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Overview of neurologic complications of non-platinum cancer chemotherapy

Eudocia Quant Lee, MD, MPH
Section Editors
Jay S Loeffler, MD
Patrick Y Wen, MD
Deputy Editor
Diane MF Savarese, MD


Neurologic complications of anticancer therapy may result from direct toxic effects on the nervous system or indirectly from drug-induced metabolic derangements, cerebrovascular disorders, or in the case of ipilimumab, autoimmune disorders. A wide range of neurologic complications is associated with antineoplastic drug treatment (table 1), the most common of which is chemotherapy-induced peripheral neuropathy (CIPN) (table 2) [1-4]. The site of peripheral nerve injury is variable (table 3).

Depending on its severity, CIPN can be dose-limiting and may also significantly diminish quality of life because it can persist and even intensify after the completion of chemotherapy.

Recognition of neurologic complication of anticancer therapy is important because of potential confusion with metastatic disease, paraneoplastic syndromes, or comorbid neurologic disorders that do not require dose reduction or discontinuation. (See "Overview of paraneoplastic syndromes of the nervous system".)

The neurotoxicity associated with a variety of conventional cytotoxic chemotherapy agents will be reviewed here. The neurologic complications of the platinum compounds (cisplatin, carboplatin, and oxaliplatin), biological response modifiers, and monoclonal antibodies are discussed elsewhere, as are strategies to prevent and manage chemotherapy-induced peripheral neuropathy. (See "Overview of neurologic complications of platinum-based chemotherapy" and "Neurologic complications of cancer treatment with biologic agents".)


Risk factors are best established for chemotherapy-induced peripheral neuropathy (CIPN), which include dose, dose intensity, length of treatment, concurrent administration of other neurotoxic agents (especially platinum derivatives), and in the case of bortezomib, route of administration. (See 'Bortezomib' below.)


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