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Numbness, tingling and pain in the hands and feet are common on platinum, taxane, vinca and proteasome-inhibitor treatment, and most of it fades. In a meta-analysis of 4,179 patients it was present in 68 per cent in the first month, 60 per cent at three months and 30 per cent at six months or later. Only duloxetine has evidence for the pain, and no drug prevents it.
The drugs that cause it are the platinums (oxaliplatin and cisplatin), the taxanes (paclitaxel, docetaxel, nab-paclitaxel), the vinca alkaloids (vincristine), bortezomib and thalidomide. Oxaliplatin adds a cold-triggered acute form during and just after each infusion, and can go on worsening for weeks after the last dose.
The timescale is the figure most often missing from patient information. A systematic review of 31 studies and 4,179 patients found prevalence of 68.1 per cent (57.7 to 78.4) when measured in the first month after chemotherapy, 60.0 per cent (36.4 to 81.6) at three months, and 30.0 per cent (6.4 to 53.5) at six months or more. The authors' own conclusion is the honest sentence to give a reader: "Although CIPN prevalence decreases with time, at 6months 30% of patients continue to suffer from CIPN."
What helps. ASCO's 2020 guideline update is blunt: "no agents are recommended for the prevention of CIPN", acetyl-L-carnitine "should be discouraged" because a trial found it made neuropathy worse, and "Duloxetine is the only agent that has appropriate evidence to support its use for patients with established painful CIPN. Nonetheless, the amount of benefit from duloxetine is limited." The trial behind that recommendation randomised 231 patients to duloxetine 60 mg daily or placebo for five weeks: average pain fell 1.06 points on a 0 to 10 scale against 0.34 on placebo, a difference of 0.73 (95 per cent confidence interval 0.26 to 1.20), and 59 per cent of those on duloxetine reported some decrease in pain against 38 per cent on placebo.
The things with the most promise are physical rather than pharmacological, and they are given during the infusion rather than afterwards: cooling and compression of the hands and feet during taxane treatment. These have their own record in the corpus. Dose reduction, delay or substitution remains the single most effective response to neuropathy that is becoming disabling, and ASCO explicitly tells clinicians to assess whether it is appropriate.
A long list has been tried and failed or has no reliable evidence: acetyl-L-carnitine (discouraged), vitamin E, glutamine, calcium and magnesium infusions, amifostine, alpha-lipoic acid, gabapentin, pregabalin and topical amitriptyline-ketamine. Acupuncture and scrambler therapy are covered separately and neither has convincing sham-controlled evidence.
What comes back, and when: partial, and mostly in the first six months. Two thirds of people have recovered by six months; about a third have symptoms that persist beyond that, and for those the evidence is about managing pain rather than restoring the nerve. Numbness responds less well than pain. Balance and falls are the part most worth treating with physiotherapy, because the risk is a fracture.
Platinums damage dorsal root ganglion cell bodies through DNA adduct formation, taxanes and vincas disrupt axonal microtubule transport, and bortezomib affects mitochondrial and endoplasmic reticulum function in sensory neurons. Because the injury is to the longest axons and sometimes the cell body itself, recovery depends on axonal regrowth at roughly a millimetre a day and is incomplete where the neuron has died.
Query for this technology: (TITLE:"Nerve damage from chemotherapy: what recovers, and what helps" OR ABSTRACT:"Nerve damage from chemotherapy: what recovers, and what helps") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Nerve damage from chemotherapy: what recovers, and what helps, not a curated reading list.
Shares Frozen gloves, socks and compression for taxane nail and nerve damage, Late effects and survivorship toxicity, Docetaxel, Toxicity and quality of life are undervalued and the tags rejuvenation, survivorship.
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Shares The exercise prescription after cancer: the dose the guidelines state, Late effects and survivorship toxicity, Survivorship care and late-effects surveillance, Survivorship and late effects are neglected and the tags rejuvenation, survivorship.
Shares Testicular germ cell tumours, Late effects and survivorship toxicity, Survivorship care and late-effects surveillance, Survivorship and late effects are neglected and the tags rejuvenation, survivorship.
Shares The exercise prescription after cancer: the dose the guidelines state, Late effects and survivorship toxicity, Survivorship care and late-effects surveillance, Survivorship and late effects are neglected and the tags rejuvenation, survivorship.
Shares Testicular germ cell tumours, Late effects and survivorship toxicity, Survivorship care and late-effects surveillance, Survivorship and late effects are neglected and the tags rejuvenation, survivorship.
Shares Late effects and survivorship toxicity, Survivorship care and late-effects surveillance, Survivorship and late effects are neglected, Toxicity and quality of life are undervalued and the tags rejuvenation, survivorship.
Shares Late effects and survivorship toxicity, Survivorship care and late-effects surveillance, Survivorship and late effects are neglected, Toxicity and quality of life are undervalued and the tags rejuvenation, survivorship.