Evaluating Laser Photobiomodulation for the Treatment of Neuropathic Pain in Chemotherapy-induced Peripheral Neuropathy in Cancer Patients (NEUROdoux)

Institut du Cancer de Montpellier - Val d'Aurelle

Status: Not yet enrolling

Conditions: Cancer Survivors; Peripheral Neuropathic Pain

Treatments: Device: Photobiomodulation sessions

Study type: Interventional

Funder types: Other

Identifiers

NCT06834685

2024-A02524-43 (Other Identifier)

PROICM 2024605 NEU

Details and patient eligibility

About

Chemotherapy-induced peripheral neuropathy (CIPN) (including taxanes, platinum, al pervenche from Madagascar alkaloids...), is a frequent secondary effect of treatments: 68% at 1-month post-chemotherapy, 60% at 3 months and 30% after 6 months. Symptoms associated with CIPN are usually symmetric and bilateral (typical distribution in "gloves and socks") inducing sensory alterations, paresthesias, dysesthesias, numbness and pain. Neuropathic Pain (NP) is an important characteristic of CIPN, affects 25-80% of patients with CIPN, and reduces quality of life (e.g., concomitant psychological distress, risks of falls, risks of neurocognitive impairments, and sleep disorders).

In severe cases, it is even necessary to delay and/or reduce the dose of chemotherapy. The benefit of drug interventions on NP remains limited. To date, there are no proven preventive strategies and few evidence-based treatment options for CIPN. Also, the use of complementary or non-pharmacological interventions are common, including photobiomodulation (PBM).

PBM is the therapeutic use of non-ionizing laser light for its anti-inflammatory and regenerative effects. Its use is currently recommended only for the prevention of oral mucositis related to cancer treatments. Recent preliminary clinical evidence suggests that PBM may be beneficial to established CIPN, with safety and improvement beyond the intervention. However, to date, clinical trials are rare, have methodological weaknesses, and/or focus on global CIPN. The overall objectives of the study are therefore to assess the effectiveness, feasibility and safety of the PBM for treating NP in the CIPN.

Enrollment: 70 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Male or female aged 18 years minimum;
• Patient treated at the Montpellier Cancer Institute for a cancer (whatever the location) requiring a chemotherapy;
• Patient with significant NP defined as a score of 4 at the clinician-rated DN4 ;
• Patient with a NP for at least 3 months after the end of an adjuvant or neo-adjuvant chemotherapy;
• Patient having signed informed consent prior to any study procedure;
• Patient affiliated to a French social protection system;
• Patient sufficiently fluent in French to complete questionnaires, as the investigator clinical discretion.

Exclusion criteria

• Patient unable to come twice a week to the Montpellier Cancer Institute;
• Patient unable to sit for a 30-minutes period;
• Patient with an open wound or ulcer on the treatment area;
• Patient whose diagnosis of peripheral neuropathy is due to another cause (n.b., diabetes without neuropathy will not be a specific exclusion);
• Patient with uncontrolled psychiatric illness or neurocognitive impairment that may interfere with assessments, as the investigator clinical discretion;
• Patient whose estimated life expectancy is less than 3 months, as estimated by a clinical investigator;
• Patient using another concurrent non-pharmacological intervention or complementary therapy for neuropathy during the study;
• Patient who has been treated with CAPSAISINE during the previous 3 months;
• Patient with pacemaker;
• Epileptic patient;
• Patient with photosensitive medications, or any medical condition causing sensitivity to light (n.b., Lupus);
• Pregnant and/or breastfeeding woman;
• Patient with primary tumor and/or metastases in areas to be treated by BPM (i.e., hands and/or feet);
• Patient with pre-existing eye disease (such as maculopathy, glaucoma, cataract and retinal lesions), or a history of family eye diseases;
• Patient who has been already been treated with photobiomodulation on the area of interest.

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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70 participants in 2 patient groups

Experimental arm

Experimental group

Description:

Photobiomodulation sessions (2 per week for 4 weeks, 8 sessions in total) will be delivered by certified laser safety clinicians (i.e., algologists, pain nurses or neuropsychologists). The treatment will be administered by an ATP38 device delivering a power of 6 Joules/cm2 at wavelengths of 620 and 820 nm. The light will be applied to all hands and/or feet for 13 minutes. The order of transfer between feet and hands will be counterbalanced so that, half of the sessions will have started with feet, and the other half will have started with hands. The dose will be specified at each session. Patients will be treated in a sitting position (to treat the hands) or a semi-seated position (for feet). They will wear opaque glasses to ensure the safety of the laser and the blind condition of treatment

Treatment:

Device: Photobiomodulation sessions

Control arm

No Intervention group

Description:

In the sham therapy, patients will have the same procedure as the laser intervention (i.e., visit schedule, eye mask, equipment, and application body regions), but without joules. Patients in this placebo arm will have the opportunity to receive the real treatment at the end of the study if they wish.