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Chemotherapy-induced peripheral neuropathy
CIPN is a common complication of chemotherapy, that is predominantly characterized by sensory neuropathy and may be accompanied by motor and autonomic changes.
CIPN can occur in patients with platinum-based antineoplastic agents (oxaliplatin, cisplatin, carboplatin), epothilones (ixabepilone), taxanes (paclitaxel, docetaxel), immunomodulatory drugs (thalidomide), vinca alkaloids (vincristine, vinblastine, vinorelbine, vindesine), and proteasome inhibitors (bortezomib).
CIPN may affect sensory, motor, and/or autonomic functions to varying degrees. Symptoms include numbness, tingling, altered touch sensation, impaired vibration, paresthesias, dysesthesias, spontaneous burning, shooting or electric shock-like pain, allodynia, hyperalgesia, distal weakness, gait and balance disturbances, impaired movements, orthostatic hypotension, constipation, and altered sexual/urinary function. Disease progression may lead to loss of sensation, paresis, complete patient immobilization, severe disability, and reduced QoL.
Prognosis and risk of recurrence
CIPN is not independently associated with increased mortality.
The following summarized guidelines for the evaluation and management of chemotherapy-induced peripheral neuropathy are prepared by our editorial team based on guidelines from the European Oncology Nursing Society (EONS/EANO/ESMO 2020), the American Society of Clinical Oncology (ASCO 2020), and the American Cancer Society (ACS 2013).
Obtain standardized assessment of CIPN including:
baseline assessment and risk profile
long-term follow-up at > 2-3 months after treatment
calculation of Total Neuropathy Score or Total Neuropathy Score clinical version
objective evidence of neurological deficits
patient-reported outcomes, such as FACT/GOG-Ntx, EORTC QLQ-CIPN20, PNQ, CIPN-R-ODS
nerve conduction studies in the clinical trials setting.
Provide education regarding symptoms. Obtain ongoing patient surveillance and assess the impact on function and QoL.
General principles: as per ESMO 2020 guidelines, focus on reduction or relief of neuropathic pain in patients experiencing chronic CIPN.
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Modification/discontinuation of chemotherapy
Other systemic agents
Physical therapies: as per ASCO 2020 guidelines, insufficient evidence to recommend exercise therapy or scrambler therapy for the treatment of CIPN outside the context of a clinical trial.
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Patients with central neurotoxicity: do not use exogenous albumin for the prevention of ifosfamide-induced acute encephalopathy. Do not use methylene blue, thiamine, and/or glucose 5% for the prevention or treatment of ifosfamide-induced acute encephalopathy.
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Primary prevention: as per ASCO 2020 guidelines, assess the risks and benefits of agents known to cause CIPN in patients with underlying neuropathy and with conditions predisposing to neuropathy, such as diabetes and/or a family or personal history of hereditary neuropathy.
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6.Follow-up and surveillance
Monitoring for ototoxicity
Obtain a pure tone audiometry (including the wide spectrum of frequencies 500-8,000 Hz) for early detection of ototoxicity in adult patients receiving platinum agents.
Insufficient evidence to recommend prophylactic treatment with sodium thiosulfate because of the uncertainty regarding a possible tumor protection and lack of evidence in adult patients with cancer.