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Varna Medical Forum

Neurotoxicity of cancer agents

Nikolay Conev, Ivan Shterev, Rostislav Manev, Eleonora Dimitrova, Dragomir Stoyanov, Yаvor Kashlov, Chavdar Bachvarov, Georgi Todorov, Stanimir Sirakov, Kameliya Bratoeva

Abstract

Neurotoxic side effects of chemotherapy occur frequently and are often a reason to limit the dose of chemotherapy. Chemotherapy dosing is often limited due to a frequently occurring side effect of the treatment - neurotoxic. The risk of neurotoxicity is increased by the possibility of higher dose usage, since bone marrow toxicity (the major limiting factor in most chemotherapeutic regimens) can be overcome with growth factors or bone marrow transplantation.

Chemotherapy may cause both peripheral neurotoxicity, consisting mainly of a peripheral neuropathy, and central neurotoxicity, ranging from minor cognitive deficits to encephalopathy with dementia or even coma. Neurotoxicity caused by the chemotherapy can be of two types - peripheral, mainly consisting of peripheral neuropathy and central, from minor cognitive deficits through encephalopathy with dementia to even coma.

Data management and neuroprotective agents are still in discussion and there are no current accepted guidelines yet. Management mainly consists of cumulative dose-reduction or lower dose-intensities, especially in patients who are at higher risk to develop neurotoxic side effects. None of the specific neuroprotective agents can be recommended in daily practice for standard use at the moment, and further studies are needed to confirm their beneficial effects.


Keywords

neurotoxicity; chemotherapy; cancer

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References

Dietrich J, Monje M, Wefel J, Meyers C. Clinical patterns and biological correlates of cognitive dysfunction associated with cancer therapy. Oncologist 2008; 13(12): 1285-95.

Scheibel RS, Meyers CA, Levin VA. Cognitive dysfunction following surgery for intracerebral glioma: influence of histopathology, lesion location, and treatment. J Neurooncol 1996; 30(1): 61-9.

Shah GD, DeAngelis LM. Treatment of primary central nervous system lymphoma. Hematol Oncol Clin North Am 2005; 19(4): 611-27, v.

Sul JK, Deangelis LM. Neurologic complications of cancer chemotherapy. Semin Oncol 2006; 33(3): 324-32.

Keime-Guibert F, Napolitano M, Delattre JY. Neurological complications of radiotherapy and chemotherapy. J Neurol 1998; 245(11): 695-708.

Laack NN, Ballman KV, Brown PB, O'Neill BP, North Central Cancer Treatment G. Whole-brain radiotherapy and high-dose methylprednisolone for elderly patients with primary central nervous system lymphoma: Results of North Central Cancer Treatment Group (NCCTG) 96-73-51. Int J Radiat Oncol Biol Phys 2006; 65(5): 1429-39.

Hilverda K, Bosma I, Heimans JJ, et al. Cognitive functioning in glioblastoma patients during radiotherapy and temozolomide treatment: initial findings. J Neurooncol 2010; 97(1): 89-94.

Macdonald DR, Kiebert G, Prados M, Yung A, Olson J. Benefit of temozolomide compared to procarbazine in treatment of glioblastoma multiforme at first relapse: effect on neurological functioning, performance status, and health related quality of life. Cancer Invest 2005; 23(2): 138-44.

LoMonaco M, Milone M, Batocchi AP, Padua L, Restuccia D, Tonali P. Cisplatin neuropathy: clinical course and neurophysiological findings. J Neurol 1992; 239(4): 199-204.

Siegal T, Haim N. Cisplatin-induced peripheral neuropathy. Frequent off-therapy deterioration, demyelinating syndromes, and muscle cramps. Cancer 1990; 66(6): 1117-23.

Markman M, Kennedy A, Webster K, Kulp B, Peterson G, Belinson J. Neurotoxicity associated with a regimen of carboplatin (AUC 5-6) and paclitaxel (175 mg/m2 over 3 h) employed in the treatment of gynecologic malignancies. J Cancer Res Clin Oncol 2001; 127(1): 55-8.

Cvitkovic E, Bekradda M. Oxaliplatin: a new therapeutic option in colorectal cancer. Semin Oncol 1999; 26(6): 647-62.

Hurwitz RL, Mahoney DH, Jr., Armstrong DL, Browder TM. Reversible encephalopathy and seizures as a result of conventional vincristine administration. Med Pediatr Oncol 1988; 16(3): 216-9.

DeAngelis LM, Gnecco C, Taylor L, Warrell RP, Jr. Evolution of neuropathy and myopathy during intensive vincristine/corticosteroid chemotherapy for non-Hodgkin's lymphoma. Cancer 1991; 67(9): 2241-6.

Seidman AD, Barrett S, Canezo S. Photopsia during 3-hour paclitaxel administration at doses > or = 250 mg/m2. J Clin Oncol 1994; 12(8): 1741-2.

Nieto Y, Cagnoni PJ, Bearman SI, et al. Acute encephalopathy: a new toxicity associated with high-dose paclitaxel. Clin Cancer Res 1999; 5(3): 501-6.

Correa DD, DeAngelis LM, Shi W, Thaler H, Glass A, Abrey LE. Cognitive functions in survivors of primary central nervous system lymphoma. Neurology 2004; 62(4): 548-55.

Dunton SF, Nitschke R, Spruce WE, Bodensteiner J, Krous HF. Progressive ascending paralysis following administration of intrathecal and intravenous cytosine arabinoside. A Pediatric Oncology Group study. Cancer 1986; 57(6): 1083-8.

Resar LM, Phillips PC, Kastan MB, Leventhal BG, Bowman PW, Civin CI. Acute neurotoxicity after intrathecal cytosine arabinoside in two adolescents with acute lymphoblastic leukemia of B-cell type. Cancer 1993; 71(1): 117-23.

Bixenman WW, Nicholls JV, Warwick OH. Oculomotor disturbances associated with 5-fluorouracil chemotherapy. Am J Ophthalmol 1977; 83(6): 789-93.

Howell SB, Pfeifle CE, Wung WE. Effect of allopurinol on the toxicity of high-dose 5-fluorouracil administered by intermittent bolus injection. Cancer 1983; 51(2): 220-5.

DiMaggio JR, Brown R, Baile WF, Schapira D. Hallucinations and ifosfamide-induced neurotoxicity. Cancer 1994; 73(5): 1509-14.

Kende G, Sirkin SR, Thomas PR, Freeman AI. Blurring of vision: a previously undescribed complication of cyclophosphamide therapy. Cancer 1979; 44(1): 69-71.

Tashima CK. Immediate cerebral symptoms during rapid intravenous administration of cyclophosphamide (NSC-26271). Cancer Chemother Rep 1975; 59(2 Pt 1): 441-2.

Imrie KR, Couture F, Turner CC, Sutcliffe SB, Keating A. Peripheral neuropathy following high-dose etoposide and autologous bone marrow transplantation. Bone Marrow Transplant 1994; 13(1): 77-9.




DOI: http://dx.doi.org/10.14748/vmf.v7i1.4213

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