Neuromuscular complications of cancer therapy

Abstract

Purpose of reviewThe neuromuscular complications of cancer therapy include chemotherapy-induced peripheral neurotoxicity (CIPN), immune-related neuromuscular complications to immune checkpoint inhibitors and radiation-induced neuropathy/plexopathy. With a wider focus on CIPN, we will discuss new pathogenetic insights, recent predictive biomarkers and emerging therapies for neuromuscular complications of cancer therapy.Recent findingsFindings from recent preclinical studies have improved our knowledge on new CIPN pathogenetic pathways, including the activation of senescence-like processes in neurons, axonal degeneration and neuroinflammation. Metabolomics and serum neurofilament light chain levels appear the most promising biomarkers to predict CIPN development and severity. There is some recent evidence of promising pharmacological compounds to prevent or treat CIPN, and new drugs are in early development and testing.SummaryA multimodal assessment, with neurophysiological, imaging and patient-reported outcome measures, coupled with the use of reliable blood or genetic biomarkers, may offer pathogenetic grounds for future preventive and symptomatic strategies for the multidisciplinary treatment of neuromuscular complications of cancer therapy.

Cerebellar involvement associated with immune checkpoint inhibitors: A systematic review

“…As an indirect consequence, ICIs may be complicated by immune-related adverse events (iRAEs). Meningitis, encephalitis, myasthenia gravis, peripheral and cranial neuropathies, myositis and central nervous system (CNS) demyelination encompass the wide and expanding spectrum of neurological ICIassociated complications [2][3][4][5][6].…”

Incidence and risk factors for developing chemotherapy‐induced neuropathic pain in 500 cancer patients: A file‐based observational study

“…CIPN is considered by healthcare professionals to be an unavoidable and overall affordable "cost" to be paid for life-saving anticancer chemotherapy, although it can be dose limiting and can affect the patients' quality of life. 9,10 Commonly used chemotherapeutic agents that are frequently associated with the induction of neurotoxicity are the platinum compounds (oxaliplatin, cisplatin and carboplatin), microtubule-stabilizing agents, such as taxanes (paclitaxel and docetaxel) and epothilones (ixabepilone), bortezomib, vinca alkaloids, purine and pyrimidine analogs (nelabarine and clofarabine), and thalidomide. 11 The pathogenetic mechanism of CIPN remains at present not fully elucidated.…”

Prospectively assessing serum neurofilament light chain levels as a biomarker of paclitaxel‐induced peripheral neurotoxicity in breast cancer patients

“…Taxane-based chemotherapy, given first line for the treatment of breast, ovarian, non-small-cell lung and gastrointestinal cancers, can often cause toxic peripheral nerve damage, the so called "paclitaxelinduced peripheral neurotoxicity" (PIPN). PIPN is a frequent doselimiting side effect of taxanes, which often compromise patients' outcome and survival rates and causes severe disability, 3,9 thus imposing a significant burden to national health systems. 1 PIPN is a dying-back axonopathy, characterized by sensory symptoms involving both the small and large fibers occasionally accompanied by motor and autonomic manifestations, mainly as a result of axonal injury and degeneration.…”

“…Taxane‐based chemotherapy, given first line for the treatment of breast, ovarian, non‐small‐cell lung and gastrointestinal cancers, can often cause toxic peripheral nerve damage, the so called “paclitaxel‐induced peripheral neurotoxicity” (PIPN). PIPN is a frequent dose‐limiting side effect of taxanes, which often compromise patients' outcome and survival rates and causes severe disability, 3,9 thus imposing a significant burden to national health systems 1 …”