Still perplexed.

Top Line: How do you manage brachial plexopathy or similar radiation-related nerve injuries?

The Study: Pentoxyfylline and vitamin E..? A French group has been intensively investigating different options for treating radiation induced plexopathy. Their current best formulation is pentoxyfylline (400 mg BID) and tocopherol (aka vitamin E, 500 mg BID), a duo best known for reducing radiation fibrosis in the breast, as well as clodronate (800 or 1600 mg 5 days per week with prednisone the other 2 days per week)—all three together termed PENTOCLO. Clodronate is an alkyl-bisphosphonate that has shown efficacy at treating osteoradionecrosis. While none of these scream neuropathic agents, this trial randomized 59 patients with developing radiation plexopathy and no active cancer to PENTOCLO versus placebo for 18 months. The majority (90%) were women treated with radiation for breast cancer. Compared to baseline, there was no significant improvement in the subjective objective management analytic (SOMA) score in either group at 18 months. On the upside, PENTOCLO did not significantly increase toxicity. So there’s that.

TBL: There’s still no silver bullet to improve symptoms of radiation-induced plexopathy. | Delanian, Int J Radiat Oncol Biol Phys 2020