Cymbalta for pain following oxaliplatin treatment

Oxaliplatin is a drug that can cause a fairly unique serve related pain, which can be difficult to manage. Two recent phase II studies suggested that Cymbalta (duloxetine) is effective for this pain. Both studies were in small number of patients and there weas a significant monority of patients who did not tolerate treatment. Overall benefit was modest. Both studies concluded that using this drug is feasible. This was followed by an abstract at 2012 ASCO meeting of a phase III trial. This was a placebo controlled crossover trial, meaning that one group got the drug and the other placebo, and if the palcebo did not work, patients could be crossed over to the active drug arm of the study . It found that  there was no difference in duloxetine efficacy based on the specific chemo agent received. Severe (Grade 3) non-hematologic toxicity was reported by 11%, and 41% reported moderate (Grade 2) toxicities. The incidence of Grade 2+ fatigue, the most commonly reported side effect, was significantly higher in the duloxetine arm as compared to placebo (11% vs. 3%, p = 0.029). It concluded that duloxetine 60mg daily is an efficacious and well-tolerated intervention for the treatment of taxane or platinum-related painful CIPN.

This trial raised more questions than it answers. It does not prove that Cymbalta is uniquely beneficial for oxaliplaitn induced neuropathy and toxicity was significant. It was a comparison against placebo, not another analgesic or anti-depressant. Clearly, comparative studies are needed before it can be considered standard of care.

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