Peripheral Neuropathy Induced by Chemotherapy: A Review

Abstract

This review explores the management of peripheral neuropathy in cancer patients, focusing on the clinical manifestations and underlying mechanisms of specific neurotoxic chemotherapy drugs. Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent and often dose-limiting side effect of cancer treatments. Around 30–40% of patients receiving neurotoxic chemotherapy will experience CIPN, with varying degrees of severity among individuals. This condition is usually sensory-based, causing pain, and can result in long-term complications for survivors. As cancer survival rates rise, the prevalence and impact of CIPN’s lasting effects are expected to grow.

Introduction

Chemotherapy-induced peripheral neuropathy (CIPN) is a common and often painful side effect of neurotoxic chemotherapy drugs, affecting sensory, motor, and autonomic nerves in cancer patients. About 30-40% of patients on such treatments develop CIPN, which can limit chemotherapy dosing and significantly impact quality of life and healthcare costs. The condition primarily results from damage to peripheral nerves, especially sensory neurons, and varies by drug type, dose, and administration method.

Common causative drugs include platinum compounds (cisplatin, oxaliplatin), taxanes, vinca alkaloids, proteasome inhibitors, and thalidomide. CIPN symptoms usually develop dose-dependently during treatment and may persist or worsen after cessation (notably with platinum drugs). Immune checkpoint inhibitors can cause rare immune-mediated neuropathies. Diagnosing CIPN requires differentiating it from other neuropathies caused by cancer or its treatments.

Treatment mainly involves reducing or stopping the offending drug and managing symptoms, with duloxetine showing some benefit for neuropathic pain. Preventive strategies are limited, and ongoing research focuses on understanding mechanisms, genetic risk factors, and developing better assessment tools. Long-term effects of chemotherapy also include persistent neuropathic pain and cognitive impairments ("chemo brain"), highlighting the need for future research as cancer survivorship increases.

Conclusion

With the development of newer and more targeted chemotherapy drugs, there was optimism that CIPN would become less of a major issue. However, many of the older drugs that cause CIPN remain essential in cancer treatment. In addition, several new therapies also result in CIPN as a dose-limiting side effect, either due to direct toxicity or immune-mediated processes. As cancer treatments improve and survival rates increase, the long-term effects of CIPN continue to cause substantial hardship for cancer survivors.

References

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Copyright

Copyright © 2025 S. Neelamani Durga, L. Renuka, N. Phani Satyavathi, P. Bhanuji Rao. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.