Pachman, D., Ruddy, K., Lafky, J., Beutler, A., Loprinzi, C., Dockter, T., . . . Sikov, W.M. (2017). A pilot study of minocycline for the prevention of paclitaxel-associated neuropathy: ACCRU study RU221408I. Supportive Care in Cancer, 25, 3407–3416.

To investigate the efficacy of minocycline for the prevention of CIPN and acute pain syndrome in patients receiving paclitaxel.

Minocycline 200 mg on day 1 followed by 100 mg twice daily or a matching placebo during 12 weeks of paclitaxel therapy. Treatment with minocycline/placebo stopped one week after paclitaxel.

• N = 47 (45 with final data)
• AGE: Mean age was 54.9 years (SD = 10.9)
• FEMALES: 100%
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: Breast cancer

• SITE: Multi-site   
• SETTING TYPE: Outpatient    
• LOCATION: 13 sites, including Mayo in Minnesota, North Carolina, North Dakota, Illinois, and Rhode Island. Authors are from these locations. Not specified in the article exact location of sites.

PHASE OF CARE: Active anti-tumor treatment

Randomized controlled trial

Patients completed a symptom pain measure and potential minocycline toxicities measure at baseline. APS symptoms were measured with a daily log of 10 items regarding pain symptoms and the use of pain medications on days 2-7 following each paclitaxel dose. On the eighth day, a 15-item questionnaire regarding symptoms was administered. CIPN was measured using the EORTC CIPN20 questionnaire at baseline, prior to each dose of paclitaxel, and then monthly after treatment ended for six months.

Significant difference in daily average pain score favoring the minocycline group (median = 96 versus 84.3, p = 0.02) and also a trend toward improvement in the daily worst pain score over the 12 cycles (p = 0.06). Also, aches and pains were less distressing (p  =0.02) and there was a trend toward less use of opioids (p = 0.05) in the minocycline group. There was no difference in the overall CIPN sensory subscale between groups or any difference in tingling, numbness, shooting/burning pain during treatment or for six months after treatment. No reports of minocycline toxicity. Patients who took minocycline reported significantly less fatigue (p = 0.02).

Minocycline in this study decreased APS symptoms but did not impact CIPN symptoms. An incidental finding was that the minocycline group had significantly less fatigue. Symptoms of APS have been reported in up to 71% of patients on 70-90 mg/m² of paclitaxel, and no agent has previously been shown to decrease these symptoms; however, analgesics are effective in alleviating the pain.

• Small sample (< 100)
• Risk of bias (sample characteristics)
• Measurement/methods not well described
• Other limitations/explanation: No report on adherence to minocycline. Sample consisted of women with breast cancer

Minocycline may be effective in reducing the symptoms of acute pain syndrome in women receiving paclitaxel therapy for breast cancer. No difference was seen in CIPN symptoms between the intervention and placebo group. Additional research is needed on women receiving higher doses of paclitaxel and to identify the impact of minocycline on treatment-related fatigue.