Beyond symptomatic relief for chemotherapy‐induced peripheral neuropathy: Targeting the source

Abstract

Chemotherapy-induced peripheral neuropathy (CIPN) is a serious adverse side effect of many chemotherapeutic agents, affecting >60% of patients with cancer. Moreover, CIPN persists long into survivorship in approximately 20% to 30% of these patients. To the authors' knowledge, no drugs have been approved to date by the US Food and Drug Administration to effectively manage chemotherapy-induced neuropathic pain. The majority of the drugs tested for the management of CIPN aim at symptom relief, including pain and paresthesia, yet are not very efficacious. The authors propose that there is a need to acquire a more thorough understanding of the etiology of CIPN so that effective, mechanism-based, disease-modifying interventions can be developed. It is important to note that such interventions should not interfere with the antitumor effects of chemotherapy. Mitochondria are rod-shaped cellular organelles that represent the powerhouses of the cell, in that they convert oxygen and nutrients into the cellular energy "currency" adenosine triphosphate. In addition, mitochondria regulate cell death. Neuronal mitochondrial dysfunction and the associated nitro-oxidative stress represent crucial final common pathways of CIPN. Herein, the authors discuss the potential to prevent or reverse CIPN by protecting mitochondria and/or inhibiting nitro-oxidative stress with novel potential drugs, including the mitochondrial protectant pifithrin-μ, histone deacetylase 6 inhibitors, metformin, antioxidants, peroxynitrite decomposition catalysts, and anti-inflammatory mediators including interleukin 10. This review hopefully will contribute toward bridging the gap between preclinical research and the development of realistic novel therapeutic strategies to prevent or reverse the devastating neurotoxic effects of chemotherapy on the (peripheral) nervous system. Cancer 2018;124:2289-98. © 2018 American Cancer Society.

Perturbations in neuroinflammatory pathways are associated with paclitaxel-induced peripheral neuropathy in breast cancer survivors

“…This study is the first to provide molecular evidence that a number of neuroinflammatory mechanisms identified in preclinical models of neuropathic pain and/or PIPN (Flatters et al, 2017;Ma et al, 2018) are perturbed in cancer survivors with PIPN. As noted in a review on the role of cytokines in chemotherapy-induced peripheral neuropathy (CIPN), (Wang et al, 2012) pro-inflammatory cytokines and chemokines play a critical role in the development and maintenance of painful peripheral neuropathy.…”

Natural compounds as potential adjuvants to cancer therapy: Preclinical evidence

“…The non‐selective character of most chemotherapeutic drugs usually initiates systemic symptoms as adverse or side effects during therapy (de Oliveira Junior et al, ). These adverse effects include cardiotoxicity, nephrotoxicity, hepatotoxicity, and peripheral neuropathy (Duwe et al, ; Ma, Kavelaars, Dougherty, & Heijnen, ; Santoni et al, ; Sharbaf et al, ). Sometimes, the adverse effects severely affect the daily quality of life for patients (X. Wu et al, ).…”

Nociceptor translational profiling reveals the RagA-mTORC1 network as a critical generator of neuropathic pain

“…Existing first-line treatments produce only 30% pain relief in the majority of patients (1). Chemotherapy-induced peripheral neuropathy (CIPN) is the primary doselimiting side effect of cancer treatment and no drugs are approved to treat this form of neuropathic pain (2). Peripheral pain sensing neurons, called nociceptors, are the cellular origin of pain caused by neuropathies (3).…”