title: Neurologic complications of chemotherapy and other newer and experimental approaches.
abstract: Neurologic complications of conventional cytototxic agents as well as those from monoclonal antibodies and targeted therapies are increasingly observed in patients with cancer. The major categories are represented by alkylating agents (platinum compounds, ifosfamide, procarbazine, thiotepa), mitotic spindle inhibitors (vinca alkaloids, taxanes, etoposide, teniposide), proteasome inhibitors (bortezomib), antibiotics, antimetabolites, thalidomide, lenalidomide, topoisomerase inhibitors, interferon-α, hormones, bevacizumab, trastuzumab, and small tyrosine kinase inhibitors. Peripheral neuropathy is a common adverse effect of a number of chemotherapeutic drugs and often represents a critical factor limiting an adequate dose-intensity of chemotherapy. Regarding the central nervous system (CNS), it is vulnerable to many forms of toxicity from chemotherapeutic agents, including encephalopathy syndromes and confusional states, seizures, headache, cerebrovascular complications, visual loss, cerebellar syndromes, and myelopathy. For a given drug, the occurrence of CNS toxicity depends on several factors, including the total dose, route of administration, presence of structural brain lesions, exposure to prior or concurrent irradiation, and interactions with other drugs. However, many of the neurotoxic reactions are rare and idiosyncratic, and remain unpredictable. Several forms of neuroprotection and rehabilitation are being investigated. Last, the so-called "chemobrain" is an emerging issue, as it is a model of a subtle of and long-lasting damage to neuronal structures from some antineoplastic agents.
authors.affiliation: Division of Neuro-Oncology, Department of Neuroscience, University and San Giovanni Battista Hospital, Turin, Italy. Electronic address: riccardo.soffietti@unito.it.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Soffietti
authors.affiliation: Division of Neuro-Oncology, Department of Neuroscience, University and San Giovanni Battista Hospital, Turin, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Trevisan
authors.affiliation: Division of Neuro-Oncology, Department of Neuroscience, University and San Giovanni Battista Hospital, Turin, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Rudà
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002493:Central Nervous System Diseases / Q000139:chemically induced; D006801:Humans; D001523:Mental Disorders / Q000139:chemically induced / Q000523:psychology; D009422:Nervous System Diseases / Q000139:chemically induced* / Q000473:pathology; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced
chemical_list: D000970:Antineoplastic Agents
keywords: Neurologic complications; cerebellar syndromes; cerebrovascular events; chemobrain; chemotherapy; encephalopathy; myelopathy; neuropathy; seizures; targeted agents