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Indian Journal of Medical and Paediatric Oncology
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Chemotherapy-induced peripheral neuropathy: Current status and future directions


1 Department of Brain and Spine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
2 Department of Oncology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India

Correspondence Address:
Shripad S Pujari,
425/57, T. M. V. Colony, Gultekadi, Pune - 411 037, Maharashtra
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmpo.ijmpo_158_20

Chemotherapy-induced peripheral neuropathy (CIPN) and dorsal root ganglionopathy occur because of several categories of chemotherapeutic drugs, the important ones being taxanes, platins, vinca alkaloids, epothilones, proteasome inhibitors, immunomodulators and topoisomerase II inhibitors. There are many predisposing factors such as diabetes, nutritional deficiencies, hypothyroidism, renal failure and HIV disease. Leprosy and antimicrobial use such as anti-tubercular therapy and antibiotics are predisposing factors specific for India. Genetic susceptibility for toxicity toward most of the chemotherapy drugs has also been identified. Important mechanisms by which these agents injure nerves/dorsal root ganglia are causing microtubule disarray, impairing DNA repair, mitochondrial and ion channel dysfunction, increasing oxidative stress, increase pro-inflammatory cytokines and chemokines and glial cell activation. Damage can at times be irreversible, leaving behind not only significant sensorimotor disability but also increased suffering through neuropathic pain. Meticulous clinical evaluation and electrophysiology can anticipate this problem and prevent progression. The present treatment modalities such as oral selective serotonergic norepinephrine inhibitors and ion channel blockers and topical agents such as ketamine, baclofen, lidocaine and menthol predominantly offer symptomatic relief. Altering doses and dosing intervals prevents/minimizes the risk to some degree, but at the cost of delivering suboptimal chemotherapy for the cancer under treatment. Future lies in addressing basic mechanisms and genetic susceptibility to help prevent and improve therapeutic armamentarium for this disabling and painful disease.


    

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