Chemotherapy Induced Neuropathy

Wikis > Neurology > Peripheral Neuropathy > Chemotherapy Induced Neuropathy

Chemotherapy induced peripheral neuropathy (CIPN) is a common adverse side effect of chemotherapy, affecting about half those undergoing chemotherapy. It is an important adverse effect as it can result in the need for a chemotherapy dose reduction or even discontinuation. It is often enduring, lasting well past the cessation of the chemotherapy. Reported to affect 47% of women 6 years after stopping chemotherapy (Kerri et al, 2017).

Aetiology:
It is most common with the taxanes (eg taxol, paclitaxel, docetaxel); vina alkaloids (eg vincristine, vindesine); bortezomib; platinum agents (eg cisplatin, carboplatin, oxaliplatin)

Clinical Features:
Often start after 3rd or 4th cycle of chemotherapy, but can start at any stage. It affects feet and hands symmetrically initially, typically in the “stocking and glove” pattern; usually described as a burning sharp or aching pains; numbness; and with parathesias.
There may be muscle cramps; sometimes motor symptoms
Sometimes can be worse for a few months after have the treatment has stopped – at 6 months after treatment, up to a third may still have symptoms
Some patients comment that symptoms are worse in the evening.
Course is often unpredictable

Differential Diagnosis:
Diabetic neuropathy | Nutritional Deficiency

Pathophysiology:
The exact pathophysiology is not well understood; different drugs are hypothesized to toxic to different part of the nerve structures:

  • Vinca alkaloids –> Binds to the microtubules and causing a cell cycle arrest
  • Taxanes –> Prevents the microtubule depolymerization and inhibits mitosis
  • Platinum agents –> Causes a cross-linking of the DNA strands, impairing cell division
  • Bortezomib –> Demyelination

Management:
Referal to pain clinic.
Pharmacological:
Duloxetine (recommeded); Gabapentin; Cymbalta; Amitriptyline
Evidence shows no support for vitamin supplements.

Physical:
Increased physical activity and movement can help. This clinical trial was registered in May 2018 to test effects of exercise.

Desensitization:
Certain textures (eg towel) to rub feet may help; compression stockings
Uncontrolled study showed foot baths better than foot massage (Ranhee, 2015)

Pay attention to risk of foot trauma (see sensory neuropathy in diabetes); check feet regularly

External Link:
Neuropathy secondary to Chemotherapy (Podiatry Arena)

Page last updated: Aug 7, 2018 @ 11:30 pm

 
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