Severe Peripheral Neuropathy in Chemotherapy Agents

Chemotherapy Agents and Peripheral Neuropathy Risk

Vinca alkaloids have the highest risk of causing severe peripheral neuropathy compared to cyclophosphamide, cytarabine, and cisplatin, with symptoms developing in a "stocking-glove" distribution, affecting distal extremities first 1, 2
Cyclophosphamide is not typically associated with significant peripheral neuropathy 1, 2

Cisplatin-induced neuropathy is primarily sensory, with numbness, tingling, and pain, and can worsen for 2-3 months after cessation of therapy (coasting phenomenon) 2
Symptoms of cisplatin-induced neuropathy may persist for years in some patients 2

No established agents are recommended for the prevention of CIPN in patients undergoing treatment with neurotoxic chemotherapy agents, and acetyl-L-carnitine should be discouraged for CIPN prevention 1, 3
Duloxetine is the only agent with moderate evidence supporting its use for painful CIPN 1, 2, 4
Dose modification is often necessary when severe neuropathy develops, and clinicians should assess the appropriateness of dose delaying, dose reduction, substitutions, or stopping chemotherapy in patients who develop intolerable neuropathy and/or functional impairment 2
Patients with pre-existing neuropathy (e.g., diabetic neuropathy) are at higher risk for developing more severe CIPN 6