Recent Advances in Diagnosis, Management, Treatment, and Prevention of Neuropathies in Cancer Patients

Abstract

Purpose of review: The purpose of this article is to provide an update on cancer-related neuropathies over the past five years, by reviewing the advances in pathophysiology and biology, diagnostic approaches, and management strategies.

Recent findings: New agents causing peripheral neuropathy include antibody-drug conjugates, combinations of immune-checkpoint inhibitor therapies, and targeted therapies. Development of axonal neuropathies has been found to be mediated through the protein sterile-α and Toll/interleukin 1 receptor motif containing protein 1 (SARM1). There have been emerging imaging modalities such as high-field MRI and neuromuscular ultrasound, and serum biomarkers, such as neurofilament light chain and glial fibrillary acid protein. Though calmangafodipir was negative for preventing peripheral neuropathy in oxaliplatin-based treatments, the POLAR trial randomizing patients to cooling or compression of the dominant hand during taxane administration significantly reduced incidence of chemotherapy-induced peripheral neuropathy. As of yet, there are no treatments for chemotherapy-induced peripheral neuropathy, but continued basic research into the SARM pathway is likely to yield novel agents that will stop, or prevent, the process.

Keywords: Cancer-related peripheral neuropathy; Chemotherapy-induced peripheral neuropathy; Immune checkpoint related adverse events; Quality-of-life.