Research Roundup

Antidepressant helps relieve pain from chemotherapy, study finds

The antidepressant drug duloxetine, known commercially as Cymbalta, helped relieve painful tingling feelings caused by chemotherapy in 59 percent of patients. This is the first clinical trial to find an effective treatment for this pain.

Chemotherapy-induced peripheral neuropathy is a common side effect of certain chemotherapy drugs. The tingling feeling -- usually felt in the toes, feet, fingers and hands -- can be uncomfortable for many patients. For about 30% of patients, the sensations are painful.

In the current study, researchers looked at 231 patients who reported painful neuropathy after receiving the chemotherapy drugs oxaliplatin or paclitaxel. Patients were randomly assigned to receive duloxetine or a placebo for five weeks. They were asked to report on their pain levels weekly.

The researchers found that 59% of patients who received duloxetine reported reduced pain compared to only 39% of those taking placebo.

"The good news is it worked in the majority of patients. We need to figure out who are the responders. If we can predict who they are, we can target the treatment to the people it's going to work for," said lead study author Ellen M. Lavoie Smith, Ph.D., A.P.R.N., A.O.C.N., assistant professor at the University of Michigan School of Nursing and a researcher at the U-M Comprehensive Cancer Center.

Duloxetine has previously been shown to help relieve painful diabetic neuropathy. This type of antidepressant is believed to work on pain by increasing neurotransmitters that interrupt pain signals to the brain.

In this study, participants received a half-dose of duloxetine initially before ramping up to a full dose of 60 mg. Few severe side effects were reported with this approach, the most common being fatigue.

Treating painful peripheral neuropathy is critical because, if the pain becomes too severe, doctors might limit the patient's chemotherapy dose.

 

Read the complete press release: Antidepressant helps relieve pain from chemotherapy, study finds.

 

Kidney cancer patients do better when whole kidney is not removed, U-M study shows

Kidney cancer patients who had just the tumor removed had better survival rates than patients who had their entire kidney removed, according to a new study from researchers at the University of Michigan Comprehensive Cancer Center.

After an average of five years, 25% of patients who had a so-called partial nephrectomy, in which only the tumor and a small amount of healthy tissue is removed, had died, while 42% of patients who had radical nephrectomy, in which the entire kidney is removed, had died, the study found.

"For patients who are candidates for partial nephrectomy, it should be the preferred treatment option. We found that patients who were younger or had pre-existing medical conditions benefited most from partial nephrectomy," said lead study author Hung-Jui Tan, M.D., a urology resident at the U-M Medical School.

The researchers looked at 7,138 Medicare recipients with early stage kidney cancer up to eight years after treatment. The study found that patients from each group were equally likely to die of kidney cancer, which suggests each procedure is equally effective at curing the cancer. The survival discrepancy was found in the number of patients who died from any cause, including complications related to surgery.

The study showed that if seven patients chose partial nephrectomy over radical nephrectomy, one extra life would be saved. The question, though, is whether partial nephrectomy -- which is a more technically challenging procedure and potentially associated with more short-term complications -- is preferable to radical nephrectomy. Removing a kidney can increase the risk of chronic kidney disease, which is associated with lipid disorders, cardiovascular disease and renal failure.

The debate is similar to breast cancer surgery, in which studies have found that lumpectomy plus radiation is comparable to mastectomy. While that choice often comes down to a cosmetic trade-off, the trade-off with kidney cancer is a potential higher risk of short-term complications with partial nephrectomy vs. avoiding chronic kidney disease in the long term.

Results of the study appear in the April 18 Journal of the American Medical Association.

 

Read the complete press release: Kidney cancer patients do better when whole kidney is not removed, U-M study shows.

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