Taxane use may cause taxane-induced peripheral neuropathy (TIPN), which still struggles for an effective treatment. A randomized, double-blind, Phase II clinical trial compared the efficacy and safety of pregabalin (150 mg daily) and duloxetine (60 mg daily) for managing TIPN in breast cancer patients.

The study enrolled Patients with breast cancer receiving paclitaxel or docetaxel and with a grade 1 or more neuropathy (according to the National Cancer Institute Common Terminology Criteria for Adverse Events), and having score 4 or higher neuropathic pain severity [based on the visual analog scale (VAS)]. It assessed response to treatment based on improvements in the VAS, NCI-CTCAE, and Patient Neurotoxicity Questionnaire (PNQ) scores during a 6-week trial.

The study found both interventions to be effective in decreasing TIPN compared to baseline. At Week 6, 92.5% and 38.1% of the patients in the pregabalin and duloxetine groups, respectively, showed improvements in the VAS scores. Further, pregabalin demonstrated more significant improvement in NCI-CTCAE sensory neuropathy and the PNQ scores than duloxetine. Tolerance was well in both interventional groups, with mild adverse events.

Thus, pregabalin and duloxetine are well tolerated and efficacious in relieving neuropathic pain. However, a 150 mg dose of pregabalin is superior to a 60 mg dose of duloxetine.

Salehifar E, Janbabaei G, Hendouei N. et al. Comparison of the Efficacy and Safety of Pregabalin and Duloxetine in Taxane-Induced Sensory Neuropathy: A Randomized Controlled Trial. Clin Drug Investig. 2020;40: 249–257. https://doi.org/10.1007/s40261-019-00882-6