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chemotherapy-induced peripheral neuropathy (CIPN)

Etiology: - taxanes - paclitaxel 60%-70% - platinums - cisplatin, carboplatin 40%-70% - vinca alkaloids - vincristine 20% - proteasome inhibitors - bortezomib 40%-80% - immunomodulatory agents - thalidomide 60% [1] - comorbidities adversely affecting CIPN - preexisting neuropathy or a family history of hereditary neuropathy - diabetes mellitus, smoking, kidney disease, vitamin deficiency, hypothyroidism, older age Clinical manifestations: - presentations vary - may present as hand & foot syndrome - onset possible within days for taxanes & platinums - onset may occur after several months for bortezomib - neuropathic effects can be sensory - hypersensitivity to stimuli, tingling, burning, altered temperature sensation - neuropathic effects may be motor - muscle cramps, tremor - neuropathic effects may be autonomic - constipation, orthostasis, bladder dysfunction - less typical manifestations of CIPN include - focal weakness, hand clumsiness, abnormal balance), symmetrical numbness in a stocking-glove distribution - neuropathy can worsen after cessation of therapy Management: - duloxetine may be useful for patients experiencing painful CIPN [1,2] - consider chemotherapy dose delays or reduction or drug cessation in patients experiencing painful CIPN [1] - do not offer cannabinoids, gabapentin/pregabalin, venlafaxine, vitamin B, vitamin E or acetylcysteine for prevention of CIPN [1]

Related

chemotherapy hand & foot syndrome; palmar-plantar erythrodysesthesia; acral erythema

General

peripheral nerve disease; peripheral neuropathy

References

  1. Derman BA, Davis AM Recommendations for Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy. JAMA Clinical Guidelines Synopsis JAMA. 2021;326(11):1058-1059. Sept 21 PMID: 34546311 https://jamanetwork.com/journals/jama/fullarticle/2784372
  2. Smith EM et al Effect of Duloxetine on Pain, Function, and Quality of Life Among Patients With Chemotherapy-Induced Painful Peripheral Neuropathy. A Randomized Clinical Trial. JAMA. 2013;309(13):1359-1367 PMID: 23549581 http://jama.jamanetwork.com/article.aspx?articleid=1674238
  3. Bassett M Cryotherapy May Help Prevent Neuropathy in Cancer Patients. Less CIPN in patients wearing ice-cold gloves and socks after taxane therapy. MedPage Today. October 12, 2017 https://www.medpagetoday.com/HematologyOncology/Chemotherapy/68498 - Hanai A, Ishiguro H, Sozu T et al Effects of Cryotherapy on Objective and Subjective Symptoms of Paclitaxel-Induced Neuropathy: Prospective Self-Controlled Trial. JNCI: J Natl Cancer Institute, 110(2) Feb 1 2018 Not indexed in PubMed https://academic.oup.com/jnci/article/4443215/Effects-of-Cryotherapy-on-Objective-and-Subjective