2021 年 38 巻 4 号 p. 657-660
Chemotherapy–induced peripheral neuropathy (CIPN) is a common dose–limiting side effect for cancer treatment and affect long–term function and quality of life in cancer survivors. It is important for neurologists to understand the pathophysiology and clinical picture of CIPN and evaluate and treat it appropriately.
The common drugs which cause CIPN were Platinum analogs, Vinca–alkaloids, Taxol and proteosome inhibitors. The neurotoxicity of the drugs is usually dose–dependent and symptoms of neuropathy become apparent as chemotherapy repeated. Typically, CIPN is sensory dominant polyneuropathy, characterized by numbness, tingling, often neuropathic pain in stocking and glove distribution. If the symptoms or medical history are atypical, it is necessary to perform blood test, nerve conduction testo or neuroimaging study for making the different diagnosis.
Accurate assessment for CIPN is difficult and several outcome scores were developed. The National Cancer Institute Common Terminology Criteria for Adverse Events (NCI–CTCAE) remains the most common assessment tool and is utilized to decide whether drug to reduced/discontinue the drug. Total neuropathy score (TNS) has been used to monitor objective evidence of neurotoxicity. Patients–Reported outcomes measures such as European Organization for Research and Treatment of Cancer (EORTC) chemotherapy–induced peripheral neuropathy questionnaire (CIPN–20) and Functional Assessment of Cancer Therapy/Gynecological Cancer group Neurotoxicity questionnaire (FACT/GOG NTX), are also used for identifying the impact of neuropathic symptoms on daily life.
To date, the treatment for CIPN is limited and relies on reducing or discontinuing the offending agent. There is a lack of good quality clinical trials on the treatment of existing CIPN or painful CIPN. Nonpharmacological treatment, such as exercise, cryotherapy and nutritional interventions, may also be useful, although there is no clear evidence of its effect. Further research on CIPN is needed.
