Velasco R, Bruna J
Unidad de Neuro-Oncología, Servicio de Neurología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
Neurologia. 2010 Mar;25(2):116-31.
INTRODUCTION: Chemotherapy-induced peripheral neuropathy (CIPN) is the most prevalent neurological complication of cancer treatment, affecting a third of all patients who undergo chemotherapy. CIPN impairs functional capacity, compromises the quality of life and results in dose reduction or cessation of chemotherapy, representing a dose-limiting side effect of many antineoplastic drugs. In addition to classic, novel agents, bortezomib and oxaliplatin have been shown to have a significant risk of CIPN. METHODS: By reviewing literature, this article analyses relevant issues and recent advances regarding the pathogenesis, incidence, risk factors, diagnosis, characteristics and management of CIPN. RESULTS: Research into the pathophysiology and identification of risk factors for individual patients is growing. A future avenue of investigation includes the identification of patients at lower or higher risk based on their genotype. Best tools for CIPN assessment are not defined. Many agents have been claimed to be neuroprotectors without showing significant results in large randomised clinical trials. CONCLUSIONS: Early recognition and subsequent dose reduction/discontinuation of the offending agent is the only way to minimise the development of this potentially debilitating complication. Due to the lack of effective prophylactic or symptomatic treatments up to now, neurological monitoring should be recommended in patient candidates to be treated with neurotoxic antineoplastic agents, mainly when they present baseline neuropathy. Development of reliable methods for CIPN assessment is essential.
引言:化疗引起的周围神经病变(CIPN)是癌症治疗中最常见的神经并发症,影响三分之一接受化疗的患者。CIPN损害功能能力,降低生活质量,并导致化疗剂量减少或停止,是许多抗肿瘤药物的剂量限制性副作用。除了传统药物外,新型药物硼替佐米和奥沙利铂也已被证明有发生CIPN的重大风险。 方法:通过回顾文献,本文分析了CIPN的发病机制、发病率、危险因素、诊断、特征及管理方面的相关问题和最新进展。 结果:对病理生理学的研究以及对个体患者危险因素的识别正在不断增加。未来的一个研究方向包括根据患者的基因型识别低风险或高风险患者。尚未确定评估CIPN的最佳工具。许多药物被宣称具有神经保护作用,但在大型随机临床试验中未显示出显著效果。 结论:尽早识别并随后减少或停用致病药物是将这种潜在致残性并发症的发生降至最低的唯一方法。由于目前缺乏有效的预防性或对症治疗,对于拟接受神经毒性抗肿瘤药物治疗的患者,应建议进行神经学监测,尤其是当他们存在基线神经病变时。开发可靠的CIPN评估方法至关重要。
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