Goshajinkigan May Not Prevent Chemotherapy-induced Peripheral Neuropathy in Cancer

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 19th century Japanese botanical illustration
19th century Japanese botanical illustration

Goshajinkigan may not be effective in preventing chemotherapy-induced peripheral neuropathy (CIPN) among patients with cancer who receive neurotoxic chemotherapy, according to a study published in Supportive Care in Cancer.

Evidence from previous studies for patients with ovarian and endometrial cancers has suggested that goshajinkigan — a Japanese herbal remedy used to treat various conditions such as diabetic neuropathy and non-specific pain and numbness — may treat and prevent CIPN.

For this analysis, the researchers evaluated the outcomes of 5 randomized controlled trials that assessed the effects of oral goshajinkigan 7.5 g daily on CIPN prevention only in 397 patients with cancer. Eligible patients received neurotoxic chemotherapy such as taxanes, vinca alkaloids, and platinum-based agents, and were excluded if they had already developed CIPN. The included studies used either the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) or the Neurotoxicity Criteria of Debiopharm (DEB-NTC) definition of CIPN.

Results show that goshajinkigan was not associated with the reduction of incidence of any grade CIPN compared with study controls for trials that utilized NCI-CTCAE definitions.

The study that used DEB-NTC definitions demonstrated goshajinkigan significantly reduced the incidence of grade 1 and greater CIPN (risk ratio [RR], 0.43; 95% CI, 0.27-0.66) and greater than grade 3 CIPN (RR, 0.42; 95% CI, 0.25-0.71). This benefit, however, was not observed in grade 2 or greater CIPN.

Goshajinkigan was also found to be associated with neither improved tumor response (RR, 1.01; 95 %CI, 0.72-1.42; P = 0.29) nor improved disease control (RR, 0.96; 95% CI, 0.85-1.08; P = 0.56).

As revealed in the study, goshakjinkigan is unlikely to prevent CIPN but the authors concluded that “given the low quality and insufficient amount of current evidence, the efficacy of goshajinkigan as prophylaxis against CIPN is still inconclusive. More trials with better, standardized reporting of clinically important outcomes are needed.”

Reference

Kuriyama A, Endo K. Goshajinkigan for prevention of chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis [published online December 18, 2017]. Support Care Canc. doi: 10.1007/s00520-017-4028-6

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