Chemotherapy‐induced peripheral neurotoxicity: A multifaceted, still unsolved issue

Abstract

Chemotherapy-induced peripheral neurotoxicity (CIPN) is a potentially dose-limiting side effect of several commonly used cytotoxic chemotherapy agents. The main pharmacological classes that may cause CIPN include classical anticancer drugs, as well as the recently introduced immune checkpoint inhibitors and antibody drug conjugates.The absence of a complete knowledge of CIPN pathophysiology is only one of the several unsolved issues related to CIPN. Among some of the most relevant aspects of CIPN deserving further attention include the real number of patients exposed to the risk of CIPN, the long-term impact on cancer survivors' quality of life due to incomplete recovery from CIPN, the economic burden related to acute and chronic CIPN, and the different perspective and education of the healthcare specialists in charge of managing patients with CIPN. Overall, CIPN remains a very challenging area of research as there are still several unresolved issues to be addressed in the future. In this special issue, the multifaceted profile of CIPN will be presented, with particular emphasis on bolstering the need to develop more optimized outcome measures than the existing ones to accurately evaluate the extent of CIPN, but also to ascertain the differences in the incidence, risk factors, clinical phenotype, and management of CIPN, according to the most commonly used neurotoxic chemotherapy classes. Perspectives for future research to pursue in order to cover the gaps in knowledge in the CIPN field will also be discussed. K E Y W O R D Sadult, chemotherapy, children, economic costs, neurotoxicity

Chemotherapy-induced peripheral neuropathy: part 1—current state of knowledge and perspectives for pharmacotherapy

“…It affects > 60% of patients receiving anticancer therapy. Although CIPN is a nonfatal condition, it significantly worsens patients' quality of life and is usually regarded as very troublesome, as it might not only influence the efficacy of antitumor agents but also be a major cause of ongoing pain in cancer survivors [15][16][17].…”

“…As mentioned above, the survival rates of patients treated with antitumor agents are increasing. Hence, CIPN and CIPN-related neuropathic pain episodes have become a significant clinical issue among cancer survivors [15]. In general, the prevalence of CIPN resulting from different antitumor drugs and doses varies significantly, with reported prevalence rates ranging from 19 to more [18][19][20][21].…”

“…Importantly, CIPN tends to occur both in adults and in younger patients. In children, most cases of CIPN are due to the use of vincristine and platinum derivatives, as other CIPN-inducing chemotherapeutics are not routinely used in this population [15]. It should also be noted that the prevalence and symptoms of CIPN seem to be age-related.…”

“…This notion is supported by previous observations that vincristine causes motor deficits more frequently in pediatric patients than adults. The reason for this seems to be unclear, and several potential mechanisms, including the use of higher doses, altered pharmacokinetics, different neuronal biology, and the lack of early detection of neurotoxic symptoms, should be considered [15]. The treatment of CIPN symptoms, recovery, and the delayed effects of chemotherapy may also vary between adult and pediatric populations.…”

Diffuse tensor imaging of lower extremities: a novel MR imaging technique for chemotherapy-induced peripheral neuropathy

“…Incidence of CIPN varies with the chemotherapeutic agent, dose, treatment duration, and method of assessment [2][3][4][5]. Chemotherapy agents with the highest incidence of CIPN are platinum agents (cisplatin and oxaliplatin), taxanes (paclitaxel and docetaxel), vinca alkaloids, and bortezomib [2][3][4][5][6][7][8]. Symptoms related to nerve damage from these drugs can be long-term and are an important issue for the increasing number of cancer survivors, with the majority of these patients being treated for breast and/or colon cancer [1].…”