What treatments, after appropriate dose reductions/delays, do you offer for patients with oxaliplatin-induced cold allodynia/dysesthesia?

The primary treatments that I use for cold-induced oxaliplatin neurotoxicity are reducing the oxaliplatin dose and limiting the duration of oxaliplatin treatment (usually not more than 16 weeks of oxaliplatin-containing therapy in the initial line of treatment). Medications that are effective for pa...

Primarily, I would use duloxetine and/or gabapentin. Duloxetine is guided by historical studies in patients with chemotherapy-induced neuropathy (including Smith et al., PMID 23549581). More recent studies (NCT04137107) may question the benefit, but additional studies may be required. Gabapentin/Pre...

Currently, there are no established recommendations for the prevention of oxaliplatin-induced cold allodynia/dysesthesia. Emerging evidence supports the use of dose/schedule modification, compression therapy, and neuromuscular training as feasible strategies to reduce the risk and severity of oxalip...

For the acute cold dysesthesia, I have lengthened the oxaliplatin infusion up to 3 hours rather than 2 hours, and have patients wear gloves and avoid fans and direct AC flow. I have not used medications.