Peripheral nerve damage associated with administration of taxanes in patients with cancer.
Peripheral neuropathy is a well recognized toxicity of taxanes, usually resulting to dose modification and changes in the treatment plan. Taxanes produce a symmetric, axonal predominantly sensory distal neuropathy with less prominent motor involvement. A "dying back" process starting from distal nerve endings followed by effects on Schwann cells, neuronal body or axonal transport changes and a disturbed cytoplasmatic flow in the affected neurons is the most widely accepted mechanism of taxanes neurotoxicity. The incidence of taxanes-induced peripheral neuropathy is related to causal factors, such as single dose per course and cumulative dose and risk factors including treatment schedule, prior or concomitant administration of platinum compounds or vinca alcaloids, age and pre-existing peripheral neuropathy of other causes. The most reliable method to assess taxanes neurotoxicity is by clinical examination combined with electrophysiological evaluation. There is currently no effective symptomatic treatment for paclitaxel-associated pain, myalgias and arthralgias. Tricyclic antidepressants and anticonvulsants have been used as symptomatic treatment of neurotoxicity with some measure of success. Therefore, new approaches for prophylaxis against taxanes-induced peripheral neuropathy are needed. Several neuroprotective agents including, thiols, neurotrophic factors, and antioxidants hold promise for their ability to prevent neurotoxicity resulting from taxanes exposure. However, further confirmatory trials are warranted on this important clinical topic. This review critically looks at the pathogenesis, incidence, risk factors, diagnosis, characteristics and management of taxanes-induced peripheral neuropathy. We also highlight areas of future research.
Argyriou
Andreas A
AA
Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, UCL, Institute for Neurology, Queen Square, London WC1N3BG, UK. andargyriou@yahoo.gr
Koltzenburg
Martin
M
Polychronopoulos
Panagiotis
P
Papapetropoulos
Spiridon
S
Kalofonos
Haralabos P
HP
D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D009369:Neoplasms / Q000188:drug therapy; D018696:Neuroprotective Agents / Q000627:therapeutic use; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D012307:Risk Factors; D043823:Taxoids / Q000009:adverse effects* / Q000627:therapeutic use
D000970:Antineoplastic Agents; D018696:Neuroprotective Agents; D043823:Taxoids