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Prevention and treatment of chemotherapy-induced peripheral neuropathy

Author
Charles L Loprinzi, MD
Section Editors
Reed E Drews, MD
Richard M Goldberg, MD
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of cancer therapy that can have a profound impact on quality of life and survivorship [1]. Long-term neurotoxicity is an important issue for the growing number of cancer survivors, with the highest number of affected patients having been treated for breast and/or colon cancer. CIPN may also adversely affect oncologic outcomes by forcing dose modifications and/or premature treatment discontinuation. (See "Patterns of relapse and long-term complications of therapy in breast cancer survivors", section on 'Neurologic' and "Approach to the long-term survivor of colorectal cancer", section on 'Oxaliplatin-induced peripheral neuropathy'.)

The incidence of CIPN varies according to the chemotherapeutic agent, dose, duration of exposure, and method of assessment. The agents with the highest incidence are the platinum drugs, especially cisplatin and oxaliplatin, taxanes, vinca alkaloids, and bortezomib. The incidence, risk factors, pathogenetic mechanisms, and clinical characteristics of CIPN from these classes of agents as well as other chemotherapeutic drugs are discussed in detail elsewhere. (See "Overview of neurologic complications of platinum-based chemotherapy" and "Overview of neurologic complications of non-platinum cancer chemotherapy".)

This topic review will cover approaches to prevention and treatment of CIPN focusing mainly on platinum drugs, taxanes, vinca alkaloids, and bortezomib. An overview of neurologic complications with platinum and non-platinum chemotherapy drugs, and recommendations for dose modification for platinum and non-platinum chemotherapeutic drugs when neuropathy develops during therapy are provided elsewhere. (See "Overview of neurologic complications of platinum-based chemotherapy" and "Overview of neurologic complications of non-platinum cancer chemotherapy".)

OVERVIEW OF CLINICAL FEATURES AND NATURAL HISTORY

Chronic neurotoxicity — Regardless of the specific drug, chronic chemotherapy-induced peripheral neuropathy (CIPN) has similar distinguishing clinical features that help to differentiate it from other neuropathies (table 1) (see "Overview of neurologic complications of non-platinum cancer chemotherapy" and "Overview of neurologic complications of platinum-based chemotherapy"):

CIPN is typically dose-dependent and cumulative.

                                                

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