefit though in

Terms of side-effect profile patients don’t have a lot of side effects now again that does have something to do with how the drug is dosed in our study we started with a lower dose 30 milligrams for the first week and then increased to 60 milligrams in the second week whereas an other studies patients were started right off with the higher dose and so side-effect

Management has a lot to do with how the drug is an initially dosed and your next step forward in terms of research our next step is actually to try to determine if we can identify people who may respond based on having evidence of abnormal central nervous system mechanisms that inhibit pain and so there may be people who are what we call pain prone people that at

The get-go either have because they have abnormal mechanisms ongoing in their brain because there may be genetic factors that are playing a role will be more likely to develop pain but then in turn if their pain is centrally mediated would be more likely to get an effect from a drug like this thank you doctor this is patrice wendling american society of clinical oncology you

Transcribed from video
ASCO: Duloxetine Effective in Treating Chemo-Induced Pain By MDedge news and insights for busy physicians