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Overview of neurologic complications of platinum-based chemotherapy

Eudocia Quant Lee, MD, MPH
Section Editors
Reed E Drews, 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 or cerebrovascular disorders. A wide range of neurologic complications are associated with antineoplastic drug treatment (table 1) [1-4].

Their recognition is important because of potential confusion with metastatic disease, paraneoplastic syndromes, or comorbid neurologic disorders that do not require dose reduction or discontinuation. If the neurologic disorder is caused by the chemotherapy, discontinuation of the offending agent may prevent irreversible injury.

Among the widely used anticancer drugs, the platinum compounds cisplatin and oxaliplatin are most commonly associated with various forms of neurotoxicity. The incidence, clinical manifestations, possible mechanisms of neurotoxicity, and management of neurotoxicities other than peripheral neuropathy with cisplatin, oxaliplatin, and the less neurotoxic analog carboplatin will be reviewed here. The neurologic complications of other chemotherapy agents and biologic therapies, as well as preventive strategies and treatments for established chemotherapy-induced peripheral neuropathy, are discussed separately. (See "Overview of neurologic complications of non-platinum cancer chemotherapy" and "Neurologic complications of cancer treatment with biologic agents" and "Prevention and treatment of chemotherapy-induced peripheral neuropathy".)


The range of cisplatin-induced neurotoxicity includes peripheral neuropathy, ototoxicity (hearing impairment and tinnitus), vestibulopathy, and encephalopathy; the most common are peripheral neuropathy and ototoxicity.

Peripheral neuropathy — Symmetrical, predominantly sensory peripheral neuropathy is a common complication of cisplatin therapy that develops in most patients typically only after a cumulative dose of 300 mg/m2 is reached. Once established, there is no effective therapy, and treatment is symptomatic only. Most patients improve over time, although recovery is often incomplete.


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