Lee James J, Swain Sandra M
Breast Cancer Section, Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20889-5015, USA.
J Clin Oncol. 2006 Apr 1;24(10):1633-42. doi: 10.1200/JCO.2005.04.0543.
Microtubule-stabilizing agents (MTSAs), including the taxanes and epothilones, are effective chemotherapeutic agents for the treatment of many cancers. Neuropathy is a major adverse effect of MTSA-based chemotherapy, with severe peripheral neuropathy (grade 3 or 4) occurring in as many as 30% of patients treated with a MTSA. MTSA-induced neuropathy usually resolves gradually after cessation of the treatment. The most reliable method to accurately assess MTSA-induced neuropathy is by clinical evaluation, although additional techniques are being developed and evaluated. Among MTSA-induced neuropathy, the most extensively studied is that induced by taxanes; such a neuropathy usually presents as sensory neuropathy and is more common with paclitaxel than docetaxel. The incidence of MTSA-induced neuropathy seems to depend on the MTSA dose per treatment cycle, the schedule of treatment, and the duration of the infusion. Although there have been several small clinical trials with neuroprotective agents, early recognition and supportive care are the best approaches for prevention and management of MTSA-induced neuropathy. In the future, research should focus on elucidating the mechanism of MTSA-induced neuropathy, developing reliable in vivo and in vitro preclinical models to study MTSA-induced neuropathy, developing a more reliable grading system for MTSA-induced neuropathy, developing more reliable methods for evaluating MTSA-induced neuropathy, and evaluating the efficacy of potential neuroprotective agents in clinical trials.
微管稳定剂（MTSAs），包括紫杉烷类和埃坡霉素类，是治疗多种癌症的有效化疗药物。神经病变是基于MTSA化疗的主要不良反应，在接受MTSA治疗的患者中，多达30%会出现严重的周围神经病变（3级或4级）。MTSA引起的神经病变通常在治疗停止后逐渐缓解。准确评估MTSA引起的神经病变最可靠的方法是临床评估，尽管其他技术也在不断开发和评估中。在MTSA引起的神经病变中，研究最广泛的是紫杉烷类引起的神经病变；这种神经病变通常表现为感觉神经病变，在紫杉醇治疗中比多西他赛更常见。MTSA引起的神经病变的发生率似乎取决于每个治疗周期的MTSA剂量、治疗方案和输注持续时间。尽管已经有几项关于神经保护剂的小型临床试验，但早期识别和支持性护理是预防和管理MTSA引起的神经病变的最佳方法。未来，研究应集中在阐明MTSA引起神经病变的机制、开发可靠的体内和体外临床前模型以研究MTSA引起的神经病变、开发更可靠的MTSA引起神经病变的分级系统、开发更可靠的评估MTSA引起神经病变的方法以及在临床试验中评估潜在神经保护剂的疗效。
