癌症患者神经病变的诊断、管理、治疗及预防的最新进展
Recent Advances in Diagnosis, Management, Treatment, and Prevention of Neuropathies in Cancer Patients.
作者信息
Rhee John Y, Paulino Maria T, Finnemore Alexander, Tentor Zachary, Cashman Christopher
机构信息
Center for Neuro-Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
Division of Adult Palliative Care, Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
出版信息
Curr Neurol Neurosci Rep. 2025 Jun 20;25(1):42. doi: 10.1007/s11910-025-01429-3.
PURPOSE OF REVIEW
The purpose of this article is to provide an update on cancer-related neuropathies over the past five years, by reviewing the advances in pathophysiology and biology, diagnostic approaches, and management strategies.
RECENT FINDINGS
New agents causing peripheral neuropathy include antibody-drug conjugates, combinations of immune-checkpoint inhibitor therapies, and targeted therapies. Development of axonal neuropathies has been found to be mediated through the protein sterile-α and Toll/interleukin 1 receptor motif containing protein 1 (SARM1). There have been emerging imaging modalities such as high-field MRI and neuromuscular ultrasound, and serum biomarkers, such as neurofilament light chain and glial fibrillary acid protein. Though calmangafodipir was negative for preventing peripheral neuropathy in oxaliplatin-based treatments, the POLAR trial randomizing patients to cooling or compression of the dominant hand during taxane administration significantly reduced incidence of chemotherapy-induced peripheral neuropathy. As of yet, there are no treatments for chemotherapy-induced peripheral neuropathy, but continued basic research into the SARM pathway is likely to yield novel agents that will stop, or prevent, the process.
综述目的
本文旨在通过回顾过去五年癌症相关神经病变在病理生理学、生物学、诊断方法及管理策略方面的进展,提供最新信息。
最新发现
导致周围神经病变的新药物包括抗体药物偶联物、免疫检查点抑制剂联合疗法及靶向疗法。已发现轴索性神经病变的发生是由含蛋白无菌α和Toll/白细胞介素1受体基序蛋白1(SARM1)介导的。出现了诸如高场MRI和神经肌肉超声等新兴成像方式,以及血清生物标志物,如神经丝轻链和胶质纤维酸性蛋白。尽管钙锰双吡啶在基于奥沙利铂的治疗中预防周围神经病变呈阴性,但将患者随机分为紫杉烷给药期间优势手冷却或加压组的POLAR试验显著降低了化疗引起的周围神经病变的发生率。目前,化疗引起的周围神经病变尚无治疗方法,但对SARM途径的持续基础研究可能会产生能够阻止该过程的新型药物。