Clin Breast Cancer. 2011 Apr;11(2):73-81. Epub 2011 Apr 11.
Peripheral neuropathy with microtubule-targeting agents: occurrence and management approach.
Carlson K,
Ocean AJ.
Source
Division of Hematology and Oncology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, NY, USA.
Abstract
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.
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