Chemotherapy-Induced Neuropathy

Abstract

Chemotherapy-induced peripheral neurotoxicity (CIPN) is one of the most severe and unpredictable side effects of modern anticancer treatment. In recent years, a clear understanding of the importance of an integrated approach to CIPN has become evident, and efforts are increasing to better characterize its features and to identify more accurate methods to report and grade its occurrence. The clinically relevant impact of CIPN on cancer patients has been known for a long time, but knowledge of its pathogenetic aspects is still very limited. This incomplete knowledge is one of the major limitations in identifying targets for evidence-based neuroprotective strategies. Nevertheless, several studies have been devoted to the prevention or at least the effective treatment of symptoms secondary to peripheral nerve damage and to the early identification of patients at high risk of developing severe CIPN. Unfortunately, none of these studies has been successful and the optimal management of CIPN patients is still an unmet clinical need. Therefore, the modification of chemotherapy is currently the only available approach to limit the severity of neuropathy in the vast majority of patients. The indications for treatment modification are not universally accepted and they can differ among the various drugs. Generally, treatment modification should be considered as soon as symptoms and signs impair the daily life activities of the patient, but the possibility of a delayed worsening of CIPN after treatment withdrawal ("coasting") should always be considered, and delay of modification decisions should be avoided.

The Vitamin E Preventive Effect on Taxol-Induced Neuropathy Among Patients With Breast Cancer: A Randomized Clinical Trial

“…Chemotherapy-induced polyneuropathy is one of the most serious problems facing patients undergoing cancer therapy, which causes treatment limitations in addition to the disabilities and other health problems in such cases (1,2). One of the most important drugs used in breast cancer chemotherapy regimens, Taxol is considered as the most common cause of CIPN among the individuals with longterm therapy (4).…”

“…The peripheral nervous system is the main target for anti-cancer agents, most of which act as negative regulators of dorsal root ganglia (DRG) neurons or peripheral nerve axons. Such events are believed to be due to the little effect of blood-nerve barrier, thus providing an easy access for toxic substances to these sites (1). The overall prevalence of CIPN in patients receiving different treatment options is around 38%, although this rate is heavily dependent on chemotherapy regimens, exposure duration, and assessment techniques (2).…”

Treatment of Multiple Myeloma: Thalidomide-, Bortezomib-, and Lenalidomide-Induced Peripheral Neuropathy

“…In a considerable number of MM patients, CIPN is the dose-limiting side effect, as it largely affects the quality of life and cannot be resolved by any proven treatment. Currently, there are no known prognostic indicators for the course of CIPN [62]. However, a careful study of the patient history and the current literature helps to evaluate the risk for side effects such as CIPN and to make them more manageable.…”

A pilot clinical trial assessing the efficacy and safety of supplementation with a B complex vitamin to reduce the incidence of chemotherapy induced peripheral neuropathy in patients diagnosed with a malignancy

“…The follow up assessment post-chemotherapy was to evaluate the possibility that participants in the clinical study may have developed a delayed CIPN from certain chemotherapy agents (i.e. the Taxane class, vincristine and oxaliplatin) [380]. The complete time of involvement for participants who consented for this clinical trial varied between six to nine months in duration depending on their chemotherapy regimen.…”

“…Total TNS CIPN is represented by both sensory and motor nerve damage, although predominately sensory is reported from neurotoxic chemotherapy agents [386]. Sensory neuropathy is experienced by numbness, tingling, burning or pain in the fingers, and toes and then progresses up the arms or legs [387,388].…”