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High concentration of topical amitriptyline for treating chemotherapy-induced neuropathies

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Supportive Care in Cancer Aims and scope Submit manuscript

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.

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Acknowledgments

The authors thank Necker-enfants malades Hospital, the Assistance Publique-Hôpitaux de Paris; and Thomas Rohban, MD, from Partner 4 Health, for his advice and for the writing of the manuscript. The work of CG is supported by École de l’Inserm-Liliane Bettencourt.

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Authors and Affiliations

  1. Department of Hematology, Assistance Publique Hôpitaux de Paris (APHP), Necker-enfants malades Hospital, Paris, France

    Julien Rossignol & Olivier Hermine

  2. University Paris Descartes, Paris, France

    Julien Rossignol, Benoit Cozzi, Marcel-Louis Viallard, Olivier Hermine & Céline Greco

  3. Inserm Unité 1163, Institut Imagine, Paris, France

    Julien Rossignol & Olivier Hermine

  4. Centre National de la Recherche Scientifique ERL8654, Paris, France

    Julien Rossignol & Olivier Hermine

  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

    Benoit Cozzi, Séverine Hatton, Marcel-Louis Viallard & Céline Greco

  6. Laboratoire d’éthique médicale EA 4569, Paris, France

    Benoit Cozzi, Marcel-Louis Viallard & Céline Greco

  7. Laboratoires Mayoly Spindler, Chatou, France

    François Liebaert

  8. Inserm UMRS 935, Villejuif, France

    Céline Greco

Authors
  1. Julien Rossignol
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  2. Benoit Cozzi
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  3. François Liebaert
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  4. Séverine Hatton
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  5. Marcel-Louis Viallard
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  6. Olivier Hermine
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  7. Céline Greco
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Contributions

CG designed and conducted the study, enrolled patients, analyzed the data, and wrote the manuscript. JR, SH, and BC enrolled and monitored patients, and collected the data. OH and MLV referred patients, and contributed to the review of the data and the manuscript. FL contributed to the review of the data and the manuscript.

Corresponding author

Correspondence to Céline Greco.

Ethics declarations

Informed consent was obtained from all patients prior to enrolment in the study. The study was approved by the Research Ethics Committee of the Hôpitaux Universitaires Paris-Ouest (HUPO), and by the French Data Protection Authority (Commission Nationale de l’Informatique et des Libertés, CNIL).

CG is acknowledged as inventor of a patent application owned by the compagny Algo Therapeutix SAS.

The authors have full control of all primary data and agree to allow the journal to review their data if requested.

Conflicts of interest

The authors declare that they have no conflicts of interest.

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Julien Rossignol and Benoit Cozzi are the first co-authors.

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Rossignol, J., Cozzi, B., Liebaert, F. et al. High concentration of topical amitriptyline for treating chemotherapy-induced neuropathies. Support Care Cancer 27, 3053–3059 (2019). https://doi.org/10.1007/s00520-018-4618-y

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  • DOI: https://doi.org/10.1007/s00520-018-4618-y

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