Chemotherapy-induced Peripheral Neuropathy

Chemotherapy-induced Peripheral Neuropathy (CIPN) is a side-effects that could occur during and after chemotherapy treatment. It is not an infrequent condition. It is second only to haematological toxicities regarding its incidence, being is related to widely-used drugs (platinum compounds, taxanes, vinka-alkaloids, proteasome inhibitors). CIPN generally consists of an axonal long-dependent peripheral neuropathy; its features are mainly sensory, even though some patients could develop a mild distal weakness. Main complaints referred by patients are related to both positive (paresthesia/disesthesia) both negative (hypoesthesia on different modalities) sensory symptoms, distributed in a stocking/glove fashion. Clinical manifestations are usually slightly different, in dependence of the specific kind of drug administered (for example sensory ataxia is more common with some drugs than others). CIPN, apart from being quite frequent, is highly relevant from a clinical point of view since it affects negatively Quality of Life (QoL) in a population of long-survival patients. Thus, in the recent years many efforts have been employed to better understand its physiopathology and to find a preventive and/or curative treatment. At the present moment an efficacious treatment has not yet been demonstrated. A reason for this could be the following: clinical trials performed so far were made even more difficult by the lack of a solid end-point to be selected in its regard. There is not yet a gold standard in CIPN assessment: it is not yet clear which clinimetric tool could be more useful and the precise role of NCS and QOL questionnaire in this specific setting. Recently a study has been published aimed to answer this unmet clinical and scientific need: CI-Perinoms Study. It has demonstrated good validity and reliability findings for a set of selected outcome measures. Subsequent responsiveness study is to be held by the same group, thus possibly allowing a reliable and valid selection of outcome measures for future clinical trials. Efforts in this regard should also be performed in combination with a genomic approach, to discover specific individual risk factors for CIPN. Selection of “genomic target” should be carefully performed; pathways that could be possibly involved in nerve damage should be aimed first. Despite the presence of many pending question, given the increased interest aroused in the Neurological and Oncological community, in the next few years initial answers could be expected to be found, in the hope of prosing a treatment this potentially curable iatrogenic neuropathy.