Chemotherapy-induced peripheral neuropathy (CIPN) develops as a challenging nerve-damaging adverse effect of anticancer drugs used in chemotherapy. The disorder may require a chemotherapy dose reduction and a cessation of administration of chemotherapeutic drugs. Its principal sensory symptoms include, tingling, and numbness in the hands and feet. Severe pain can be encompassed among clinical manifestations. CIPN affects dramatically the patient's quality of life (QoL). Pain and sensory symptoms may occur for months, or even years after the termination of chemotherapeutic drugs. Although many pharmacological and non-pharmacological therapeutic approaches have been tested to overcome these symptoms, there is currently no standardized treatment for CIPN. According to current guidelines, Duloxetine is the only recommended agent for painful neuropathic symptoms. Therefore, finding effective therapies for CIPN is mandatory. The aim of this review was to dissect CIPN, the target and immunotherapy-based approaches to this disorder, as well as to offer new insights for new therapeutic perspectives.Chemotherapy-induced peripheral neurotoxicity (CIPN) is a common side effect of cancer therapy, affecting approximately 40% of patients receiving active treatment (1). CIPN is mainly characterized by sensory symptoms in a typical distribution (i.e., 'stocking and glove') that first appear in the toes and fingers and then spread to the legs and arms. Patients suffering from a more severe form of CIPN, also show fatigue, pain, and gastrointestinal disorder. Interestingly, patient age, impaired renal function, exposure to other neurotoxic chemotherapeutic agents, or other disorders represent predisposing risk factors of CIPN (2). The pathophysiology of CIPN is very complex and relies on several processes depending on the type of chemotherapy used, although the underlying molecular mechanisms are still unknown (1-4). Many chemotherapy agents are associated with indirect or direct neurotoxicity and CIPN, including platinum derivates, taxanes, vinca alkaloids, proteasome inhibitors, Bortezomib, immunomodulatory agents and several classes of biological agents such as targeted therapies, multikinase inhibitors, immunotherapy, and antibody-drug conjugates (5). Moreover, cognitive impairment may arise from anticancer treatments.The most common clinical manifestation of CIPN is sensory axonal neuropathy with motor and autonomic involvement. Specifically, depression, anxiety, and cognitive disorder, represent typical central symptoms. CIPN is a peripheral neurotoxicity. Cognitive impairment, commonly termed chemo-brain, affects cancer patients treated with chemotherapy agents (CNS toxicity) (6). A significant role of neuroinflammation, blood-brain barrier disruption, defective neurogenesis, and oxidative stress has been postulated in causing cognitive deficits (7).Persistent CIPN symptoms are associated with an increased risk of falling, disability, and psychosocial distress (8). Moreover, as symptoms have been reported to be chemotherapy ...
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