Chemotherapy-Induced Peripheral Neuropathy: Epidemiology, Pathomechanisms and Treatment.
Chemotherapy-Induced Peripheral Neuropathy: Epidemiology, Pathomechanisms and Treatment.
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DOI：
10.1007/s40487-021-00168-y
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发表时间：
2021-12
影响因子：
2.7
通讯作者：
Alam U
中科院分区：
文献类型：
--
作者：
Burgess J;Ferdousi M;Gosal D;Boon C;Matsumoto K;Marshall A;Mak T;Marshall A;Frank B;Malik RA;Alam U
这篇综述提供了当前临床、流行病学和病理生理学证据的最新信息，以及化疗引起的周围神经病变（CIPN）的诊断、预防和治疗方法。癌症的发病率和治疗后的长期生存率正在增加。 CIPN 影响感觉、运动和自主神经，是化疗药物引起的最常见不良事件之一，严重时会导致剂量减少或停止治疗，死亡率增加。与 CIPN 相关的化疗药物的主要类别是铂类药物、紫杉烷类、长春花生物碱、硼替佐米和沙利度胺。铂类药物的神经毒性最强，其中奥沙利铂导致 CIPN 的患病率最高。 CIPN 可以从急性发展为慢性，甚至在治疗停止后也可能恶化（这种现象称为惯性）或仅部分减弱。不同的化疗药物在病理生理学和临床表现方面既有相似之处，也有关键差异。 CIPN 的诊断在很大程度上依赖于症状的识别，针对受影响神经纤维类别的客观诊断方法有限。 Studies have consistently failed to identify at-risk cohorts, and there are no proven strategies or interventions to prevent or limit the development of CIPN.此外，为缓解 CIPN 症状和改变潜在疾病而开发的多种治疗方法均已失败。 CIPN 患病率的增加需要一种客观的方法来识别高危患者，以预防或限制进展并有效缓解与 CIPN 相关的症状。新靶点以及药物和非药物治疗的证据基础正在开始出现，并且最近在美国临床肿瘤学会和 ACTTION 等镇痛试验设计专家组的出版物中得到认可。
This review provides an update on the current clinical, epidemiological and pathophysiological evidence alongside the diagnostic, prevention and treatment approach to chemotherapy-induced peripheral neuropathy (CIPN). The incidence of cancer and long-term survival after treatment is increasing. CIPN affects sensory, motor and autonomic nerves and is one of the most common adverse events caused by chemotherapeutic agents, which in severe cases leads to dose reduction or treatment cessation, with increased mortality. The primary classes of chemotherapeutic agents associated with CIPN are platinum-based drugs, taxanes, vinca alkaloids, bortezomib and thalidomide. Platinum agents are the most neurotoxic, with oxaliplatin causing the highest prevalence of CIPN. CIPN can progress from acute to chronic, may deteriorate even after treatment cessation (a phenomenon known as coasting) or only partially attenuate. Different chemotherapeutic agents share both similarities and key differences in pathophysiology and clinical presentation. The diagnosis of CIPN relies heavily on identifying symptoms, with limited objective diagnostic approaches targeting the class of affected nerve fibres. Studies have consistently failed to identify at-risk cohorts, and there are no proven strategies or interventions to prevent or limit the development of CIPN. Furthermore, multiple treatments developed to relieve symptoms and to modify the underlying disease in CIPN have failed. The increasing prevalence of CIPN demands an objective approach to identify at-risk patients in order to prevent or limit progression and effectively alleviate the symptoms associated with CIPN. An evidence base for novel targets and both pharmacological and non-pharmacological treatments is beginning to emerge and has been recognised recently in publications by the American Society of Clinical Oncology and analgesic trial design expert groups such as ACTTION.
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