Chemotherapy peripheral neuropathy

Peripheral neuropathy (degeneration of peripheral sensory and/or motor neurons) represents another target for neurotrophic intervention. It often occurs as a complication of diabetes or in cancer patients receiving chemotherapy. In severe cases, amputation of limbs affected by neuronal loss is warranted. Pre-clinical studies have clearly shown that sensory and sympathetic neurons depleted in peripheral neuropathy respond to NGF. Indeed, NGF, along with IGF-1, can prevent the occurrence of drug-induced peripheral neuropathy in animals. Human clinical trials continue. 

Xiao, W., Boroujerdi, A., Bennett, G. J., and Luo, Z. D. (2007). Chemotherapy-evoked painful peripheral neuropathy Analgesic effects of gabapentin and effects on expression of the alpha-2-delta type-1 calcium channel subunit. Neuroscience 144, 714—720. 

There are several individual and serial case reports of patients with tumors and extrapyramidal features such as chorea, ballistic movements, and dystonia [35, 63-65]. Again, SCLC is the most common associated tumor, but renal cancer and lymphoma are also reported [65]. Patients with Hu or Ma antibodies can exhibit extrapyramidal symptoms as part of the multifocal CNS involvement [65, 66], whereas CRMP-5 is probably the most common antibody associated with paraneoplastic chorea. Coexisting neuronal antibodies are found in 50% of the CRMP-5 positive cases, and accompanying symptoms such as vision loss, LE, loss of smell or taste, and peripheral neuropathy are often present [65]. Movement disorders are uncommon in CRMP-5 positive patients in general, being a clinical feature in only 15% (subacute chorea in 11%) [30]. In some patients, paraneoplastic causation is strongly suspected even when no known onconeural antibody is detected [64, 65]. Individual patients have shown clinical improvement and decline in antibody levels after chemotherapy or methylprednisolone [65, 67]. 

In 21 patients with advanced non-small cell lung cancer carboplatin had no effect on the pharmacokinetics of paclitaxel 135-200 mg/m as a 24-hour intravenous infusion (58). Peripheral neuropathy occurred in 13 of 37 patients treated with paclitaxel 175 mg/m and carboplatin (59). The authors concluded that clinically important neurotoxicity increases with every cycle of chemotherapy. The peripheral neuropathy mainly affected sensory fibers without involving motor nerves. The same paclitaxeP carboplatin chemotherapy in 28 women caused no signs of acute central neurotoxicity or neuropsychological deterioration however, 11 patients had a peripheral neuropathy (60). 

Oshita F, Saijo N, Shinkai T, Eguchi K, Sasaki Y, et al. Correlation between total dose of cisplatin and vibratory perception threshold in chemotherapy-induced peripheral neuropathy of cancer patients. Cancer J 1992 5 165-9. 

Quasthoff S, Hartung HP. Chemotherapy-induced peripheral neuropathy. J Neurol 2002 249(1) 9-17. 

Encephalopathy, peripheral neuropathy, cerebellar syndromes, autonomic neuropathy, and cranial nerve toxicity represent the range of neurological complications associated with cancer chemotherapy. Dose, route of administration, age of the patient, hepatic and renal function, prior and/or concomitant use of other neurotoxic drugs, and the concurrent use of cranial or CNS radiotherapy can each influence the incidence rate and severity of neurologic symptoms associated with selected chemotherapy drugs. 

Management of Side Effects in the Personalized Medicine Era Chemotherapy-Induced Peripheral Neuropathy... 

Cavaletti G, Cornblath DR, Merkies IS, The CI-PeriNomS Group et al (2013) The chemotherapy-induced peripheral neuropathy outcome measures standardization study from consensus to the first validity and reliability findings. Ann Oncol 24 454-462... 

Chemotherapy is a common method of treatment for many types of cancer. The side effects of chemotherapy come about in part because cancer cells are not the only dividing cells in the body. Chemotherapeutic agents cause increased production of free radicals that can be harmful for normal cells, and these free radicals can be bound by antioxidant vitamins and supplements, including lycopene. A large number of studies have reported the beneficial effects of a variety of antioxidants in antineoplastic agents-induced nephrotoxicity, hepatotoxicity, ototoxicity, and peripheral neuropathy [218, 219]. Chemoprotective activities of lycopene [219, 220], and other dietary components that scavenge free radicals induced by exposure to antineoplastic agents [218, 220] have been well documented (Table 129.2). 

Cavaletti G, Frigeni B, Lanzani F et al (2007) The total neuropathy score as an assessment tool for grading the course of chemotherapy-induced peripheral neurotoxicity comparison with the National Cancer Institute-Common Toxicity Scale. J Peripher Nerv Syst 12 210-215... 

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