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Burgess J, Ferdousi M, Gosal D, Boon C, Matsumoto K, Marshall A, Mak T, Marshall A, Frank B, Malik RA, Alam U. Chemotherapy-Induced Peripheral Neuropathy: Epidemiology, Pathomechanisms and Treatment. Oncol Ther 2021; 9:385-450. [PMID: 34655433 PMCID: PMC8593126 DOI: 10.1007/s40487-021-00168-y] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/12/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This review provides an update on the current clinical, epidemiological and pathophysiological evidence alongside the diagnostic, prevention and treatment approach to chemotherapy-induced peripheral neuropathy (CIPN). FINDINGS The incidence of cancer and long-term survival after treatment is increasing. CIPN affects sensory, motor and autonomic nerves and is one of the most common adverse events caused by chemotherapeutic agents, which in severe cases leads to dose reduction or treatment cessation, with increased mortality. The primary classes of chemotherapeutic agents associated with CIPN are platinum-based drugs, taxanes, vinca alkaloids, bortezomib and thalidomide. Platinum agents are the most neurotoxic, with oxaliplatin causing the highest prevalence of CIPN. CIPN can progress from acute to chronic, may deteriorate even after treatment cessation (a phenomenon known as coasting) or only partially attenuate. Different chemotherapeutic agents share both similarities and key differences in pathophysiology and clinical presentation. The diagnosis of CIPN relies heavily on identifying symptoms, with limited objective diagnostic approaches targeting the class of affected nerve fibres. Studies have consistently failed to identify at-risk cohorts, and there are no proven strategies or interventions to prevent or limit the development of CIPN. Furthermore, multiple treatments developed to relieve symptoms and to modify the underlying disease in CIPN have failed. IMPLICATIONS The increasing prevalence of CIPN demands an objective approach to identify at-risk patients in order to prevent or limit progression and effectively alleviate the symptoms associated with CIPN. An evidence base for novel targets and both pharmacological and non-pharmacological treatments is beginning to emerge and has been recognised recently in publications by the American Society of Clinical Oncology and analgesic trial design expert groups such as ACTTION.
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Affiliation(s)
- Jamie Burgess
- Department of Cardiovascular and Metabolic Medicine, The Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool University Hospital NHS Trust, Liverpool, UK.
- Clinical Sciences Centre, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK.
| | - Maryam Ferdousi
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - David Gosal
- Department of Neurology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Cheng Boon
- Department of Clinical Oncology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Kohei Matsumoto
- Department of Cardiovascular and Metabolic Medicine, The Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool University Hospital NHS Trust, Liverpool, UK
| | - Anne Marshall
- Department of Cardiovascular and Metabolic Medicine, The Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool University Hospital NHS Trust, Liverpool, UK
| | - Tony Mak
- Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Andrew Marshall
- Faculty of Health and Life Sciences, Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L7 8TX, UK
- Faculty of Health and Life Sciences, The Pain Research Institute, University of Liverpool, Liverpool, L9 7AL, UK
- Department of Pain Medicine, The Walton Centre, Liverpool, L9 7LJ, UK
| | - Bernhard Frank
- Department of Pain Medicine, The Walton Centre, Liverpool, L9 7LJ, UK
| | - Rayaz A Malik
- Research Division, Qatar Foundation, Weill Cornell Medicine-Qatar, Education City, Doha, Qatar
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - Uazman Alam
- Department of Cardiovascular and Metabolic Medicine, The Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool University Hospital NHS Trust, Liverpool, UK.
- Division of Endocrinology, Diabetes and Gastroenterology, University of Manchester, Manchester, M13 9PT, UK.
- Clinical Sciences Centre, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK.
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LeBlanc MR, Hirschey R, Leak Bryant A, LeBlanc TW, Smith SK. How are patient-reported outcomes and symptoms being measured in adults with relapsed/refractory multiple myeloma? A systematic review. Qual Life Res 2019; 29:1419-1431. [PMID: 31848847 DOI: 10.1007/s11136-019-02392-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Patients with relapsed and/or refractory multiple myeloma (RRMM) are living longer due in part to changing treatment patterns. It is important to understand how changing treatment patterns affect patients' lives beyond extending survival. Research suggests that direct patient report is the best way to capture information on how patients feel and function in response to their disease and its treatment. Therefore, the purpose of this review is to summarize evidence of patients' experience collected through patient-reported outcomes (PRO) in RRMM patients, and to explore PRO reporting quality. METHODS We conducted a systematic search to identify manuscripts reporting PROs in RRMM and summarized available evidence. We assessed PRO reporting quality using the Consolidated Standards of Reporting Trials (CONSORT) PRO Extension checklist. RESULTS Our search resulted in 30 manuscripts. Thirteen unique PRO measures were used to assess 18 distinct PRO domains. Pain, fatigue, and emotional function were commonly assessed domains though reporting formats limited our ability to understand prevalence and severity of PRO challenges in RRMM. Evaluation of PRO reporting quality revealed significant reporting deficiencies. Several reporting criteria were included in less than 25% of manuscripts. CONCLUSIONS Existing evidence provides a limited window for understanding the patient experience of RRMM and is further limited by suboptimal reporting quality. Observational studies are needed to describe prevalence, severity and patterns of PROs in RRMM overtime. Future studies that incorporate PROs would benefit from following existing guidelines to ensure that study evidence and conclusions can be fully assessed by readers, clinicians and policy makers.
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Affiliation(s)
- Matthew R LeBlanc
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA.
| | - Rachel Hirschey
- University of North Carolina Chapel Hill School of Nursing, Campus Box #7460, Carrington Hall, Chapel Hill, NC, 27599, USA
| | - Ashley Leak Bryant
- University of North Carolina Chapel Hill School of Nursing, Campus Box #7460, Carrington Hall, Chapel Hill, NC, 27599, USA
| | - Thomas W LeBlanc
- Duke University School of Medicine, 8 Searle Center Drive, Durham, NC, 27710, USA
| | - Sophia K Smith
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
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Islam B, Lustberg M, Staff NP, Kolb N, Alberti P, Argyriou AA. Vinca alkaloids, thalidomide and eribulin-induced peripheral neurotoxicity: From pathogenesis to treatment. J Peripher Nerv Syst 2019; 24 Suppl 2:S63-S73. [PMID: 31647152 DOI: 10.1111/jns.12334] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/16/2019] [Indexed: 02/06/2023]
Abstract
Vinca alkaloids, thalidomide, and eribulin are widely used to treat patients with childhood acute lymphoblastic leukemia (ALL), adults affected by multiple myeloma and locally invasive or metastatic breast cancer, respectively. However, soon after their introduction into clinical practice, chemotherapy-induced peripheral neurotoxicity (CIPN) emerged as their main non-hematological and among dose-limiting adverse events. It is generally perceived that vinca alkaloids and the antiangiogenic agent thalidomide are more neurotoxic, compared to eribulin. The exposure to these chemotherapeutic agents is associated with an axonal, length-dependent, sensory polyneuropathy of mild to moderate severity, whereas it is considered that the peripheral nerve damage, unless severe, usually resolves soon after treatment discontinuation. Advanced age, high initial and prolonged dosing, coadministration of other neurotoxic chemotherapeutic agents and pre-existing neuropathy are the common risk factors. Pharmacogenetic biomarkers might be used to define patients at increased susceptibility of CIPN. Currently, there is no established therapy for CIPN prevention or treatment; symptomatic treatment for neuropathic pain and dose reduction or withdrawal in severe cases is considered, at the cost of reduced cancer therapeutic efficacy. This review critically examines the pathogenesis, epidemiology, risk factors (both clinical and pharmacogenetic), clinical phenotype and management of CIPN as a result of exposure to vinca alkaloids, thalidomide and its analogue lenalidomide as also eribulin.
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Affiliation(s)
- Badrul Islam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Maryam Lustberg
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer, Columbus, Ohio
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Noah Kolb
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont
| | - Paola Alberti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- NeuroMI (Milan Center for Neuroscience), Milan, Italy
| | - Andreas A Argyriou
- Department of Neurology, "Saint Andrew's" State General Hospital of Patras, Patras, Greece
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Nozza A, Terenghi F, Gallia F, Adami F, Briani C, Merlini G, Giordano L, Santoro A, Nobile-Orazio E. Lenalidomide and dexamethasone in patients with POEMS syndrome: results of a prospective, open-label trial. Br J Haematol 2017; 179:748-755. [PMID: 29048107 DOI: 10.1111/bjh.14966] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/14/2017] [Indexed: 11/28/2022]
Abstract
Given its anti-angiogenic activity, lenalidomide may have a role in the treatment of POEMS (Peripheral neuropathy, Organomegaly, Endocrinopathy, Monoclonal plasma cell disorder and Skin changes) syndrome. This prospective, open-label, pilot study evaluated the combination of lenalidomide + dexamethasone (RD) in 18 POEMS syndrome patients (13 pre-treated, 5 newly-diagnosed but ineligible for high-dose therapy). Treatment consisted of six cycles of lenalidomide (25 mg/day for 21 days followed by 7 days rest) plus dexamethasone (40 mg/once a week). Patients responding after six cycles continued treatment until progression or unbearable toxicity. The primary endpoint was the proportion of patients with either neurological or clinical improvement. The RD combination was considered as deserving further evaluation if 9 of the first 15 patients responded. Ten responses were observed among the first 15 enrolled patients, meeting the primary endpoint. Fifteen of 18 patients (83%) completed six RD cycles: 13 (72%) patients responded and nine had both clinical and neurological improvement. Among the 15 patients who completed the six RD cycles, four were still on treatment after a 25-month follow-up. At 39 months of follow-up, all patients were alive with a 3-year progression-free survival of 59%. No patient discontinued RD for toxicity. Overall, the RD regimen showed a high incidence of prolonged symptoms improvement and was well tolerated in most POEMS patients.
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Affiliation(s)
- Andrea Nozza
- Department of Medical Oncology and Haematology, Humanitas Cancer Centre, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy
| | - Fabrizia Terenghi
- Neuromuscular and Neuroimmunology Service, Department of Medical Biotechnology and Translational Medicine, Milan University, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy
| | - Francesca Gallia
- Neuromuscular and Neuroimmunology Service, Department of Medical Biotechnology and Translational Medicine, Milan University, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy
| | - Fausto Adami
- Department of Medicine - Haematology & Clinical Immunology Section, University of Padova, Padua, Italy
| | - Chiara Briani
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Centre, Foundation "Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo", Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Laura Giordano
- Biostatistic Unit, Humanitas Cancer Centre, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy
| | - Armando Santoro
- Department of Medical Oncology and Haematology, Humanitas Cancer Centre, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Humanitas University, Milan, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Service, Department of Medical Biotechnology and Translational Medicine, Milan University, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy
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Staff NP, Grisold A, Grisold W, Windebank AJ. Chemotherapy-induced peripheral neuropathy: A current review. Ann Neurol 2017; 81:772-781. [PMID: 28486769 PMCID: PMC5656281 DOI: 10.1002/ana.24951] [Citation(s) in RCA: 451] [Impact Index Per Article: 64.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 04/30/2017] [Accepted: 05/01/2017] [Indexed: 12/16/2022]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting side effect experienced by patients receiving treatment for cancer. Approximately 30 to 40% of patients treated with neurotoxic chemotherapy will develop CIPN, and there is considerable variability in its severity between patients. It is often sensory-predominant with pain and can lead to long-term morbidity in survivors. The prevalence and burden of CIPN late effects will likely increase as cancer survival rates continue to improve. In this review, we discuss the approach to peripheral neuropathy in patients with cancer and address the clinical phenotypes and pathomechanisms of specific neurotoxic chemotherapeutic agents. Ann Neurol 2017;81:772-781.
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Affiliation(s)
| | - Anna Grisold
- Department of Neurology, Medical University of Vienna, Austria
| | - Wolfgang Grisold
- Ludwig Boltzmann Institute for Experimental und Clinical
Traumatology, Vienna, Austria
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Kandula T, Farrar MA, Kiernan MC, Krishnan AV, Goldstein D, Horvath L, Grimison P, Boyle F, Baron-Hay S, Park SB. Neurophysiological and clinical outcomes in chemotherapy-induced neuropathy in cancer. Clin Neurophysiol 2017; 128:1166-1175. [PMID: 28511129 DOI: 10.1016/j.clinph.2017.04.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/21/2017] [Accepted: 04/14/2017] [Indexed: 12/14/2022]
Abstract
Chemotherapy induced peripheral neuropathy (CIPN) is a significant toxicity of cancer treatment, with the potential to affect long-term function and quality of life in cancer survivors. There remains a lack of consensus around optimal assessment techniques. While current approaches to CIPN assessment are focused on clinical grading scales, it is becoming increasingly evident that a more comprehensive multimodal assessment package is necessary to accurately characterise the impact of CIPN as well as gauge the utility of neuroprotective mechanisms. Neurophysiological techniques provide objective biomarkers and may enable early detection of toxicity while patient reported outcomes are necessary to determine the significance of symptoms to individual patients. In addition to providing an objective assessment, clinical neurophysiological techniques provide important insights into the contributory pathophysiological mechanisms of CIPN with different chemotherapy agents. There is a paucity of implementation of these techniques in the clinical trial setting. The present Review aims to facilitate the use of neurophysiological studies as part of comprehensive assessment packages for the monitoring of CIPN by summarising current understanding of neurophysiological changes that underlie the development of neuropathy, clinical presentations and patient reported outcomes as well as advantages and limitations of current techniques for the neurophysiological assessment of CIPN.
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Affiliation(s)
- Tejaswi Kandula
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Randwick, NSW, Australia; Department of Neurology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Michelle A Farrar
- Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Randwick, NSW, Australia; Department of Neurology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Matthew C Kiernan
- Brain & Mind Centre, Sydney Medical School, University of Sydney, 94 Mallett Street, Sydney, NSW, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, UNSW Medicine, The University of New South Wales, Randwick, NSW, Australia
| | - David Goldstein
- Prince of Wales Clinical School, UNSW Medicine, The University of New South Wales, Randwick, NSW, Australia
| | - Lisa Horvath
- Chris O'Brien Lifehouse, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia; Department of Oncology, Royal Prince Alfred Hospital, NSW, Australia
| | - Peter Grimison
- Chris O'Brien Lifehouse, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia
| | - Frances Boyle
- Sydney Medical School, University of Sydney, NSW, Australia; Patricia Ritchie Centre for Cancer Care and Research, The Mater Hospital, NSW, Australia
| | - Sally Baron-Hay
- Department of Oncology, Royal North Shore Hospital, NSW, Australia
| | - Susanna B Park
- Brain & Mind Centre, Sydney Medical School, University of Sydney, 94 Mallett Street, Sydney, NSW, Australia; Prince of Wales Clinical School, UNSW Medicine, The University of New South Wales, Randwick, NSW, Australia.
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7
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Briani C, Visentin A, Salvalaggio A, Imbergamo S, Piazza F, Cacciavillani M, Campagnolo M, Frezzato F, Semenzato G, Trentin L. Peripheral neuropathies in chronic lymphocytic leukemia: a single center experience on 816 patients. Haematologica 2016; 102:e140-e143. [PMID: 27927770 DOI: 10.3324/haematol.2016.153064] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Chiara Briani
- Neurology Unit, Department of Neuroscience, University of Padova, Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Italy
| | | | - Silvia Imbergamo
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Italy
| | - Francesco Piazza
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Italy
| | | | - Marta Campagnolo
- Neurology Unit, Department of Neuroscience, University of Padova, Italy
| | - Federica Frezzato
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Italy
| | - Gianpietro Semenzato
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Italy
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Liew WKM, Pacak CA, Visyak N, Darras BT, Bousvaros A, Kang PB. Longitudinal Patterns of Thalidomide Neuropathy in Children and Adolescents. J Pediatr 2016; 178:227-232. [PMID: 27567409 DOI: 10.1016/j.jpeds.2016.07.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/15/2016] [Accepted: 07/27/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To characterize the longitudinal clinical and electrophysiological patterns of thalidomide neuropathy in children and adolescents. STUDY DESIGN Retrospective analysis of clinical records at a tertiary care children's hospital, including serial electrophysiological studies. RESULTS Sixteen patients aged 6-24 years received thalidomide to treat Crohn's disease from 2002 to 2012. Nine subjects had electrophysiological evidence of sensorimotor axonal polyneuropathy, 8 of whom had sensory and/or motor symptoms. The patients with polyneuropathy received thalidomide for 5 weeks to 52 months, with cumulative doses ranging from 1.4 to 207.7 g. All subjects with cumulative doses greater than 60 g developed polyneuropathy, and 4 of the 5 subjects who received thalidomide for more than 20 months developed polyneuropathy. The 7 subjects who had normal neurophysiological studies received therapy for 1 week to 25 months, with cumulative doses ranging from 0.7 to 47 g. In contrast to some previous reports, several patients had sensorimotor polyneuropathies, rather than pure sensory neuropathies. In patients with neuropathy who received therapy for more than 24 months and had 3 or more electromyography studies, the severity of the neuropathy plateaued. CONCLUSIONS Factors in addition to the total dose may contribute to the risk profile for thalidomide neuropathy, including pharmacogenetic susceptibilities. The severity of the neuropathy does not worsen relentlessly. Children, adolescents, and young adults receiving thalidomide should undergo regular neurophysiological studies to monitor for neuropathy.
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Affiliation(s)
- Wendy K M Liew
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Neurology Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore
| | - Christina A Pacak
- Child Health Research Institute, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL
| | - Nicole Visyak
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Basil T Darras
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Athos Bousvaros
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Peter B Kang
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Division of Pediatric Neurology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL.
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Dalla Torre C, Zambello R, Cacciavillani M, Campagnolo M, Berno T, Salvalaggio A, De March E, Barilà G, Lico A, Lucchetta M, Ermani M, Briani C. Lenalidomide long-term neurotoxicity. Neurology 2016; 87:1161-6. [DOI: 10.1212/wnl.0000000000003093] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/26/2016] [Indexed: 11/15/2022] Open
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Cavaletti G, Alberti P, Marmiroli P. Chemotherapy-induced peripheral neurotoxicity in cancer survivors: an underdiagnosed clinical entity? Am Soc Clin Oncol Educ Book 2016:e553-60. [PMID: 25993222 DOI: 10.14694/edbook_am.2015.35.e553] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Systemic chemotherapy is a cornerstone of the modern medical management of cancer, although its use is limited by toxicity on normal tissues and organs, including the nervous system. Long-surviving or cured people strongly require a high level of wellness in addition to prolongation of life (the concept of the quality of survival), but neurologic dysfunction can severely affect daily life activities. Chemotherapy-related peripheral neurotoxicity is becoming one of the most worrisome long-term side effects in patients affected by a neoplasm. The central nervous system has a limited capacity to recover from injuries, and it is not surprising that severe damage can determine long-term or permanent neurologic dysfunction. However, the peripheral nervous system also can be permanently damaged by anticancer treatments despite its better regeneration capacities, and the effect on patients' daily life activities might be extremely severe. However, only recently, the paradigms of peripheral neurotoxicity reversibility have been scientifically challenged, and studies have been performed to capture the patients' perspectives on this issue and to measure the effect of peripheral neurotoxicity on their daily life activities. Despite these efforts, knowledge about this problem is still largely incomplete, and further studies are necessary to clarify the several still-unsettled aspects of long-term peripheral neurotoxicity of conventional and targeted anticancer chemotherapy.
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Affiliation(s)
- Guido Cavaletti
- From the Experimental Neurology Unit and Milan Center for Neuroscience, Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy
| | - Paola Alberti
- From the Experimental Neurology Unit and Milan Center for Neuroscience, Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy
| | - Paola Marmiroli
- From the Experimental Neurology Unit and Milan Center for Neuroscience, Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy
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11
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Grisold W, Grisold A, Marosi C, Meng S, Briani C. Neuropathies associated with lymphoma †. Neurooncol Pract 2015; 2:167-178. [PMID: 31386037 DOI: 10.1093/nop/npv025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Indexed: 12/12/2022] Open
Abstract
Neuropathy occurs with various manifestations as a consequence of lymphoma, and an understanding of the etiology is necessary for proper treatment. Advances in medical imaging have improved the detection of peripheral nerve involvement in lymphoma, yet tissue diagnosis is often equally important. The neoplastic involvement of the peripheral nervous system (PNS) in lymphoma can occur within the cerebrospinal fluid (CSF), inside the dura, or outside of the CSF space, affecting nerve root plexuses and peripheral nerves. The infiltration of either cranial or peripheral nerves in lymphoma is termed neurolymphomatosis (NL). These infiltrations can occur as mononeuropathy, multifocal neuropathy, symmetric neuropathies, or plexopathies. In rare cases, intravascular lymphoma (IL) can affect the PNS and an even rarer condition is the combination of NL and IL. Immune-mediated and paraneoplastic neuropathies are important considerations when treating patients with lymphoma. Demyelinating neuropathies, such as Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy, occur more frequently in non-Hodgkin's lymphoma than in Hodgkin's disease. Paraproteinemic neuropathies can be associated with lymphoma and paraneoplastic neuropathies are rare. While the treatment of lymphomas has improved, a knowledge of neurotoxic, radiotherapy, neoplastic, immune-mediated and paraneoplastic effects are important for patient care.
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Affiliation(s)
- Wolfgang Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
| | - Anna Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
| | - Christine Marosi
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
| | - Stefan Meng
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
| | - Chiara Briani
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
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12
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Raheja D, Specht C, Simmons Z. Paraproteinemic neuropathies. Muscle Nerve 2014; 51:1-13. [DOI: 10.1002/mus.24471] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Divisha Raheja
- Department of Neurology; Penn State Hershey Medical Center; EC 037, 30 Hope Drive Hershey Pennsylvania 17033 USA
| | - Charles Specht
- Department of Neurology; Penn State Hershey Medical Center; EC 037, 30 Hope Drive Hershey Pennsylvania 17033 USA
- Department of Pathology; Penn State Hershey Medical Center; Hershey Pennsylvania USA
- Department of Ophthalmology; Penn State Hershey Medical Center; Hershey Pennsylvania USA
- Department of Neurosurgery; Penn State Hershey Medical Center; Hershey Pennsylvania USA
| | - Zachary Simmons
- Department of Neurology; Penn State Hershey Medical Center; EC 037, 30 Hope Drive Hershey Pennsylvania 17033 USA
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Argyriou AA, Kyritsis AP, Makatsoris T, Kalofonos HP. Chemotherapy-induced peripheral neuropathy in adults: a comprehensive update of the literature. Cancer Manag Res 2014; 6:135-47. [PMID: 24672257 PMCID: PMC3964029 DOI: 10.2147/cmar.s44261] [Citation(s) in RCA: 192] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Commonly used chemotherapeutic agents in oncology/hematology practice, causing toxic peripheral neuropathy, include taxanes, platinum compounds, vinca alkaloids, proteasome inhibitors, and antiangiogenic/immunomodulatory agents. This review paper intends to put together and discuss the spectrum of chemotherapy-induced peripheral neuropathy (CIPN) characteristics so as to highlight areas of future research to pursue on the topic. Current knowledge shows that the pathogenesis of CIPN still remains elusive, mostly because there are several sites of involvement in the peripheral nervous system. In any case, it is acknowledged that the dorsal root ganglia of the primary sensory neurons are the most common neural targets of CIPN. Both the incidence and severity of CIPN are clinically under- and misreported, and it has been demonstrated that scoring CIPN with common toxicity scales is associated with significant inter-observer variability. Only a proportion of chemotherapy-treated patients develop treatment-emergent and persistent CIPN, and to date it has been impossible to predict high-and low-risk subjects even within groups who receive the same drug regimen. This issue has recently been investigated in the context of pharmacogenetic analyses, but these studies have not implemented a proper methodological approach and their results are inconsistent and not really clinically relevant. As such, a stringent approach has to be implemented to validate that information. Another open issue is that, at present, there is insufficient evidence to support the use of any of the already tested chemoprotective agents to prevent or limit CIPN. The results of comprehensive interventions, including clinical, neurophysiological, and pharmacogenetic approaches, are expected to produce a consistent advantage for both doctors and patients and thus allow the registration and analysis of reliable data on the true characteristics of CIPN, eventually leading to potential preventive and therapeutic interventions.
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Affiliation(s)
- Andreas A Argyriou
- Department of Neurology, "Saint Andrew's" General Hospital of Patras, Greece ; Department of Medicine-Division of Oncology, University of Patras Medical School, Rion-Patras, Greece
| | | | - Thomas Makatsoris
- Department of Medicine-Division of Oncology, University of Patras Medical School, Rion-Patras, Greece
| | - Haralabos P Kalofonos
- Department of Medicine-Division of Oncology, University of Patras Medical School, Rion-Patras, Greece
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