A step towards tackling chemotherapy-induced peripheral neuropathy (CIPN)
As the contributors point out, this study has various limitations (1). However, prospective randomized controlled trials (RCTs) in this field are scarce, and conducting a prospective RCT like ours to evaluate the hypothesis that “lafutidine has a preventive effect on chemotherapy-induced peripheral neuropathy (CIPN) induced by paclitaxel-containing chemotherapy” holds significant value (2). Although we were unable to collect the number of cases we estimated and did not achieve statistically significant results, conducting prospective comparative studies to address issues in the field of palliative care will become increasingly important.
Regarding the divided doses mentioned by the contributors, it is indeed known that divided doses, such as those introduced with nanoparticle albumin-bound paclitaxel (nab-PTX), reduce CIPN (3), and paclitaxel (PTX) is increasingly being administered in divided doses (4). However, treatments like atezolizumab + bevacizumab + CBDCA + PTX (ABCP) therapy still use single-dose administration of PTX, and this regimen is useful for patients with EGFR gene mutation lung cancer and liver metastasis, making it a viable option for many patients (5). Thus, the issue of preventing CIPN with single-dose PTX administration remains relevant.
As for the side effects of lafutidine, they cannot be underestimated, but as an H2 blocker that has been used for a long time, severe side effects are considered to be rare. We believe that the compliance with lafutidine is not an issue due to the low incidence of side effects from the drug itself. Patients undergo a questionnaire survey about neuropathy every time, which itself serves as a motivation for medication adherence, thus enhancing compliance.
This study does not address the pharmacological and neurological mechanisms of lafutidine. Elucidation through basic research, including animal experiments, is necessary. While this study may lack a strong fundamental background in that sense, if the efficacy of lafutidine is proven, basic research is expected to progress simultaneously.
Finally, receiving comments and interest in our research is a great encouragement for us as researchers. We expect to continue discussions with readers and contribute to the advancement of medicine.
Acknowledgments
Funding: None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Palliative Medicine. The article did not undergo external peer review.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-24-113/coif). M.M. reports receiving lecture fees from Taiho Pharmaceutical. The other authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
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