Efficacy of topical capsaicin for treatment of chemotherapy-induced peripheral neuropathy
Keywords:capsaicin, neuropathy, CIPN, chemotherapy, topical
Chemotherapy-induced peripheral neuropathy (CIPN) is a commonly problem entity following many chemotherapies for cancer therapy, among which sensory abnormalities and pain are common and the most suffering issues. Current treatments for CIPN are largely ineffective. Topical capsaicin is produced from chili pepper extraction and effective for treatment of neuropathic pain in diabetic neuropathy, postherpetic neuropathy and HIV-associated neuropathy. Topical capsaicin was approved in Thai FDA for these indications. There are no studies of capsaicin cream in CIPN. This study assessed the efficacy of topical capsaicin in CIPN patients. This study is prospective study. Our study consisted of 50 patients with clinically confirm chemotherapy-induced peripheral neuropathy from various antineoplastic agents. They were treated with topical capsaicin at area of neuropathy and neuropathic pain. Baseline characteristics including primary cancer site, neurotoxic agent and cumulative dose, prior treatments were recorded. Symptoms were monitored and followed using the numerical rating scale (NRS), Grading of neurotoxicity by NCI-CTCAE version 4.0 and questionnaires of neurotoxicity and quality of life in these toxicities (FACT/GOG-NTX and EORTC-QLQ CIPN 20). These documents were collected at baseline, 1 week and 4 weeks after topical capsaicin application, including toxicities of this agent. A mixed effects linear regression model was applied to identify efficacy of topical capsaicin. These 50 patients with CIPN reported significant reduction all of scoring at 4 weeks after application. NRS = -0.35 (95%CI: -0.50, -0.20), Neurotoxicity by NCI-CTCAE = -0.09 (95%CI: -0.15, -0.02), FACT/GOG-NTX = -2.80 (95%CI: -3.50, -2.10) and EORTCQLQ CIPN score = -5.13 (95%CI: -6.17, -4.08). Global assessment of quality of life was improve by overall score. The efficacy and quality of life were constant after 1 week to 4 weeks after application. 21 (42%) patients has reported toxicities with burning but those are mild symptoms without quality of life effects. Topical capsaicin
has efficacy in significant reduction CIPN symptoms and improves quality of life of these patients.
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