Article information
Abstract
Introduction
Chemotherapy-induced peripheral neuropathy (CIPN) is the most prevalent neurological complication of cancer treatment, affecting a third of all patients who undergo chemotherapy. CIPN impairs functional capacity, compromises the quality of life and results in dose reduction or cessation of chemotherapy, representing a dose-limiting side effect of many antineoplastic drugs. In addition to classic, novel agents, bortezomib and oxaliplatin have been shown to have a significant risk of CIPN.
MethodsBy reviewing literature, this article analyses relevant issues and recent advances regarding the pathogenesis, incidence, risk factors, diagnosis, characteristics and management of CIPN.
ResultsResearch into the pathophysiology and identification of risk factors for individual patients is growing. A future avenue of investigation includes the identification of patients at lower or higher risk based on their genotype. Best tools for CIPN assessment are not defined. Many agents have been claimed to be neuroprotectors without showing significant results in large randomised clinical trials.
ConclusionsEarly recognition and subsequent dose reduction/discontinuation of the offending agent is the only way to minimise the development of this potentially debilitating complication. Due to the lack of effective prophylactic or symptomatic treatments up to now, neurological monitoring should be recommended in patient candidates to be treated with neurotoxic antineoplastic agents, mainly when they present baseline neuropathy. Development of reliable methods for CIPN assessment is essential.
Keywords:
Chemotherapy-induced peripheral neuropathy
Chemotherapy
Neuropathy
Toxic neuropathy
Antineoplastic agent
Resumen
Introducción
La neuropatía periférica inducida por quimioterapia (NIQ) es la complicación neurológica más frecuente del tratamiento del cáncer, y afecta aproximadamente a una tercera parte de los pacientes. La NIQ deteriora la funcionalidad, compromete la calidad de vida y, frecuentemente, conlleva la reducción y/o suspensión del tratamiento, lo que representa un efecto adverso limitante de dosis de muchos antineoplásicos. Además de los clásicos, agentes nuevos como bortezomib y oxaliplatino presentan un marcado riesgo de neuropatía.
MétodosTras revisión de la literatura, se analizan los trabajos relevantes y los recientes avances sobre patogenia, incidencia, factores de riesgo, diagnóstico, características y manejo de la NIQ.
ResultadosEl conocimiento sobre la fisiopatología de la NIQ es creciente. La investigación incluye la identificación de los genes relacionados con un mayor o menor riesgo de NIQ. La mejor herramienta que permita diagnosticar y graduar la severidad de la NIQ no está definida. Numerosos agentes se están investigando como potenciales neuroprotectores o tratamientos sintomáticos, con resultados negativos en la mayoría de ellos.
ConclusionesEl reconocimiento precoz y posterior reducción de dosis o suspensión del agente neurotóxico es actualmente la única forma de minimizar el desarrollo de esta complicación. Ante la ausencia de tratamientos preventivos o sintomáticos eficaces en la NIQ, sería recomendable la monitorización neurológica de los pacientes candidatos a recibir quimioterapia con agentes neurotóxicos, sobre todo si presentan una neuropatía de base o subclínica. Es necesario definir e implementar la mejor medida para evaluar la NIQ.
Palabras clave:
Neuropatía inducida por quimioterapia
Quimioterapia
Neuropatía
Neuropatía tóxica
Agente antineoplásico
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