Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE1 1UL, UK.
Division of Anaesthesia, Critical Care and Pain Medicine, Department of Pain Medicine Research, The University of Texas M.D. Anderson Cancer Centre, Houston, TX, USA.
Br J Anaesth. 2017 Oct 1;119(4):737-749. doi: 10.1093/bja/aex229.
This review provides an update on the current clinical and preclinical understanding of chemotherapy induced peripheral neuropathy (CIPN). The overview of the clinical syndrome includes a review of its assessment, diagnosis and treatment. CIPN is caused by several widely-used chemotherapeutics including paclitaxel, oxaliplatin, bortezomib. Severe CIPN may require dose reduction, or cessation, of chemotherapy, impacting on patient survival. While CIPN often resolves after chemotherapy, around 30% of patients will have persistent problems, impacting on function and quality of life. Early assessment and diagnosis is important, and we discuss tools developed for this purpose. There are no effective strategies to prevent CIPN, with limited evidence of effective drugs for treating established CIPN. Duloxetine has moderate evidence, with extrapolation from other neuropathic pain states generally being used to direct treatment options for CIPN. The preclinical perspective includes a discussion on the development of clinically-relevant rodent models of CIPN and some of the potentially modifiable mechanisms that have been identified using these models. We focus on the role of mitochondrial dysfunction, oxidative stress, immune cells and changes in ion channels from summary of the latest literature in these areas. Many causal mechanisms of CIPN occur simultaneously and/or can reinforce each other. Thus, combination therapies may well be required for most effective management. More effective treatment of CIPN will require closer links between oncology and pain management clinical teams to ensure CIPN patients are effectively monitored. Furthermore, continued close collaboration between clinical and preclinical research will facilitate the development of novel treatments for CIPN.
这篇综述更新了化疗引起的周围神经病(CIPN)的临床和临床前认识。对临床综合征的概述包括对其评估、诊断和治疗的回顾。CIPN 是由几种广泛使用的化疗药物引起的,包括紫杉醇、奥沙利铂、硼替佐米。严重的 CIPN 可能需要减少或停止化疗剂量,从而影响患者的生存。虽然 CIPN 通常在化疗后会缓解,但约 30%的患者会持续存在问题,影响功能和生活质量。早期评估和诊断很重要,我们讨论了为此目的开发的工具。目前尚无预防 CIPN 的有效策略,对于已确立的 CIPN,有效药物的证据有限。度洛西汀有中等证据,通常从其他神经病理性疼痛状态推断出用于指导 CIPN 治疗选择的证据。临床前观点包括讨论开发与临床相关的 CIPN 啮齿动物模型以及使用这些模型确定的一些潜在可调节机制。我们重点关注线粒体功能障碍、氧化应激、免疫细胞和离子通道变化的作用,总结了这些领域的最新文献。CIPN 的许多因果机制同时发生和/或可以相互加强。因此,大多数有效的管理可能需要联合治疗。更有效的 CIPN 治疗需要肿瘤学和疼痛管理临床团队之间更紧密的联系,以确保 CIPN 患者得到有效监测。此外,临床和临床前研究之间的持续密切合作将有助于为 CIPN 开发新的治疗方法。
Curr Opin Support Palliat Care. 2016-6
Expert Opin Drug Saf. 2015-8
J Pain Palliat Care Pharmacother. 2020-9
Clin Pharmacol Ther. 2011-8-3
Pharmaceuticals (Basel). 2025-8-5