Chemotherapy-induced peripheral neuropathy: prevention and treatment strategies.
Chemotherapy-induced peripheral neuropathy (CIPN) is a major dose limiting side effect of many commonly used chemotherapeutic agents, including platinum drugs, taxanes, epothilones and vinca alkaloids, and also newer agents such as bortezomib and lenolidamide. Symptom control studies have been conducted looking at ways to prevent or alleviate established CIPN. This manuscript provides a review of studies directed at both of these areas. New evidence strongly suggests that intravenous calcium and magnesium therapy can attenuate the development of oxaliplatin-induced CIPN, without reducing treatment response. Accumulating data suggest that vitamin E may also attenuate the development of CIPN, but more data regarding its efficacy and safety should be obtained prior to its general use in patients. Other agents that look promising in preliminary studies, but need substantiation, include glutamine, glutathione, N-acetylcysteine, oxcarbazepine, and xaliproden. Effective treatment of established CIPN, however, has yet to be found. Lastly, paclitaxel causes a unique acute pain syndrome which has been hypothesised to be caused by neurologic injury. No drugs, to date, have been proven to prevent this toxicity.
Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA. wolf.sherry@mayo.edu
Sherry
S
Wolf
Debra
D
Barton
Lisa
L
Kottschade
Axel
A
Grothey
Charles
C
Loprinzi
D000108:Acetylcarnitine / Q000627:therapeutic use; D000111:Acetylcysteine / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001418:Baclofen / Q000627:therapeutic use; D002118:Calcium / Q000008:administration & dosage*; D005973:Glutamine / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D007649:Ketamine / Q000627:therapeutic use; D008274:Magnesium / Q000008:administration & dosage*; D009281:Naphthalenes / Q000627:therapeutic use; D018697:Nootropic Agents / Q000627:therapeutic use; D017239:Paclitaxel / Q000627:therapeutic use; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000517:prevention & control; D011725:Pyridines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D014810:Vitamin E / Q000627:therapeutic use
D000927:Anticonvulsants; D000929:Antidepressive Agents, Tricyclic; D000970:Antineoplastic Agents; D009281:Naphthalenes; D018697:Nootropic Agents; D011725:Pyridines; D005973:Glutamine; D014810:Vitamin E; D007649:Ketamine; D000108:Acetylcarnitine; D001418:Baclofen; D008274:Magnesium; D017239:Paclitaxel; D002118:Calcium; C462299:xaliproden; D000111:Acetylcysteine