Chemotherapy-Induced Peripheral Neuropathy (CIPN)

The incidence of chemotherapy-induced peripheral neuropathy (CIPN) can be up to 68% in the first month following an infusion of a neurotoxic agent. ¹

Several common chemotherapeutic drugs can accumulate to levels in the body that are neurotoxic and result in the development of chemotherapy-induced peripheral neuropathy. This can significantly impact a patient’s quality of life and ability to perform activities of daily living.

The most common and concerning drug classes leading to CIPN include platinum agents, vinca alkaloids, and taxanes which are used in many different types of malignancies. This includes oxaliplatin, cisplatin, as well as paclitaxel, docetaxel and vincristine and vinblastine. Additionally, thalidomide and bortezomib are medications used for the treatment of multiple myeloma that may also cause severe sensory neuropathy.

The precise pathophysiology that underlies CIPN is complex and differs between each class of medications. Risk can also increase if there is pre-existing nerve damage, such as from diabetes. Generally speaking, the pathophysiologic mechanisms may include: ^2-4

• Oxidative stress and mitochondrial dysfunction
• Altered calcium homeostasis and changes in neural excitability
• Axonal degeneration
• Inflammation
• Immune system activation

CIPN can begin as pain, numbness, tingling, burning, and/or cold sensitivity in the fingers and toes bilaterally. It can then gradually start to spread up the palms and soles. Patients may report difficulty with fine motor skills such as writing, fastening buttons, holding objects or have changes to their gait. It is important that if a patient does notice any of these symptoms while on treatment, that they inform their medical team immediately.

The symptoms of CIPN include:

• Numbness
• Burning
• Tingling
• Reduced sensation
• Decreased strength and movement
• Sensitivity to cold
• Pain in extremities, including the fingers, hands, toes, and feet

Depending on the grade of neuropathy, severity of motor and sensory symptoms, and their impact of activities of daily living; a dose reduction or change in treatment may need to occur. This is because it can lead to permanent nerve damage.

While there is no “standard of care” for the prevention and treatment of CIPN, there is considerable preliminary data on various integrative therapies and natural agents that have shown benefit. There are also some pharmaceutical agents that can also be incorporated with natural agents to help improve patients symptoms.

For example, one of my patients diagnosed with metastatic pancreatic adenocarcinoma to the liver, was being treated with FOLFIRINOX. The oxaliplatin, lead to neuropathies in his fingers and toes, which diminished his ability to do up a zipper or button his shirt. He was started on regimen that included calcium, magnesium, B complex, L-glutamine, and alpha-lipoic acid. He was also recommended to ensure adequate hydration and moderate exercise each week. He was able to continue treatment for 9 months but did eventually have to switch to FOLFIRI due to progression of the disease.

Want to learn more about CIPN and possible integrative treatments? Consider the Advanced Integrative Oncology Palliative Care Course by the Integrative Oncology Institute.