Peripheral neuropathy: from guidelines to clinical practise

Chemotherapy-induced peripheral neuropathy (CIPN) is a substantial adverse effect of anticancer therapy. No effective preventive strategies are established in clinical routine, although some forms of cryotherapy or compression therapy seem to be promising. CIPN is difficult to grade objectively and has mostly relied on a clinician- or patient-based rating that is subjective and not easily reproducible.

Recent preclinical and clinical studies showed an indicative hint of serum neurofilaments for axonal damage as a biomarker and might be introduced in clinical practice in the future. Axonal degeneration in toxic neuropathy is triggered by molecular pathways including SARM1. Presence of certain genotypes predispose for developing severe vincristine neuropathy. Still, treatment of CIPN is focused on treating neuropathic pain primarily based on physicians experience. A positive effect of membrane stabilizers such as gabapentinoids could not be shown in a systematic review mostly due to inconsistent study populations. In the treatment and prevention of functional disability, physical exercise including sensorimotor-training and whole-body vibration seems promising.

More research is needed on quantification of biomarkers indicative for axonal degeneration prior to CIPN symptom expression. All these recent findings should support the health-care team for a patient centred treatment approach.