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Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common and potentially dose-limiting side effect of neurotoxic chemotherapies. No therapies are available to prevent CIPN. The small number of positive randomized clinical trials (RCTs) evaluating preventive therapies for CIPN provide little guidance to inform the design of future trials. Moreover, the lack of consensus regarding major design features in this area poses challenges to development of new therapies. An Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities and Networks (ACTTION)–Consortium on Clinical Endpoints and Procedures for Peripheral Neuropathy Trials (CONCEPPT) meeting attended by neurologists, oncologists, pharmacists, clinical trialists, statisticians, and regulatory experts was convened to discuss design considerations and provide recommendations for CIPN prevention trials. This article outlines considerations related to design of RCTs that evaluate preventive therapies for CIPN including (1) selection of eligibility criteria (e.g., cancer types, chemotherapy types, inclusion of preexisting neuropathy); (2) selection of outcome measures and endpoints, including those that incorporate alterations in chemotherapy dosing, which may affect the rate of CIPN development and its severity; (3) potential effects of the investigational therapy on the efficacy of chemotherapy; and (4) sample size estimation. Our hope is that attention to the design considerations and recommendations outlined in this article will improve the quality and assay sensitivity of CIPN prevention trials and thereby accelerate the identification of efficacious therapies.
Glossary
- ACTTION=
- Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities and Networks;
- CIPN=
- chemotherapy-induced peripheral neuropathy;
- ClinRO=
- clinician-rated outcome measure;
- CONCEPPT=
- Consortium on Clinical Endpoints and Procedures for Peripheral Neuropathy Trials;
- DOOR=
- Desirability of Outcome Ranking;
- EORTC-CIPN20=
- European Organisation for Research and Treatment of Cancer–CIPN20;
- FACT-Taxane=
- Functional Assessment of Cancer Therapy–Taxane;
- FDA=
- Food and Drug Administration;
- LOCF=
- last observation carried forward;
- NCI-CTCAE=
- National Cancer Institute–Common Terminology Criteria for Adverse Events;
- PRO=
- patient-reported outcome;
- QST=
- quantitative sensory testing;
- RCT=
- randomized clinical trial;
- TNS=
- Total Neuropathy Score;
- TNS-SF=
- TNS–short form;
- TNSc=
- TNS–clinical
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
The views expressed in this article are those of the authors and no official endorsement by the Food and Drug Administration (FDA) or the pharmaceutical and device companies that provided unrestricted grants to support the activities of the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership should be inferred.
Editorial, page 379
- Received February 1, 2018.
- Accepted in final form May 24, 2018.
- © 2018 American Academy of Neurology
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