Side Effect: Peripheral Neuropathy

What is Peripheral Neuropathy?

In cancer patients, the most common cause of peripheral neuropathy is the use of various treatments that can potentially damage nerves and impair the healing of damaged nerves. In many cases, the damage can be reversible if the medication is stopped or if the dose is lowered but may lead to permanent nerve damage if not addressed. Therefore, it is extremely important to tell your doctor if you are experiencing any signs or symptoms of peripheral neuropathy as soon as they arise.

What does Peripheral Neuropathy look like?

Peripheral neuropathy can result in either sensory (feeling) or motor (movement) dysfunction. Patients who develop sensory peripheral neuropathy commonly experience pain, tingling, and/or numbness in their fingers and/or toes. Patients who develop motor peripheral neuropathy may experience weakness in their arms or legs and can have difficulty walking or performing precise movements. Symptoms most commonly present during the first two months of treatment.

Who gets Peripheral Neuropathy?

Not all cancer therapies cause peripheral neuropathy. Some of the treatments that have been known to cause peripheral neuropathy include:

• Taxanes
  • Paclitaxel (Taxol®)
  • Docetaxel (Taxotere®)
  • Cabazitaxel (Jevtana®)
• Vinca Alkaloids
  
  • Vincristine (Oncovin®)
  • Vinblastine (Velban®)
  • Vinorelbine (Navelbine®)
• Proteosome Inhibitors
  
  • Bortezomib (Velcade®)
  • Carfilzomib (Kyprolis®)
  • Ixazomib (Ninlaro®)
• Platinums
  
  • Oxaliplatin (Eloxatin®)
  • Cisplatin (Platinol®)
  • Carboplatin (Paraplatin®)
• Antibody-Drug Conjugates
  
  • Ado-trastuzumab emtansine (Kadcyla®)
  • Brentuximab (Adcetris®)
• Thalidomide (Thalomid®)
• Ixebepilone (Ixempra®)
• Eribulin (Halaven®)

How long does last?

Peripheral neuropathy symptoms should stop getting worse when treatment is stopped but may take several months to completely go away as it can take time for nerves to heal. It’s important to note that in some patients treated with cisplatin or oxaliplatin, symptoms may get worse for a few months after discontinuing treatment before they start getting better. This is known as the “coasting” phenomenon.

How to prevent Peripheral Neuropathy

Unfortunately, there are no preventative treatments for peripheral neuropathy. This is due to the very complex mechanisms behind why certain cancer treatments cause nerve damage and the concern that addressing them may potentially decrease the effectiveness of the treatment. There have been several studies on various preventative strategies, but none with sufficient data to recommend using.

How to treat Peripheral Neuropathy

Peripheral neuropathy is often managed by either reducing the dose of the causative agent or discontinuing the agent all together. However, your doctor will weigh the benefits of treatment such as chance of remission or cure versus the risk of worsening symptoms of neuropathy.

Some commonly prescribed medications to help treat symptoms of peripheral neuropathy include duloxetine (Cymbalta®), gabapentin (Neurontin®), and pregabalin (Lyrica®). Use of opioid pain medications is not common as they tend to be less effective in treating nerve pain than other types of pain.