Peripheral neuropathy (chemotherapy-induced)
Nerve damage from chemotherapy that causes numbness, tingling and pain in the hands and feet, and sometimes weakness or hearing loss. It builds up with each dose, can be permanent, and is the main reason oxaliplatin, taxanes and vincristine have to be stopped or reduced.
Oxaliplatin (acute cold-triggered and chronic cumulative), paclitaxel, docetaxel, vincristine, bortezomib, brentuximab vedotin and other MMAE ADCs, and cisplatin (which also damages hearing, especially in children, prevented by sodium thiosulfate) are the main culprits. There is no proven preventive drug; duloxetine helps painful neuropathy, and dose reduction or stopping is the only reliable measure, which is why 3 rather than 6 months of adjuvant oxaliplatin (IDEA) was so consequential. Neuropathy is graded by function (grade 2 limits instrumental activities, grade 3 self-care) and often reported by patients as more severe than by clinicians. Cisplatin eligibility in bladder cancer includes absence of neuropathy and hearing loss.
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