Chemotherapy-induced peripheral neuropathy

Peripheral neurotoxicity is an important side-effect of several chemotherapeutic agents. These agents may cause a usually axonal neuropathy, which may ultimately lead to severe and disabling symptoms and signs. We describe in this review the pathogenesis, clinical presentation, neurophysiologic findings, nerve biopsies and the relation between cumulative dosage/dosage per cycle and neuropathy for the cytostatic drugs for which neurotoxicity is an important side-effect: cisplatin, vincristine, paclitaxel, docetaxel and suramin. With the development of strategies to circumvent toxicities of other organs and with the use of combinations of neurotoxic agents such as cisplatin/paclitaxel, neurotoxicity is an important and dose-limiting side-effect of many treatment regimens. Detailed knowledge of the neurologic side-effects of these drugs is essential for the management of their neurotoxicity. The review concludes with a short discussion of neuroprotective agents. Although several nerve growth factors, gluthatione and ethiofos hold promise as possible neuroprotective factors, the clinical data on these drugs are still limited. New trials are needed to confirm the value of these drugs. If neurotoxicity could indeed be prevented or delayed, this may lead to more effective treatment regimens.