Swain Sandra M, Arezzo Joseph C
Washington Cancer Institute, Washington Hospital Center, Washington, DC 20010, USA.
Clin Adv Hematol Oncol. 2008 Jun;6(6):455-67.
Microtubule inhibitor (MTI)-based chemotherapies used in the treatment of breast cancer--including vinca alkaloids, taxanes, and epothilones--are known to be associated with peripheral neuropathy. The incidence and severity of neuropathy, most frequently sensory in nature, depend on the agent used, absolute and cumulative drug dose, administration schedule, and presence of comorbidities. Although some first-generation vinca alkaloids, such as vincristine, were associated with severe mixed sensory/motor neuropathy, the deficits associated with newer agents in this class (eg, vinflunine) are generally milder and limited to distal sensory signs and symptoms. Among the taxanes, sensory neuropathy is reported more often with administration of paclitaxel and albumin-bound paclitaxel and less frequently with docetaxel. Epothilones, a new class of MTI, may be associated with grade 3/4 peripheral neuropathy; however, the neuropathy associated with ixabepilone, a novel epothilone B analog, is generally mild to moderate and reversible to baseline or grade 1 levels. The neuropathy induced by MTI therapy is best managed with dose adjustments and/or treatment delay. This article provides an overview of the incidence, characteristics, and management of MTI-associated neurotoxicities for known vinca alkaloids and taxanes, as well as newer agents, such as vinflunine and ixabepilone.
用于治疗乳腺癌的基于微管抑制剂（MTI）的化疗药物——包括长春花生物碱、紫杉烷类和埃坡霉素——已知与周围神经病变有关。神经病变的发生率和严重程度，本质上大多为感觉性的，取决于所使用的药物、绝对和累积药物剂量、给药方案以及合并症的存在情况。尽管一些第一代长春花生物碱，如长春新碱，与严重的混合性感觉/运动神经病变有关，但该类新型药物（如长春氟宁）相关的缺陷通常较轻，且仅限于远端感觉体征和症状。在紫杉烷类中，紫杉醇和白蛋白结合型紫杉醇给药后感觉神经病变的报告更为常见，多西他赛则较少见。埃坡霉素是一类新型MTI，可能与3/4级周围神经病变有关；然而，与新型埃坡霉素B类似物伊沙匹隆相关的神经病变通常为轻至中度，且可恢复至基线或1级水平。MTI治疗引起的神经病变最好通过调整剂量和/或延迟治疗来处理。本文概述了已知长春花生物碱和紫杉烷类以及新型药物（如长春氟宁和伊沙匹隆）与MTI相关神经毒性的发生率、特征及处理方法。
