Division of Hematology and Oncology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, NY, USA.
Clin Breast Cancer. 2011 Apr;11(2):73-81. doi: 10.1016/j.clbc.2011.03.006. Epub 2011 Apr 11.
Microtubule-targeting agents (MTAs), which include vinca alkaloids, taxanes, and the recently introduced epothilone, ixabepilone, are widely used chemotherapeutic agents for treatment of patients with cancer. MTAs interfere with the normal structure and function of microtubules, leading to cell-cycle arrest and tumor cell death. Microtubule function is critical to normal neuronal function, thus MTA therapy is commonly associated with some form of neuropathy. There is poor agreement between tools for clinical assessment of MTA-associated peripheral neuropathy, and standardization of grading scales is needed to reduce variability. For a majority of patients, MTA-associated neuropathy is mild to moderate in intensity and reversible, but it can be severe and resolve incompletely. The incidence and severity of MTA-associated neuropathy is drug, dose, and schedule dependent. The first-generation vinca alkaloids (eg, vincristine) are associated with severe mixed sensory and motor neuropathy, whereas the newer vinca alkaloids (eg, vinorelbine, vinflunine) induce a milder sensory neuropathy. Taxane-associated sensory neuropathy occurs more often with standard (polyoxyethylated castor oil-based) and albumin-bound paclitaxel than with docetaxel. The incidence and presentation of peripheral neuropathy with ixabepilone, alone or in combination with capecitabine, are similar to that with taxanes. Management of neuropathy may involve reducing or delaying the MTA dose, or in severe persistent or disabling cases discontinuing treatment. Reversal of neuropathy after dosage intervention appears to be more rapid with ixabepilone than with other MTAs.
微管靶向药物（MTAs），包括长春花生物碱、紫杉烷类和最近推出的埃博霉素、伊沙匹隆，被广泛用于癌症患者的化疗。MTAs 干扰微管的正常结构和功能，导致细胞周期停滞和肿瘤细胞死亡。微管功能对正常神经元功能至关重要，因此 MTA 治疗通常与某种形式的周围神经病相关。用于临床评估 MTA 相关周围神经病的工具之间存在较差的一致性，需要对分级量表进行标准化，以减少变异性。对于大多数患者，MTA 相关神经病的强度为轻度至中度，是可逆的，但也可能是严重的，无法完全恢复。MTA 相关神经病的发生率和严重程度取决于药物、剂量和方案。第一代长春花生物碱（如长春新碱）与严重的混合感觉运动神经病相关，而新型长春花生物碱（如长春瑞滨、长春氟宁）则引起较轻的感觉神经病。与多西紫杉醇相比，标准（聚氧乙基化蓖麻油基）和白蛋白结合紫杉醇更常引起紫杉烷类相关的感觉神经病。伊沙匹隆单独或与卡培他滨联合使用时，周围神经病的发生率和表现与紫杉烷类相似。周围神经病的治疗可能涉及减少或延迟 MTA 剂量，或在严重的持续性或致残性病例中停止治疗。与其他 MTAs 相比，伊沙匹隆在剂量干预后神经病变的逆转似乎更快。
