Chemotherapy-Induced Peripheral Neuropathy Characteristics and Management

Introduction to CIPN

The American Society of Clinical Oncology notes that different chemotherapy agents cause distinct peripheral neuropathy patterns with varying symptom profiles and timelines, with platinum compounds and taxanes being the most commonly associated with CIPN 1, 2

Oxaliplatin is associated with acute neuropathy symptoms, including cold sensitivity, throat discomfort, difficulty swallowing cold liquids, and muscle cramps, with symptoms beginning during infusion and peaking 2-3 days after each dose 1, 2
The American Society of Clinical Oncology recommends that patients receiving oxaliplatin be monitored for chronic/cumulative neuropathy, which is more severe in upper limbs than lower limbs and exhibits a "coasting phenomenon" where symptoms worsen for 2-3 months after therapy completion before beginning to improve 4, 5

Paclitaxel is associated with acute neuropathy symptoms, including pain syndrome occurring days after each dose, primarily in the truncal/hip distribution, peaking approximately 2-3 days after each dose 1, 2

The American Society of Clinical Oncology notes that CIPN is characterized by a symmetric, distal, length-dependent "glove and stocking" distribution, with primarily sensory symptoms rather than motor symptoms 3, 4
The American Society of Clinical Oncology recommends that patients be monitored for dose-dependent occurrence of CIPN, with higher incidence with increased cumulative dose 1, 4

The American Society of Clinical Oncology recommends that duloxetine be considered for established painful CIPN, though benefit is limited, and that dose delay, reduction, substitution, or discontinuation be considered in patients with intolerable neuropathy and/or functional impairment 2, 5, 7

The American Society of Clinical Oncology recommends regular monitoring during treatment to detect early signs of CIPN, with assessment of both sensory and motor function important for comprehensive evaluation 4, 5