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%
• 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
• consider chemotherapy dose delays or reduction or drug cessation in patients experiencing painful CIPN
• do not offer cannabinoids, gabapentin/pregabalin, venlafaxine, vitamin B, vitamin E or acetylcysteine for prevention of CIPN

More general terms

• peripheral nerve disease; peripheral neuropathy

Additional terms

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