Prevention and Management of Chemotherapy-Induced Polyneuropathy

Abstract

Chemotherapy-induced peripheral neurotoxicity (CIPN) is a severe and common side effect caused by a variety of antineoplastic agents. Approximately 30–40% of patients treated with agents such as taxanes, vinca alkaloids, or platinum derivatives will develop CIPN. CIPN presents predominantly as a sensory axonal neuro(no)pathy with occasional motor and autonomic dysfunction exhibiting considerable variability of clinical symptoms ranging from mild tingling sensation to severe neuropathic pain. Typical symptoms include numbness (“minus symptom”), weakness, and abnormal gait as well as paresthesia and pain (“positive symptoms”). As CIPN symptoms potentially lead to long-term morbidity and can even aggravate after cessation of therapy, patients’ quality of life can be tremendously affected. In view of improved breast cancer survival outcomes, the late effects of CIPN are an unmet need in these patients. Therefore, early detection and assessment of first symptoms is important to effectively prevent severe CIPN. Therapeutic options for patients with CIPN are still limited, and pharmacological treatment focuses primarily on reduction or relief of neuropathic pain. CIPN is usually acutely managed by dose reduction or discontinuation of causative chemotherapy, potentially compromising treatment outcome. Currently, there is no causative proven therapy for the prevention of CIPN.

Influences on pathologic complete response in breast cancer patients after neoadjuvant chemotherapy

“…Peripheral neurotoxicity was the most common reason why patients had to discontinue chemotherapy (7%). Unfortunately, therapeutic options like pharmacological treatments are limited [ 24 ]. Thus, only dose reduction or discontinuation are current options [ 24 ].…”

Hypnosis Sedation Reduces the Duration of Different Side Effects of Cancer Treatments in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

“…No therapies are approved by the US Food and Drug Administration (FDA) or the European Medicines Agency (EMA) to prevent or treat chemotherapy-induced polyneuropathy [26,27]. Drugs such as gabapentin, duloxetine and vitamins used to decrease the severity and duration of polyneuropathy are associated with limited success.…”

“…Drugs such as gabapentin, duloxetine and vitamins used to decrease the severity and duration of polyneuropathy are associated with limited success. It is thus generally admitted that therapeutic options for CIPN are still limited, and pharmacological treatment focuses on reduction or relief of neuropathic pain [26][27][28]. It is therefore essential to detect chemically-induced polyneuropathy early in order to prevent the development of severe forms and to limit the duration of toxicity over time [29,30].…”

“…It is therefore essential to detect chemically-induced polyneuropathy early in order to prevent the development of severe forms and to limit the duration of toxicity over time [29,30]. Currently, there is no causative proven therapy for the prevention of CIPN [27,30]. Pharmacological research needs to intensify its efforts and study new molecules.…”

Leveraging GWAS Data Derived From a Large Cooperative Group Trial to Identify a SNP Cluster Associated With the Risk of Taxane-induced Peripheral Neuropathy

“…Consequences of CIPN include pain, numbness, falls, and difficulty in walking [2,3]. Attempts at effective interventions for CIPN [4,5] have not been successful and there are currently no confirmed preventative strategies. Not all patients are at equal risk for CIPN.…”