Oxaliplatin-induced peripheral neuropathy (OIPN) is a common and debilitating toxicity in gastrointestinal (GI) cancer patients. Current guidelines lack consensus on pharmacological prevention and different interventions have shown mixed results without a definitive prevention against OIPN. Given the high incidence of OIPN in GI cancers, effective strategies are required to reduce toxicity, maintain treatment adherence and improve patient outcomes. These limitations warrant an updated review and meta-analysis to evaluate pharmacological interventions for preventing OIPN in GI cancers.
A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines by searching Embase, Medline, Web of Science, CINAHL and CENTRAL (January 2015–June 2025). Two reviewers performed screening and data extraction. RoB2 was used for quality assessment.
17 studies consisted of 18 RCTs with 14 different pharmacological interventions were analysed for prevention of incidence (≥1 grade) and severity (≥2 grade) OIPN in GI cancers. Overall non-significant prevention was observed for ≥1 grade (RR=0.88, 95% CI 0.76 to 1.02, PI: 0.73–1.06) and ≥2 grade OIPN (RR=0.89, 95% CI 0.71 to 1.12, PI: 0.51–1.55). Subgroup analysis reported regimen and intervention-specific effect with a trend towards benefit in CAPOX/XELOX group compared with FOLFOX group and in antioxidant group compared with neuroprotective group for prevention of ≥2 grade OIPN in GI cancer patients.
Current evidence remains insufficient to confirm effectiveness of pharmacological interventions in preventing OIPN in GI cancers. Larger, standardised RCTs are needed to establish effective preventive strategies and improve patient outcomes.
CRD420251044325