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Fingolimod for treatment and or prevention of chemotherapy-induced peripheral neuropathy in humans?

Purpose: Substantial preclinical data support that fingolimod, a drug that dysregulates sphingolipid metabolism, could both prevent chemotherapy-induced neuropathy (CIPN) and treat established chemotherapy-induced neuropathy. Methods: Two pilot-phase clinical trials were developed to evaluate whether fingolimod could 1) inhibit the development of paclitaxel-induced peripheral neuropathy and 2) diminish established CIPN in humans. Results: Unfortunately, both clinical trials were not able to fulfill planned accrual goals. One of the major accrual problems was the requirement for patients to be in the clinic for 8 hours following their first oral dose of fingolimod. The prevention of paclitaxel CIPN trial accrued 2 patients, one of whom did very well without any significant CIPN while the other patient developed CIPN that led to early paclitaxel dose cessation. The treatment of established CIPN trial accrued 7 of 10 planned patients. The results from the 6 patients who started daily treatment with fingolimod did not suggest that it substantially decreased CIPN over what might have been expected from a placebo effect. Conclusion: Fingolimod is a clinically difficult treatment for patients to start and the limited clinical data from these protocols did not support that it was able to prevent CIPN or treat established CIPN.