Chemotherapy-induced peripheral neuropathy in patients treated with taxanes and platinum derivatives

Abstract

Background. Chemotherapy with taxanes and platinum compounds has resulted in substantial survival benefi ts both in adjuvant and metastatic settings. However, as a side effect, such chemotherapy may cause peripheral neuropathy (CIPN) which may result in discontinuation of treatment, and if it persists after treatment completion, has a negative impact on quality of life (QoL). Results. Symptoms of CIPN are sensory, like pain, numbness, and tingling, typically located in the hands and feet. For oxaliplatin, there is an acute form of CIPN, resulting in paraesthesias in the mouth and throat during or shortly after the infusion triggered by exposure to cold. Risks factors for CIPN include preexisting neuropathy, either from treatment with other neurotoxic agents, or from comorbid conditions. The incidence of CIPN is related to dose per cycle, cumulative dose, and duration of infusion. While cisplatin-induced neuropathy is irreversible, CIPN induced by taxanes may persist for several years in about 30% of patients. Evidence from the literature is suggestive that CIPN is likely to be negatively associated with QoL. No agents have been identifi ed to be recommended for the prevention of CIPN. For treatment of CIPN, the best available data supports a moderate recommendation for treatment with duloxetine and evidence is inconclusive regarding the use of tricyclic antidepressants (such as nortriptyline), gabapentin, and a compounded topical gel containing baclofen, amitriptyline HCL, and ketamine. Conclusion. Research is still needed to predict which patients are at high risk of developing CIPN during treatment and in whom CIPN will persist after completion of chemotherapy.

Characterization of risk factors for adjuvant radiotherapy-associated pain in a tri-racial/ethnic breast cancer population

“…Second, higher proportions of AA and HW had more advanced tumor stage (IIA–IIIC) that may require more aggressive treatments, such as chemotherapy and/or ALND. Third, higher proportions of AA and HW had HER2 positive tumors and most likely received trastuzumab combined with taxane chemotherapy that may contribute to pain and neuropathy [12]. Fourth, higher proportions of HW (36%) had received hormonal therapy with aromatase inhibitor, which is known to cause musculoskeletal pain in breast cancer patients [24], compared to 24% in AA and 21% in NHW.…”

Chemotherapy-induced peripheral neuropathy after neoadjuvant or adjuvant treatment of breast cancer: a prospective cohort study

“…Treatments associated with a higher incidence of CIPN include those with platinum drugs, vinca alkaloids, or taxanes [9]. The estimated occurrence of CIPN among patients undergoing chemotherapy varied widely across previous investigations, largely reflecting differences in study designs, populations studied, specificities of the treatment schemes, and lack of uniformity in CIPN assessment methods [10][11][12][13][14].…”

The effectiveness of regional cooling for paclitaxel-induced peripheral neuropathy

“…Activities of daily living (ADLs), such as writing, getting dressed, and eating, are gradually affected. When PN reaches a severe stage, motor nerve disorders of the hands and feet inhibit some ADLs, such as walking; these can persist for a long time, greatly impairing the quality of life [2, 3]. Reduction or discontinuation of PN-inducing anticancer drugs based on appropriate evaluation and early detection is an important component of the management of chemotherapy.…”