Neuropatia obwodowa – Zapobieganie i profilaktyka

Neuropatia obwodowa
Zapobieganie i profilaktyka

Neuropatia obwodowa, często związana z cukrzycą (występuje u nawet 50% chorych), ekspozycją na toksyny, nadużywaniem alkoholu, niedoborami witaminy B12, lekami neurotoksycznymi (w tym chemioterapeutykami) oraz chorobami autoimmunologicznymi, wymaga kompleksowej profilaktyki. Kluczowe jest kontrolowanie czynników ryzyka, takich jak ścisła kontrola glikemii i ciśnienia tętniczego, unikanie alkoholu i nikotyny, oraz promowanie zdrowego stylu życia obejmującego zbilansowaną dietę bogatą w witaminę B12, regularną aktywność fizyczną (30-60 minut, 3 razy w tygodniu) i utrzymanie prawidłowej masy ciała. Szczepienia, np. przeciwko półpaścowi (szczepionka Shingrix dla osób >50 r.ż.), oraz codzienna higiena i kontrola stóp u pacjentów z cukrzycą są istotnymi elementami zapobiegania powikłaniom neuropatii.

Definicja profilaktyki neuropatii obwodowej

Neuropatia obwodowa to schorzenie, które dotyka układu nerwowego obwodowego, powodując nieprawidłowe funkcjonowanie nerwów odpowiedzialnych za przewodzenie impulsów pomiędzy ośrodkowym układem nerwowym a resztą ciała. Profilaktyka neuropatii obwodowej obejmuje działania mające na celu zapobieganie rozwojowi tego stanu lub ograniczenie jego nasilenia poprzez wczesną interwencję i kontrolę czynników ryzyka.¹² Jest to szczególnie istotne, ponieważ w wielu przypadkach neuropatia obwodowa może być nieodwracalna lub trudna do leczenia po jej rozwinięciu.

Czynniki ryzyka neuropatii obwodowej

Identyfikacja czynników ryzyka jest kluczowym elementem profilaktyki neuropatii obwodowej. Do najważniejszych czynników predysponujących do rozwoju tego schorzenia należą:¹²

Cukrzyca – szczególnie źle kontrolowana, stanowi jeden z głównych czynników ryzyka neuropatii
Ekspozycja na toksyczne substancje chemiczne i metale ciężkie (ołów, rtęć)
Nadużywanie alkoholu
Niedobory żywieniowe, szczególnie witaminy B12
Leki neurotoksyczne, w tym chemioterapeutyki
Przewlekłe choroby autoimmunologiczne
Infekcje, takie jak półpasiec czy HIV
Urazy mechaniczne nerwów
Otyłość i nadwaga
Zaburzenia naczyniowe

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Ogólne strategie profilaktyczne

Zdrowy tryb życia

Promowanie zdrowego stylu życia stanowi podstawę profilaktyki neuropatii obwodowej:¹²

Zbilansowana dieta – bogata w owoce, warzywa, pełnoziarniste produkty i chude białko wspiera zdrowie nerwów. Szczególną uwagę należy zwrócić na produkty bogate w witaminę B12 (mięso, ryby, jaja, niskotłuszczowe produkty mleczne, fortyfikowane płatki śniadaniowe)
Regularna aktywność fizyczna – co najmniej 30-60 minut aktywności fizycznej 3 razy w tygodniu poprawia krążenie i wspiera zdrowie nerwów
Utrzymanie prawidłowej masy ciała – pomaga zapobiegać rozwojowi cukrzycy typu 2 i zmniejsza obciążenie nerwów obwodowych
Unikanie alkoholu i nikotyny – ograniczenie lub całkowite wyeliminowanie tych substancji zmniejsza ryzyko uszkodzenia nerwów

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Kontrola chorób współistniejących

Odpowiednie leczenie i monitorowanie chorób, które mogą powodować neuropatię obwodową, jest kluczowe w profilaktyce:¹²

Kontrola cukrzycy – ścisła kontrola glikemii zmniejsza ryzyko rozwoju neuropatii cukrzycowej
Kontrola ciśnienia tętniczego – utrzymywanie prawidłowych wartości ciśnienia zapobiega uszkodzeniom naczyniowym, które mogą prowadzić do neuropatii
Leczenie chorób autoimmunologicznych – odpowiednia terapia chorób takich jak reumatoidalne zapalenie stawów czy toczeń może zapobiec rozwojowi neuropatii

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Szczepienia ochronne

Szczepienia mogą zapobiegać infekcjom prowadzącym do neuropatii:¹

Szczepienie przeciwko półpaścowi – szczepionka Shingrix jest zalecana dla dorosłych powyżej 50. roku życia w celu zmniejszenia ryzyka półpaśca i związanej z nim neuropatii

Profilaktyka w grupach wysokiego ryzyka

Pacjenci z cukrzycą

U pacjentów z cukrzycą neuropatia obwodowa występuje u nawet 50% chorych. Specyficzne strategie profilaktyczne dla tej grupy obejmują:¹

Codzienna kontrola stóp – regularne badanie stóp pod kątem otarć, ran, zaczerwienień i obrzęków
Odpowiednia higiena stóp – codzienne mycie i starannie osuszanie, szczególnie między palcami
Nawilżanie skóry – stosowanie balsamów nawilżających (z wyjątkiem przestrzeni międzypalcowych)
Noszenie odpowiedniego obuwia – buty z gumową podeszwą i wystarczającą ilością miejsca na palce
Regularne wizyty u diabetologa i podologa – monitorowanie stanu stóp i wczesne wykrywanie potencjalnych problemów

Pacjenci poddawani chemioterapii

Chemioterapia indukowana neuropatia obwodowa (CIPN) jest częstym powikłaniem leczenia przeciwnowotworowego, dotykającym około 40% pacjentów podczas aktywnego leczenia.¹ Strategie profilaktyczne w tej grupie są przedmiotem intensywnych badań:¹²

Metody niefarmakologiczne w profilaktyce CIPN

Krioterapia (terapia zimnem) – chłodzenie dłoni i stóp podczas infuzji chemioterapii, przy użyciu specjalnych rękawic i skarpet z lodem
Terapia uciskowa – noszenie uciskowych rękawiczek podczas infuzji chemioterapii, często w postaci dwóch par ściśle dopasowanych jednorazowych rękawiczek nitrylowych lub lateksowych
Aktywność fizyczna – ćwiczenia co najmniej dwa razy w tygodniu, obejmujące ćwiczenia siłowe, równoważne i ogólnoruchowe

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Metody te mogą działać poprzez zmniejszenie krążenia w kończynach podczas podawania chemioterapii, co może obniżyć ilość leków chemioterapeutycznych docierających do tych obszarów. Należy jednak podkreślić, że potrzebne są dalsze badania, aby potwierdzić skuteczność tych metod i określić najlepsze sposoby ich stosowania.¹

Metody farmakologiczne w profilaktyce CIPN

Aktualnie, zgodnie z wytycznymi American Society of Clinical Oncology (ASCO), nie ma rekomendowanych środków farmakologicznych do zapobiegania CIPN.¹ Niektóre badane substancje wykazały jednak obiecujące wyniki w badaniach klinicznych:¹²³

Metformina – badania RCT wykazały, że rozwój neuropatii obwodowej stopnia 2 lub wyższego był znacząco niższy w grupie otrzymującej metforminę w porównaniu do placebo
Kwasy tłuszczowe omega-3 – badania RCT wykazały istotną różnicę w występowaniu neuropatii obwodowej
Witamina E – w trzech badaniach RCT stwierdzono, że częstość występowania CIPN i zmodyfikowany wynik neuropatii obwodowej były znacząco niższe przy stosowaniu witaminy E
Lit – jest jednym z niewielu środków, które wydają się być skuteczne w zapobieganiu CIPN, jednak potrzebne są dobrze zaprojektowane badania kliniczne do potwierdzenia tych wyników u pacjentów z chorobą nowotworową

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Należy jednak podkreślić, że stosowanie acetylo-L-karnityny powinno być zniechęcane, ponieważ badania wykazały, że może być szkodliwa w kontekście profilaktyki CIPN.¹²

Modyfikacje dawek chemioterapii

Aktualnie jedną z głównych strategii zapobiegawczych jest modyfikacja schematu leczenia chemioterapeutycznego:¹²

Zmniejszenie dawki lub wydłużenie odstępów między podaniami leków neurotoksycznych
Wczesne przerwanie podawania leku wywołującego objawy przed rozwojem trwałych objawów
Zastosowanie alternatywnych schematów leczenia

Klinicyści powinni ocenić zasadność opóźnienia dawki, redukcji dawki, zastosowania zamienników lub przerwania chemioterapii u pacjentów, u których rozwija się nietolerowana neuropatia i/lub upośledzenie funkcjonalne.¹ Należy jednak pamiętać, że takie modyfikacje mogą potencjalnie wpływać na skuteczność leczenia przeciwnowotworowego i długoterminowe wyniki.¹

Specyficzne strategie dla różnych typów neuropatii

Neuropatia związana z oksaliplatyną

Oksaliplatyna jest powszechnie stosowanym lekiem chemioterapeutycznym opartym na platynie w leczeniu raka jelita grubego, który często wywołuje neuropatię obwodową. Specyficzne strategie profilaktyczne dla tego leku obejmują:¹²

Ograniczenie ekspozycji na zimno – unikanie zimnych napojów, zimnych posiłków i niskich temperatur, zwłaszcza w pierwszych dniach po podaniu oksaliplatyny
Wydłużenie czasu infuzji – podawanie oksaliplatyny w dłuższym czasie może zmniejszyć ryzyko neuropatii
Schemat „stop and go” – okresowe przerywanie i ponowne wprowadzanie oksaliplatyny
Suplementacja wapniem i magnezem – może być korzystna w zapobieganiu ostrej oksaliplatyna/” title=”neuropatia indukowana oksaliplatyną” class=”to-tag” data-termid=”75361″>neuropatii indukowanej oksaliplatyną
Suplementacja kwasów tłuszczowych omega-3 – badanie kliniczne OxaNeuro bada skuteczność dużych dawek suplementów oleju rybiego zawierających długołańcuchowe n-3 wielonienasycone kwasy tłuszczowe (n-3 LCPUFA) w zmniejszaniu częstości występowania i nasilenia neuropatii indukowanej oksaliplatyną

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paklitakselem”>Neuropatia związana z paklitakselem

Paklitaksel jest jednym z najczęściej stosowanych chemioterapeutyków wywołujących neuropatię obwodową. Badania wskazują na potencjalne strategie profilaktyczne:¹²

Inhibitory receptora C5aR1 – badania wykazały, że paklitaksel wiąże się i aktywuje receptor C5aR1, a blokowanie tego receptora może zapobiegać neuropatii indukowanej paklitakselem i reakcjom nadwrażliwości
Cilostazol – w badaniach porównujących grupę cilostazolu z grupą kontrolną zaobserwowano znaczącą różnicę w występowaniu neuropatii obwodowej stopnia 2 i 3
Kwas gangliozydu monosialowego (GM1) – randomizowane, podwójnie zaślepione, kontrolowane placebo badanie wykazało, że grupa GM1 miała niższą częstość występowania neuropatii obwodowej stopnia 1 lub wyższego w skali CTCAE v4.0

Ponadto badanie POLAR wykazało, że zarówno chłodzenie, jak i kompresja są wysoce skuteczne w zapobieganiu neuropatii obwodowej stopnia 2 indukowanej paklitakselem (chłodzenie: 25% vs 46%; kompresja: 23% vs 39%), bez istotnej różnicy między tymi metodami.¹

Inne obiecujące metody profilaktyczne

Akupunktura

Akupunktura jest badana jako potencjalna metoda zapobiegania neuropatii obwodowej, szczególnie indukowanej chemioterapią. Trwające badania kliniczne, takie jak badanie fazy II oceniające wpływ akupunktury w zapobieganiu CIPN u pacjentów z rakiem piersi w stadium I-III poddawanych chemioterapii opartej na taksanach, mają na celu określenie skuteczności tej metody.¹ Chociaż wyniki są obiecujące, potrzebne są dalsze badania, aby ustalić jednoznaczne rekomendacje.

Ćwiczenia i rehabilitacja

Regularna aktywność fizyczna, zwłaszcza ćwiczenia poprawiające krążenie, może pomóc w zapobieganiu neuropatii obwodowej:¹²

Ćwiczenia aerobowe (np. spacery, pływanie, jazda na rowerze)
Ćwiczenia równoważne i proprioceptywne
Ćwiczenia wzmacniające mięśnie
Specjalnie dostosowane programy rehabilitacyjne

Badania wykazały, że trening sensomotoryczny (SMT) i/lub trening oporowy (RT) mogą łagodzić subiektywnie odczuwane czuciowe objawy neuropatii obwodowej w stopach, jeśli osiągnięty zostanie odpowiedni bodziec treningowy.¹

Profilaktyka w kontekście jakości życia

Zapobieganie neuropatii obwodowej ma istotny wpływ na jakość życia pacjentów. Neuropatia może prowadzić do znacznego cierpienia, niepełnosprawności i pogorszenia jakości życia, zwłaszcza u pacjentów onkologicznych.¹² Profilaktyka neuropatii obwodowej może przynieść następujące korzyści:

Zmniejszenie bólu i dyskomfortu
Zachowanie sprawności funkcjonalnej
Możliwość kontynuowania leczenia przeciwnowotworowego w pełnych dawkach
Redukcja ryzyka upadków i urazów
Poprawa ogólnej jakości życia

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Edukacja pacjentów i zalecenia bezpieczeństwa

Edukacja pacjentów na temat środków zapobiegawczych i wczesnych objawów neuropatii obwodowej jest kluczowym elementem profilaktyki:¹²

Rozpoznawanie wczesnych objawów – uczulenie pacjentów na rozpoznawanie początkowych objawów neuropatii, takich jak drętwienie, mrowienie czy ból
Ochrona kończyn – używanie rękawic podczas prac domowych i ogrodowych, noszenie wygodnego obuwia z gumową podeszwą zarówno w pomieszczeniach, jak i na zewnątrz
Ostrożność przy temperaturach ekstremalnych – unikanie zbyt zimnej lub gorącej wody, sprawdzanie temperatury wody inną częścią ciała przed zanurzeniem dłoni lub stóp
Regularna inspekcja stóp i dłoni – codzienne sprawdzanie pod kątem ran, otarć i innych uszkodzeń, które mogą być niewyczuwalne z powodu zmniejszonego czucia
Stosowanie sprzętu ochronnego – używanie odpowiedniego sprzętu ochronnego podczas pracy i aktywności rekreacyjnych może chronić przed urazami

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Wyzwania w profilaktyce neuropatii obwodowej

Pomimo postępów w badaniach nad neuropatią obwodową, profilaktyka wciąż stanowi wyzwanie z kilku powodów:¹²³

Niepełna wiedza o mechanizmach – nie w pełni poznane mechanizmy patofizjologiczne utrudniają opracowanie skutecznych strategii profilaktycznych
Brak biomarkerów predykcyjnych – trudno przewidzieć, którzy pacjenci są narażeni na najwyższe ryzyko rozwoju neuropatii
Ograniczone dowody kliniczne – większość interwencji profilaktycznych ma ograniczone lub niejednoznaczne dowody kliniczne
Konflikt między leczeniem a profilaktyką – w przypadku CIPN może istnieć konflikt między skutecznym leczeniem nowotworu a zapobieganiem neuropatii

Przyszłe kierunki badań i perspektywy

Badania nad profilaktyką neuropatii obwodowej koncentrują się obecnie na kilku obiecujących obszarach:¹²³⁴⁵

Lepsze zrozumienie patofizjologii – badania mające na celu zrozumienie, w jaki sposób leki chemioterapeutyczne wpływają na komórki nerwowe, w tym badania nad barierą krew-nerw
Identyfikacja biomarkerów – poszukiwanie markerów, które mogą pomóc przewidzieć, którzy pacjenci są narażeni na najwyższe ryzyko rozwoju neuropatii
Nowe środki farmakologiczne – badania nad nowymi lekami zapobiegającymi neuropatii, takimi jak 4-aminopirydyna (4AP), która jest badana zarówno jako jednoczesne leczenie z paklitakselem w celu zapobiegania rozwojowi CIPN, jak i jako środek zapewniający ulgę objawową w ustalonym CIPN
Kombinacje terapeutyczne – badanie skuteczności krioterapii kompresyjnej w celu przezwyciężenia ograniczeń obserwowanych w przypadku samej krioterapii
Niefarmakologiczne interwencje – dalsze badania nad skutecznością akupunktury, ćwiczeń i innych niefarmakologicznych interwencji

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Badania kliniczne, takie jak badanie fazy 3 SWOGS2205 ICE COMPRESS aktywowane przez National Cancer Institute’s National Clinical Trials Network, mają na celu znalezienie skutecznej strategii zapobiegania CIPN.¹

Wnioski

Profilaktyka neuropatii obwodowej jest kluczowa dla poprawy jakości życia pacjentów, zwłaszcza tych z czynnikami ryzyka lub poddawanych leczeniu potencjalnie neurotoksycznemu.¹² Chociaż obecnie nie ma jednoznacznie skutecznych metod zapobiegania neuropatii obwodowej, szczególnie indukowanej chemioterapią, istnieją obiecujące strategie, które mogą zmniejszyć ryzyko lub nasilenie tego stanu.¹²

Najlepsze aktualne podejście do profilaktyki obejmuje:¹²

Kontrolę chorób podstawowych, takich jak cukrzyca
Promocję zdrowego stylu życia z odpowiednią dietą i aktywnością fizyczną
Unikanie znanych czynników ryzyka, takich jak alkohol i ekspozycja na toksyny
Wczesne rozpoznawanie objawów i odpowiednią modyfikację leczenia
Edukację pacjentów na temat środków ostrożności i zapobiegawczych

Dalsze badania nad patofizjologią neuropatii obwodowej i nowymi strategiami profilaktycznymi są niezbędne, aby rozwijać bardziej skuteczne podejścia do zapobiegania temu powszechnemu i upośledzającemu stanowi.¹²

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Materiały źródłowe

#1 Prevention of Chemotherapy-Induced Peripheral Neuropathy: A Review of Recent Findings.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6982645/
Chemotherapy-induced peripheral neuropathy (CIPN) is an adverse effect of chemotherapy that is frequently experienced by patients receiving treatment for cancer. […] The management of CIPN is a significant challenge, as it is not possible to predict which patients will develop symptoms, the timing for the appearance of symptoms can develop anytime during the chemotherapy course, there are no early indications that warrant a reduction in the dosage to halt CIPN progression, and there are no drugs approved to prevent or alleviate CIPN. […] It is therefore crucial to find methods to manage the neurological complications of chemotherapy treatment. […] For many patients, when the signs of CIPN first appear, dose reduction or cessation of treatment is implemented, a strategy that ultimately may negatively affect overall survival.
#1 Peripheral neuropathy – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061
The best way to prevent peripheral neuropathy is to manage medical conditions that put you at risk. […] These habits support your nerve health: […] Eat a diet rich in fruits, vegetables, whole grains and lean protein to keep nerves healthy. Protect against low levels of vitamin B-12 by eating meats, fish, eggs, low-fat dairy foods and fortified cereals. If you’re vegetarian or vegan, fortified cereals are a good source of vitamin B-12, but talk to your health care professional about B-12 supplements. […] Exercise regularly. With a health care professional’s OK, try to get at least 30 minutes to one hour of exercise at least three times a week. […] Avoid factors that may cause nerve damage. These factors can include repetitive motions, exposure to toxic chemicals, smoking and drinking too much alcohol.
#1 Peripheral Neuropathy: What It Is, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/14737-peripheral-neuropathy
Some of the possible causes of peripheral neuropathy are preventable. You can also lower your chances of developing it by preventing or delaying certain conditions. In general, the best preventive or precautionary steps you can take include: […] Eating a balanced diet. Certain vitamin deficiencies, especially vitamin B12 deficiency, can affect your nervous system and cause major problems. Other vitamins, especially B6, are toxic and cause peripheral neuropathy at high levels. […] Staying physically active and maintaining a healthy weight. This, along with managing your diet, can help prevent or delay the onset of type 2 diabetes, which damages your peripheral nerves over time. […] Wearing safety equipment as needed. Injuries are a major source of nerve damage. Using safety equipment during work and play activities can protect you from these injuries or limit how severe the injuries are.
#1 Peripheral neuropathy: Causes, symptoms, treatment, and prevention – Harvard Health
https://www.health.harvard.edu/diseases-and-conditions/peripheral-neuropathy-causes-symptoms-treatment-and-prevention
You can take steps to prevent peripheral neuropathy by: […] managing diabetes and other health conditions that can cause nerve damage […] reducing your risk of falls, accidents, and strains on your body. You can do this by removing tripping hazards at home, driving cautiously, and having good body mechanics at your desk or computer […] avoiding recreational and illegal drugs, excess alcohol, and smoking […] asking your doctor if any medication you are taking could cause peripheral neuropathy […] eating a balanced diet […] keeping active each day […] maintaining a healthy weight. […] To reduce the risk of shingles-related nerve damage, adults 50 years and older should get two doses of the Shingrix shingles vaccine. This has been shown to greatly reduce the risk of shingles and its complications, including peripheral neuropathy.
#1 Treatment of Peripheral Neuropathy
https://www.webmd.com/brain/understanding-peripheral-neuropathy-treatment
How Can Peripheral Neuropathy Be Prevented? […] Some forms of peripheral neuropathy can be avoided with good health habits. Eating a nutritious diet, exercising regularly, and limiting how much alcohol you drink can all help prevent nerve damage. Avoiding injuries and toxic chemicals and carefully managing underlying disorders, such as diabetes, can also help prevent peripheral neuropathy.
#1 Diabetic Peripheral Neuropathy: Prevention and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2024/0300/diabetic-peripheral-neuropathy.html
Diabetic peripheral neuropathy occurs in up to 50% of patients with diabetes mellitus and increases the risk of diabetic foot ulcers and infections. Consistent screening and clear communication are essential to decrease disparities in assessment of neuropathic symptoms and diagnosis. Physicians should address underlying risk factors such as poor glycemic control, vitamin B12 deficiency, elevated blood pressure, and obesity to reduce the likelihood of developing neuropathy. […] Nondrug therapies with low- to moderate-quality evidence include exercise and neuromodulation with spinal cord stimulation or transcutaneous electrical nerve stimulation. […] Other treatments, such as acupuncture, alpha-lipoic acid, acetyl-L-carnitine, cannabidiol, and onabotulinumtoxinA need further study in patients with diabetic peripheral neuropathy. […] Evaluation and prevention of diabetic neuropathy.
#1 Peripheral Neuropathy: Symptoms, Causes, and More
https://www.healthline.com/health/peripheral-neuropathy
You can take steps to prevent peripheral neuropathy and lower your risk by: […] Eating healthy to prevent vitamin deficiency and support vascular health is of particular importance. Keeping a balanced diet that includes all the food groups is your best course of action. […] If you have diabetes, take special care of your feet. Wash and inspect your feet daily, and keep the skin moist with lotion.
#1 Pathophysiology and Therapeutic Perspectives for Chemotherapy-induced Peripheral Neuropathy | Anticancer Research
https://ar.iiarjournals.org/content/42/10/4667
Chemotherapy-induced peripheral neurotoxicity (CIPN) is a common side effect of cancer therapy, affecting approximately 40% of patients receiving active treatment. […] Currently, the main approach to prevention and treatment of iatrogenic peripheral neurotoxicity relies on dose modifications and the adaptation of schedules with a shorter treatment duration or premature cessation of the neurotoxic drug in case of severe symptoms. Despite several randomized trials conducted, no agent has been recommended for the prevention of CIPN. Many preventative interventions have been proposed including exercise, acupuncture, cryotherapy, and ganglioside monosialic acid. However, their use has no clinical indication. […] Non-pharmacological interventions. Despite several pharmacological agents have been studied for CIPN prevention, no agent has demonstrated efficacy and no positive recommendation exists in this setting. Different studies (i.e., meta-analysis, systematic review) demonstrated the efficacy of non-pharmacological treatments of CIPN (i.e., massage, acupuncture, physical therapy, foot bath, scrambled therapy). […] Future strategies should be based on a multimodal methodological approach with the implementation of subjective and objective outcomes, to define better CIPN, their impact on patients function and quality of life, and provide insights into CIPN pathophysiology.
#1 Prevention of Chemotherapy-Induced Peripheral Neuropathy: A Review of Recent Findings.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6982645/
Recently, there has been an increase in the number of active collaborations between basic and clinical research teams aimed at providing a deeper understanding of the underlying mechanisms that initiate and cause the progression of CIPN. […] With this knowledge, it will be possible to develop effective preventive methods and treatment plans. […] Clinical practice guidelines from the American Society of Clinical Oncology (ASCO) state that there is no preventative agent to be recommended, but early termination of the offending agent should be done prior to the development of disabling symptoms. […] It is therefore challenging to predict who will be at high risk of developing negative side effects, and which patients will have irreversible damage. […] Due to the incomplete knowledge about the underlying pathophysiology of CIPN, symptomatic treatments are usually unsuccessful.
#1 Peripheral Neuropathy | American Cancer Society
https://www.cancer.org/cancer/managing-cancer/side-effects/pain/peripheral-neuropathy.html
Can peripheral neuropathy (PN) be prevented? […] There are some therapies that have been used to prevent or limit the effects of peripheral neuropathy caused by chemotherapy, but more research is needed to prove they are effective. […] During chemo infusions, some experts recommend: […] Cold therapy (Cryotherapy): This involves cooling down your hands and feet during your chemo infusions. This is often done by freezing ice packs that fit into special socks and mittens or gloves. […] Compression therapy: This involves wearing tight gloves to compress (squeeze) your fingertips during your chemo infusions. This is often done by wearing two pairs of tight-fitting disposable nitrile or latex gloves. […] These therapies may help by reducing circulation in the hands and feet while chemo is being given, which may lower the amount of chemo drugs reaching these areas. More research is needed to prove these methods are effective and to determine the best ways to apply cold or compression.
#1 Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update – PubMed
https://pubmed.ncbi.nlm.nih.gov/32663120/
Purpose: To update the ASCO guideline on the recommended prevention and treatment approaches in the management of chemotherapy-induced peripheral neuropathy (CIPN) in adult cancer survivors. […] Recommendations: The identified data reconfirmed that no agents are recommended for the prevention of CIPN. The use of acetyl-l-carnitine for the prevention of CIPN in patients with cancer should be discouraged. […] Furthermore, clinicians should assess the appropriateness of dose delaying, dose reduction, substitutions, or stopping chemotherapy in patients who develop intolerable neuropathy and/or functional impairment.
#1 Prevention of paclitaxel-induced peripheral neuropathy: literature review of potential pharmacological interventions | Future Journal of Pharmaceutical Sciences | Full Text
https://fjps.springeropen.com/articles/10.1186/s43094-024-00638-w
Numerous preclinical studies in rats and rodents showed that several therapeutic agents have neuroprotective mechanisms and reduce the incidence of PIPN, proving their effectiveness in the prevention of PIPN in animal models. […] Prevention of PIPN is currently considered an emergent field of research. This review highlights the potential interventions and presents recent findings from both preclinical and clinical studies on the significant prevention of PIPN to help in effective decision-making. However, further well-designed research is required to ascertain recommendations for clinical practice. […] Because of the evolving pathophysiologic pathways mechanisms and the diversity of causes and risk factors, preventive interventions are desperately needed to lower the prevalence of PIPN.
#1 Prevention of Chemotherapy-Induced Peripheral Neuropathy: A Review of Recent Findings.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6982645/
As the success in identifying anti-tumor agents has increased, efforts have increased to develop approaches for prevention and management of CIPN, such that it will be possible to enhance quality of life for cancer survivors. […] Ongoing work, including work from our laboratory, provides hope that we are approaching some consensus on strategies to decrease the rate of developing and severity of CIPN. […] Here we discuss both pharmacological and non-pharmacological approaches for prevention of CIPN and suggest considerations for future research. […] Lithium is one of the few agents that appears to be effective in preventing CIPN. […] A well-designed clinical study is needed to validate these findings in cancer patients. […] More studies are still needed to optimize the use of these modalities to prevent the distressing symptoms of CIPN and put them into clinical practice.
#1 Prevention and treatment of chemotherapy-induced peripheral neuropathy – UpToDate
https://www.uptodate.com/contents/prevention-and-treatment-of-chemotherapy-induced-peripheral-neuropathy
Prevention and treatment of chemotherapy-induced peripheral neuropathy […] PREVENTIVE APPROACHES […] Pharmacologic agents and physical strategies […] Interventions with potential but unproven benefit […] Cryotherapy, compression therapy, or both […] Exercise […] Acupuncture […] GM1 […] Glucocorticoids and NSAIDs for taxane-associated acute pain syndrome […] Potentially beneficial measures for specific drugs […] Oxaliplatin […] Limiting exposure to cold […] Stopping and reintroducing oxaliplatin […] Lengthened infusion duration […] TREATMENT […] Chronic neurotoxicity […] Adjustments to drug dose, administration, or regimen […] Symptomatic treatment […] Physical therapy and rehabilitation […] Specific interventions that are recommended […] Duloxetine […] Interventions that may be beneficial that have limited harms […] Exercise […] Acupuncture […] Acupressure and reflexology […] Scrambler therapy
#1 A Prevention Strategy for Chemotherapy-Induced Peripheral Neuropathy in Patients with Breast Cancer May Be in Sight
https://www.pharmacytimes.com/view/a-prevention-strategy-for-chemotherapy-induced-peripheral-neuropathy-in-patients-with-breast-cancer-may-be-in-sight
There are currently no effective treatments for CIPN prevention. […] Theres currently no effective pharmacologic agent for CIPN prevention, and the current strategy when patients develop CIPN is to dose-reduce their taxane therapy, which raises the concern of potentially impacting efficacy and long-term outcomes. […] So this really calls out that its important for us to find effective prevention therapies. […] ASCO notes that the current data available for compression therapy and cryotherapy are insufficient to support a recommendation for their use outside the context of a clinical trial. […] Accordino explained that going forward, a potential intervention strategy could be cryocompression therapy to overcome the limitations observed with cryotherapy. […] Overall, these data have led to the phase 3 SWOGS2205 ICE COMPRESS trial that was recently activated through the National Cancer Institutes National Clinical Trials Network. […] A lot of work has been done in trying to find a successful prevention strategy for CIPN development. It’s apparent, though, that work is still needed to be done, and hopefully this phase 3, randomized study can help find a definitive strategy to help prevent CIPN.
#1 Study protocol: fish oil supplement in prevention of oxaliplatin-induced peripheral neuropathy in adjuvant colorectal cancer patients â a randomized controlled trial. (OxaNeuro) | BMC Cancer | Full Text
https://bmccancer.biomedcentral.com/articles/10.1186/s12885-024-11856-z
Oxaliplatin-induced peripheral neuropathy (OIPN) in general and painful OIPN in particular is a debilitating late effect that severely affects cancer survivors quality of life and causes premature cessation of potentially lifesaving treatment. […] One of several suggested mechanisms includes neuroinflammation as a contributing factor to OIPN. Fish oil containing long-chain n-3 polyunsaturated fatty acids (n-3 LCPUFAs) are precursors to specialized proresolving mediators that mediate the resolution of inflammation. Our primary hypothesis is that a high supplementation of n-3 LCPUFAs will lower the prevalence and severity of OIPN. […] If readily available fish oil supplementation alleviates OIPN prevalence and severity, it will significantly improve the lives of both cancer survivors and palliative cancer patients receiving oxaliplatin; it will improve their quality of life, optimize chemotherapeutic treatment plans by lowering the need for dose reduction or premature cessation, and potentially increase survival.
#1 Paclitaxel binds and activates C5aR1: A new potential therapeutic target for the prevention of chemotherapy-induced peripheral neuropathy and hypersensitivity reactions | Cell Death & Disease
https://www.nature.com/articles/s41419-022-04964-w
Chemotherapy-induced peripheral neuropathy (CIPN) and hypersensitivity reactions (HSRs) are among the most frequent and impairing side effects of the antineoplastic agent paclitaxel. […] Altogether these data identified C5aR1 as a key mediator and a new potential pharmacological target for the prevention and treatment of CIPN and HSRs induced by paclitaxel. […] Thus, the IL-8 pathway has been proposed as a potential pharmacological target for the treatment of CIPN, and this prompt us to investigate IL-8 upstream events that could be involved in paclitaxel-induced CIPN and anaphylaxis to eventually develop effective strategies that are urgently needed for the prevention and treatment of these side effects of paclitaxel. […] Here, we demonstrate that paclitaxel binds and activates C5aR1, and this binding is crucial in the etiology of paclitaxel-induced CIPN and anaphylaxis.
#1 ESMO Congress 2022 | OncologyPRO
https://oncologypro.esmo.org/meeting-resources/esmo-congress-2022/chemotherapy-induced-peripheral-neuropathy-cipn-prevention-trial-evaluating-the-efficacy-of-hand-cooling-and-compression-in-patients-undergoing-t
CIPN is a common, dose-limiting side effect of taxane-based chemotherapy. Currently there is no established strategy for prevention or treatment. Smaller studies suggest that cooling or compression could have a preventive effect. In this randomized trial we investigated the effectiveness of one-sided hand-cooling or compression for the prevention of CIPN. […] Cooling and compression were highly effective in preventing grade 2 CIPN (cooling: 25 vs. 46%; p-value=0.0008; compression: 23 vs. 39%; p-value=0.0016) with similar efficacy (no significant difference was found: p-value=0.7303). […] POLAR is the first trial to compare cooling and compression for preventing CIPN. Both interventions were highly effective and almost halved the risk of grade 2 CIPN. These findings could play an important role beyond gynecological oncology.
#1 Acupuncture for the Prevention of Chemotherapy-Induced Peripheral Neuropathy in Patients with Stage I-III Breast Cancer – NCIFacebookFollow on XInstagramYoutubeLinkedin
https://www.cancer.gov/about-cancer/treatment/clinical-trials/search/v?id=NCI-2022-07829
This phase II trial evaluates the impact of acupuncture in preventing chemotherapy-induced peripheral neuropathy (CIPN) in patients with stage I-III breast cancer patients without pre-existing neuropathy who are undergoing taxane-based chemotherapy. […] There are currently no proven treatments to prevent chemotherapy-induced peripheral neuropathy. […] Acupuncture may help relieve pain from peripheral neuropathy caused by chemotherapy and may improve the quality of life of patients with breast cancer. […] PRIMARY OBJECTIVE: I. To determine the impact of an acupuncture intervention (version [vs] relaxation exercise control) on the severity of chemotherapy-induced peripheral neuropathy (CIPN) symptoms in women receiving taxane-based chemotherapy for stage I-III breast cancer. […] SECONDARY OBJECTIVES: I. To determine the impact of an acupuncture intervention (vs relaxation exercise control) in women receiving taxane-based chemotherapy for stage I-III breast cancer on: Ia. Incidence of CIPN; Ib. Relative dose intensity (RDI) of taxane treatment; Ic. Maximum CIPN severity and CIPN pain intensity; Id. Quality of life; Ie. Other patient reported outcomes (fatigue and sleep).
#1
https://archiv.ub.uni-heidelberg.de/volltextserver/30169/
„Effective prevention and treatment measures, however, do not yet exist, creating an urgent need for further research.” […] „The cumulative dissertation at hand is therefore intended to contribute to this research area by (a) comprehensively analyzing the association between CIPN and postural control of cancer patients before, during and up to six months after neurotoxic chemotherapy, and (b) addressing the preventive potential of exercise on the onset of CIPN during neurotoxic chemotherapy.” […] „In conclusion, this cumulative dissertation provides comprehensive information about postural control in cancer patients before, during and up to six months after neurotoxic chemotherapy and its associations to CIPN signs and symptoms, but also CIPN-independent influencing factors.” […] „On the other hand, the present work makes an important contribution to the evaluation of the preventive potential of exercise on CIPN during neurotoxic chemotherapy by demonstrating that SMT and/or RT alleviate subjectively perceived sensory CIPN symptoms in the feet, if an appropriate training stimulus is achieved.”
#1
https://link.springer.com/article/10.1007/s00520-025-09190-6
Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating toxicity of many drugs used in cancer treatment. There are numerous available strategies for preventing or treating CIPN, but few are guideline-recommended, due to limited evidence of their effectiveness. […] Most of the 447 survey participants did not use any CIPN prevention strategy (71%), though given options of any strategy the plurality preferred a prescribed medication or supplement (30%). […] In the absence of many guideline-recommended strategies for CIPN prevention and treatment, some patients use options with minimal evidence of effectiveness. Additional research is needed to determine which strategies are effective for prevention and treatment so these can be implemented in practice to improve treatment outcomes in patients with cancer.
#1 Tips for Managing Neuropathy | Dana-Farber Cancer Institute
https://www.dana-farber.org/health-library/tips-for-managing-neuropathy
The most important prevention tip is to be attentive to your symptoms and to report any concerns to your doctor right away. Your cancer team will be able to create a treatment plan that will protect you from injury and possibly prevent your symptoms from worsening. […] There is some evidence that a well-balanced diet can help prevent or reduce symptoms of neuropathy. It is also important to avoid alcohol and smoking, as they can make neuropathy worse. […] It is very important for patients with CIPN to protect their hands and feet from injury. Some suggestions: Use gloves to protect your hands when doing yard work or household repairs. Be extra cautious with sharp objects. Use well-padded potholders when cooking. Inspect your fingers and feet regularly for cuts and scrapes. Check the weather and wear gloves and warm socks in cold weather. Wear shoes with a rubber sole both inside and outside. Always use cold water first and gradually move to warmer water you can also check the water temperature with another part of your body. […] Neuropathy can cause other side effects, such as constipation and sexual health issues, so patients should speak with their doctors about care plans for these specific problems, should they arise.
#1 Stopping neuropathy â one of chemotherapyâs most challenging side effects – Cancer Research UK – Cancer Newsfacebook icontwitter iconlinkedin iconfacebook icontwitter iconinstagram iconlinkedin iconyoutube iconfundraising regulator icon
https://news.cancerresearchuk.org/2023/05/22/stopping-chemotherapy-induced-peripheral-neuropathy/
The problem Andrea was â and, to some extent, still is â dealing with is a type of nerve damage called chemotherapy-induced peripheral neuropathy (CIPN, or neuropathy from chemo). […] To make things better, we need to find out more about how chemotherapy drugs affect nerve cells. Thatâs Lloydâs specialism. Her investigations have brought an almost unknown system in our bodies into the spotlight. They could give doctors a way to predict, treat and even prevent neuropathy from chemo. […] Understanding how to strengthen or close the blood-nerve barrier could help us stop chemotherapy-induced peripheral neuropathy. […] Because there arenât any tests for peripheral neuropathy today, all doctors like her can do is help patients talk about their symptoms. […] We have such great knowledge of so many things, and peripheral neuropathy doesnât seem to be insurmountable. […] Hopefully our fantastic research scientists will eventually breakthrough with a drug that can remove this very unpleasant side effect of these life saving drugs.
#1 Funded Grants | Division of Cancer Prevention
https://prevention.cancer.gov/funding-and-grants/funded-grants/R21CA277447
Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating condition with potentially devastating effects on large numbers of cancer patients. […] Currently, there are no established treatments for CIPN. We propose that 4-aminopyridine (4AP), principally a K+ channel inhibitor, is a promising candidate to prevent and/or treat CIPN. […] The over-arching hypothesis of this proposal is that 4AP can be used to prevent or decrease caused by exposure to paclitaxel (PTX). Our experiments will test the independent sub-hypotheses that (i) initiation of 4AP treatment prior to establishment of CIPN prevents its development without compromising the effectiveness of PTX in treating a well-accepted syngeneic model of breast cancer in mice; and (ii) established CIPN is responsive to 4AP as a means of decreasing neuropathic pain after CIPN is established. […] 4AP will be studied both as a concurrent treatment with PTX to prevent CIPN development, and as a means of providing symptomatic relief in established CIPN.
#1
https://www.federalregister.gov/documents/2025/01/17/2025-01197/prevention-and-treatment-of-chemotherapy-induced-peripheral-neuropathy-developing-drug-and
The Food and Drug Administration (FDA or Agency) is announcing the availability of a draft guidance for industry entitled Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy: Developing Drug and Biological Products in Oncology. Chemotherapy-induced peripheral neuropathy (CIPN), a painful, disabling, and potentially irreversible condition commonly affecting patients receiving neurotoxic chemotherapies, could diminish survival by potentially increasing chemotherapy treatment interruptions, dose reductions, and discontinuations. This guidance provides recommendations to sponsors for the clinical development of drug and biological products intended for the prevention and treatment of CIPN in oncology patient populations. […] This guidance provides recommendations to sponsors for the clinical development of drug and biological products intended for the prevention and treatment of CIPN in oncology patient populations. The recommendations include trial population, design, and selection of appropriate oncology-specific endpoints. […] Thus, CIPN can negatively affect overall cancer treatment outcome and survival.
#1 Prevention and therapy of chemotherapy-induced peripheral neuropathy: a review of recent findings. – International Association for the Study of Pain (IASP)
https://www.iasp-pain.org/publications/pain-research-forum/papers-of-the-week/paper/215438-prevention-and-therapy-chemotherapy-induced-peripheral-neuropathy-review-recent/
Chemotherapy-induced peripheral neuropathy is one of the most frequent dose-limiting side effects, observed in patients receiving antineoplastic agents, persisting for up to two years after completing treatment, greatly affecting both the course of chemotherapy and patients’ quality of life. […] Currently, there are only a few therapeutic options available for the prevention or successful therapy because the mechanisms of chemotherapy-induced peripheral neuropathy remain unclear. […] A better understanding of the risk factors and underlying mechanisms of chemotherapy-induced peripheral neuropathy is needed to develop effective preventive and therapeutic strategies.
#2 Diabetic Peripheral Neuropathy: Prevention and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2024/0300/diabetic-peripheral-neuropathy.html
Diabetic peripheral neuropathy occurs in up to 50% of patients with diabetes mellitus and increases the risk of diabetic foot ulcers and infections. Consistent screening and clear communication are essential to decrease disparities in assessment of neuropathic symptoms and diagnosis. Physicians should address underlying risk factors such as poor glycemic control, vitamin B12 deficiency, elevated blood pressure, and obesity to reduce the likelihood of developing neuropathy. […] Nondrug therapies with low- to moderate-quality evidence include exercise and neuromodulation with spinal cord stimulation or transcutaneous electrical nerve stimulation. […] Other treatments, such as acupuncture, alpha-lipoic acid, acetyl-L-carnitine, cannabidiol, and onabotulinumtoxinA need further study in patients with diabetic peripheral neuropathy. […] Evaluation and prevention of diabetic neuropathy.
#2 Answers to 8 FAQ About Chemotherapy-Induced Peripheral Neuropathy (CIPN) | Memorial Sloan Kettering Cancer Center
https://www.mskcc.org/news/answers-faq-about-chemotherapy-induced-peripheral-neuropathy-cipn
Peripheral neuropathy can have many triggers not related to cancer treatment, including diabetes, immune disorders, alcohol abuse, and problems with the brain or spine, including tumors. […] Unfortunately, we don’t know of anything that can completely prevent the symptoms of peripheral neuropathy caused by chemotherapy. However, we believe that treating it early, before symptoms become too severe, can help reduce its effects. […] Some small studies have suggested that cryotherapy (wearing chilled socks and gloves) may reduce the occurrence of CIPN, particularly in people receiving taxane-based chemotherapy. […] Promising new research to learn more about how chemotherapy damages the nerves at the cellular level in order to find ways to prevent it is ongoing. We hope that in the future we will have drugs that reduce or eliminate this nerve damage.
#2 Peripheral Neuropathy: What It Is, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/14737-peripheral-neuropathy
Managing chronic conditions as recommended. If you have a chronic condition that can affect your peripheral nerves, especially type 2 diabetes, it’s important to manage it as your healthcare provider recommends. That can limit the effects of the condition or delay how long it takes to get worse. […] Avoiding alcohol in excess. Excessive consumption of alcohol is a proven cause of peripheral neuropathy. You can reduce your risk of neuropathy (and some other medical complications) by avoiding alcohol, or consuming it in moderation only. […] Avoiding exposures to toxins, poisons and heavy metals. Heavy metals like lead and mercury can cause severe damage to your nervous system. Mercury exposure is rare thanks to environmental regulations, but older thermometers or thermostats may still contain it. Older homes may also contain lead-based paint. Local, state and national agencies may have resources and services to help you avoid exposure to toxic metals and chemicals. If you work around such metals and chemicals, follow all safety regulations and use recommended or required protective gear.
#2 Peripheral neuropathy – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061
The best way to prevent peripheral neuropathy is to manage medical conditions that put you at risk. […] These habits support your nerve health: […] Eat a diet rich in fruits, vegetables, whole grains and lean protein to keep nerves healthy. Protect against low levels of vitamin B-12 by eating meats, fish, eggs, low-fat dairy foods and fortified cereals. If you’re vegetarian or vegan, fortified cereals are a good source of vitamin B-12, but talk to your health care professional about B-12 supplements. […] Exercise regularly. With a health care professional’s OK, try to get at least 30 minutes to one hour of exercise at least three times a week. […] Avoid factors that may cause nerve damage. These factors can include repetitive motions, exposure to toxic chemicals, smoking and drinking too much alcohol.
#2 Peripheral Neuropathy: What It Is, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/14737-peripheral-neuropathy
Some of the possible causes of peripheral neuropathy are preventable. You can also lower your chances of developing it by preventing or delaying certain conditions. In general, the best preventive or precautionary steps you can take include: […] Eating a balanced diet. Certain vitamin deficiencies, especially vitamin B12 deficiency, can affect your nervous system and cause major problems. Other vitamins, especially B6, are toxic and cause peripheral neuropathy at high levels. […] Staying physically active and maintaining a healthy weight. This, along with managing your diet, can help prevent or delay the onset of type 2 diabetes, which damages your peripheral nerves over time. […] Wearing safety equipment as needed. Injuries are a major source of nerve damage. Using safety equipment during work and play activities can protect you from these injuries or limit how severe the injuries are.
#2 Prevention of Chemotherapy-Induced Peripheral Neuropathy: A Review of Recent Findings.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6982645/
As the success in identifying anti-tumor agents has increased, efforts have increased to develop approaches for prevention and management of CIPN, such that it will be possible to enhance quality of life for cancer survivors. […] Ongoing work, including work from our laboratory, provides hope that we are approaching some consensus on strategies to decrease the rate of developing and severity of CIPN. […] Here we discuss both pharmacological and non-pharmacological approaches for prevention of CIPN and suggest considerations for future research. […] Lithium is one of the few agents that appears to be effective in preventing CIPN. […] A well-designed clinical study is needed to validate these findings in cancer patients. […] More studies are still needed to optimize the use of these modalities to prevent the distressing symptoms of CIPN and put them into clinical practice.
#2 Peripheral Neuropathy | American Cancer Society
https://www.cancer.org/cancer/managing-cancer/side-effects/pain/peripheral-neuropathy.html
Exercising at least twice a week, including strength, balance, and general movement exercises, might also lower your risk for neuropathy. Exercise may improve circulation to support nerve health and help keep you stronger and healthier during treatment. But again, more research is needed to understand how exercise might help prevent CIPN. […] These methods can be used alone or together. Ask your cancer care team about options that might be best for you.
#2 Prevention of paclitaxel-induced peripheral neuropathy: literature review of potential pharmacological interventions | Future Journal of Pharmaceutical Sciences | Full Text
https://fjps.springeropen.com/articles/10.1186/s43094-024-00638-w
Despite emerging evidence, there are no established pharmacological interventions for PIPN prevention. This review aims to map the existing literature on interventions evaluated for the prevention of PIPN. […] A double-blinded randomized controlled trial (RCT) assessing the efficacy of metformin in the prevention of PIPN showed that the development of grade two or more peripheral neuropathy (PN) was significantly lower in the metformin group compared to placebo. […] Omega 3 fatty acid protective effect in PIPN was assessed in a double-blinded RCT and showed a significant difference in PN occurrence. […] Vitamin E neuroprotective effect was evaluated in three RCTs, where the incidence of PIPN and modified peripheral neuropathy (PNP) score were significantly lower with Vitamin E. […] A randomized controlled study investigating glutamine in PIPN reported an overall frequency of neuropathy across all grades to be 78% at three months and 80% at six months.
#2 The prevention of chemotherapy induced peripheral neuropathy by concurrent treatment with drugs used for bipolar disease: a retrospective chart analysis in… | Oncotarget
https://www.oncotarget.com/article/23467/text/
Peripheral neuropathy is a major adverse effect in the use of chemotherapeutic drugs. In nearly 50% of patients, chemotherapy induced peripheral neuropathy (CIPN) has been reported as irreversible. […] Our data did provide evidence supporting the belief that treatment with lithium or valproic acid concurrently with chemotherapy was associated with a decreased incidence of developing CIPN. […] At this time there are limited treatment options for the treatment of CIPN and no treatment options for the prevention of CIPN. […] If chemotherapy side effects could be precluded or mitigated, patients would be less likely to experience dose reductions, intermittent discontinuations, or termination of a chemotherapy regimen due to toxicity, and potentially would be more likely to receive optimally safe and effective regimens.
#2 Updated ASCO Guideline Revisits Evidence on Prevention and Treatment of Chemotherapy-Induced Neuropathy – The ASCO Post
https://ascopost.com/issues/august-10-2020/updated-asco-guideline-revisits-evidence-on-prevention-and-treatment-of-chemotherapy-induced-neuropathy/
Lastly, regarding prevention, there are now data to strongly support that acetyl-L-carnitine could be harmful, Dr. Loprinzi added. So, it should be avoided. […] We really hope the guideline helps inform which [agents] people should use but also which they shouldn’t use for the prevention and treatment of chemotherapy-induced peripheral neuropathy.
#2 Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update – PubMed
https://pubmed.ncbi.nlm.nih.gov/32663120/
Purpose: To update the ASCO guideline on the recommended prevention and treatment approaches in the management of chemotherapy-induced peripheral neuropathy (CIPN) in adult cancer survivors. […] Recommendations: The identified data reconfirmed that no agents are recommended for the prevention of CIPN. The use of acetyl-l-carnitine for the prevention of CIPN in patients with cancer should be discouraged. […] Furthermore, clinicians should assess the appropriateness of dose delaying, dose reduction, substitutions, or stopping chemotherapy in patients who develop intolerable neuropathy and/or functional impairment.
#2
https://link.springer.com/article/10.1007/s00415-020-09942-w
Oxaliplatin (OXA) is a commonly used platinum-based chemotherapy drug for colorectal cancer. […] There are some methods like reducing exposure to cold, calcium and magnesium salts, amifostine could be beneficial in acute OIPN prevention and dose modification, changing in schedule glutathione, duloxetine, selective serotonin reuptake inhibitors, carbonic anhydrase inhibitor in chronic OIPN prevention. […] Recent updates are provided in this article in relation to the clinical features, potential mechanisms, prevention and treatment of OIPN.
#2 Study protocol: fish oil supplement in prevention of oxaliplatin-induced peripheral neuropathy in adjuvant colorectal cancer patients â a randomized controlled trial. (OxaNeuro) | BMC Cancer | Full Text
https://bmccancer.biomedcentral.com/articles/10.1186/s12885-024-11856-z
The primary aim of this study is to evaluate whether a daily intake of a high dosage of fish oil containing n-3 LCPUFAs reduces the prevalence and severity of OIPN and neuropathic pain 8 months after adjuvant oxaliplatin following surgery for high-risk colorectal cancer. […] In this study we aim both to explore the mechanisms behind OIPN, evaluate different potential predictive biomarkers and we examine a potential preventive treatment with a robust design. The main goal is to increase quality of life in cancer survivors receiving neurotoxic chemotherapy and potentially optimize treatment with oxaliplatin without invalidating side-effects.
#2 Paclitaxel binds and activates C5aR1: A new potential therapeutic target for the prevention of chemotherapy-induced peripheral neuropathy and hypersensitivity reactions | Cell Death & Disease
https://www.nature.com/articles/s41419-022-04964-w
Thus, we identify C5aR1 as a new potential target for the prevention and treatment of anaphylaxis and CIPN in patients receiving paclitaxel. […] Taken together, these results demonstrate that paclitaxel can competitively and specifically bind and activate C5aR1, thus suggesting the potential involvement of C5aR1 in the mediation of paclitaxel side effects. […] These data clearly demonstrate the key role of C5aR1 in mediating paclitaxel-induced CIPN and the potential therapeutic effects of the inhibition of C5aR1 in this condition. […] These findings are groundbreaking, as not only they shed light on the mechanisms that underlie the pathophysiology of CIPN and HSRs due to paclitaxel treatment, but also indicate a potential pharmacological target for their prevention, opening new possibilities for the management of the continuously growing number of patients that still experience serious long-term consequences or even death following the treatment with paclitaxel.
#2
https://www.federalregister.gov/documents/2025/01/17/2025-01197/prevention-and-treatment-of-chemotherapy-induced-peripheral-neuropathy-developing-drug-and
The Food and Drug Administration (FDA or Agency) is announcing the availability of a draft guidance for industry entitled Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy: Developing Drug and Biological Products in Oncology. Chemotherapy-induced peripheral neuropathy (CIPN), a painful, disabling, and potentially irreversible condition commonly affecting patients receiving neurotoxic chemotherapies, could diminish survival by potentially increasing chemotherapy treatment interruptions, dose reductions, and discontinuations. This guidance provides recommendations to sponsors for the clinical development of drug and biological products intended for the prevention and treatment of CIPN in oncology patient populations. […] This guidance provides recommendations to sponsors for the clinical development of drug and biological products intended for the prevention and treatment of CIPN in oncology patient populations. The recommendations include trial population, design, and selection of appropriate oncology-specific endpoints. […] Thus, CIPN can negatively affect overall cancer treatment outcome and survival.
#2 Stopping neuropathy â one of chemotherapyâs most challenging side effects – Cancer Research UK – Cancer Newsfacebook icontwitter iconlinkedin iconfacebook icontwitter iconinstagram iconlinkedin iconyoutube iconfundraising regulator icon
https://news.cancerresearchuk.org/2023/05/22/stopping-chemotherapy-induced-peripheral-neuropathy/
The problem Andrea was â and, to some extent, still is â dealing with is a type of nerve damage called chemotherapy-induced peripheral neuropathy (CIPN, or neuropathy from chemo). […] To make things better, we need to find out more about how chemotherapy drugs affect nerve cells. Thatâs Lloydâs specialism. Her investigations have brought an almost unknown system in our bodies into the spotlight. They could give doctors a way to predict, treat and even prevent neuropathy from chemo. […] Understanding how to strengthen or close the blood-nerve barrier could help us stop chemotherapy-induced peripheral neuropathy. […] Because there arenât any tests for peripheral neuropathy today, all doctors like her can do is help patients talk about their symptoms. […] We have such great knowledge of so many things, and peripheral neuropathy doesnât seem to be insurmountable. […] Hopefully our fantastic research scientists will eventually breakthrough with a drug that can remove this very unpleasant side effect of these life saving drugs.
#2 Drugs that cause peripheral neuropathy: Symptoms and prevention – Prospera Biotech
https://www.prosperabiotech.com/en/blog/drugs-cause-peripheral-neuropathy/
Drug-induced peripheral neuropathy affects between 50% and 90% of patients undergoing chemotherapy. […] Despite being one of the most common side effects of cancer treatment, chemotherapy drugs are not the only medications that can cause peripheral neuropathy. […] However, recent research suggests several promising strategies: […] Dose modifications and treatment adjustments: Reducing the dose or discontinuing the neurotoxic agent before symptoms worsen can minimize nerve damage. […] Non-Pharmacological Interventions: […] Patient Education: Training patients to recognize early symptoms can facilitate timely intervention. […] Early Detection: The use of clinical and digital tools to assess early symptoms is crucial in adjusting treatments while neuropathy remains reversible. […] Oncapsisens helps reduce skin discomfort in chemotherapy treatment. […] relieve the discomfort associated with peripheral neuropathy.
#2 Tips for Managing Neuropathy | Dana-Farber Cancer Institute
https://www.dana-farber.org/health-library/tips-for-managing-neuropathy
The most important prevention tip is to be attentive to your symptoms and to report any concerns to your doctor right away. Your cancer team will be able to create a treatment plan that will protect you from injury and possibly prevent your symptoms from worsening. […] There is some evidence that a well-balanced diet can help prevent or reduce symptoms of neuropathy. It is also important to avoid alcohol and smoking, as they can make neuropathy worse. […] It is very important for patients with CIPN to protect their hands and feet from injury. Some suggestions: Use gloves to protect your hands when doing yard work or household repairs. Be extra cautious with sharp objects. Use well-padded potholders when cooking. Inspect your fingers and feet regularly for cuts and scrapes. Check the weather and wear gloves and warm socks in cold weather. Wear shoes with a rubber sole both inside and outside. Always use cold water first and gradually move to warmer water you can also check the water temperature with another part of your body. […] Neuropathy can cause other side effects, such as constipation and sexual health issues, so patients should speak with their doctors about care plans for these specific problems, should they arise.
#2 Prevention of Chemotherapy-Induced Peripheral Neuropathy: A Review of Recent Findings.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6982645/
Recently, there has been an increase in the number of active collaborations between basic and clinical research teams aimed at providing a deeper understanding of the underlying mechanisms that initiate and cause the progression of CIPN. […] With this knowledge, it will be possible to develop effective preventive methods and treatment plans. […] Clinical practice guidelines from the American Society of Clinical Oncology (ASCO) state that there is no preventative agent to be recommended, but early termination of the offending agent should be done prior to the development of disabling symptoms. […] It is therefore challenging to predict who will be at high risk of developing negative side effects, and which patients will have irreversible damage. […] Due to the incomplete knowledge about the underlying pathophysiology of CIPN, symptomatic treatments are usually unsuccessful.
#2 Emerging Pharmacological and Non-Pharmacological Therapeutics for Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy
https://www.mdpi.com/2072-6694/13/4/766
Chemotherapy-induced peripheral neuropathy (CIPN) is a common and persistent complication of commonly used chemotherapy drugs. This article provides an overview of emerging therapeutics for the prevention and treatment of CIPN and focuses on pharmacological strategies that are derived from novel mechanistic insights and have the potential to be translated into clinically beneficial approaches. […] Given the dearth of effective established agents for preventing or treating CIPN, and the increasing number of cancer survivors, there is an urgent need for the identification and development of new, effective intervention strategies that can prevent or mitigate this debilitating side effect. […] This review focuses on the emerging therapeutics for the prevention and treatment of CIPN, including pharmacological and non-pharmacological strategies, and calls for fostering collaboration between basic and clinical researchers to improve the development of effective strategies.
#2 Compression therapy for prevention of Chemotherapy-induced peripheral | JPR
https://www.dovepress.com/compression-therapy-for-prevention-of-chemotherapy-induced-peripheral–peer-reviewed-fulltext-article-JPR
Chemotherapy-induced peripheral neuropathy (CIPN) significantly impairs the quality of life of patients undergoing chemotherapy and diminishes their adherence to the treatment regimen. Existing studies suggest that compression therapy may prevent the onset of CIPN, yet the specific efficacy remains to be conclusively determined. […] Moderate- to low-certainty evidence supports compression therapy’s effectiveness in preventing CIPN and alleviating depression while showing no substantial impact on other outcomes. […] This comprehensive systematic review and meta-analysis evaluated the efficacy of compression therapy for CIPN prevention. We found moderate-certainty evidence that compression therapy may result in an absolute reduction of 265 per 1000 patients on incidence of CIPN, with high adherence (72.6% to 98.3%) in the same population. Additionally, low-certainty evidence suggested potential benefits in reducing depression. However, other outcomes showed no significant associations, supported by low to very low certainty evidence. Given the variable evidence quality across outcomes, additional well-designed RCTs are warranted to strengthen the current evidence base.
#2 Chemotherapy-Induced Peripheral Neuropathy
https://jhoponline.com/issue-archive/2014-issues/september-vol-4-no-3/16203-chemotherapy-induced-peripheral-neuropathy
The symptoms of CIPN frequently attenuate after therapy, but they can be dose-limiting and result in suboptimal chemotherapy dosing. Treatment goals include the prevention or attenuation of neuropathies associated with therapy, the relief of symptoms, improving patient quality of life, and maintaining optimal chemotherapy dosing. […] A recent review of CIPN showed that no medications have enough evidence to suggest that they should be used to prevent CIPN, and there was adequate evidence to suggest that a variety of agents should not be used for that purpose, because of lack of efficacy, risk for harm, or both. […] It is hoped that useful agents for the prevention and management of neuropathies can be found, and that patients with increased risk for neuropathies could be offered alternative therapies.
#2 Management of Chemotherapy-Induced Peripheral Neuropathy
https://www.uspharmacist.com/article/management-of-chemotherapyinduced-peripheral-neuropathy
There is currently no strong evidence to support the utilization of pharmacologic agents for prevention of CIPN. […] Patients are encouraged to consume a healthy, balanced diet and abstain from alcohol as additional preventive strategies for CIPN. […] Pharmacists may play a pivotal role in the prevention of CIPN by recommending evidence-based pharmacologic and nonpharmacologic strategies appropriate for the individual patient, including a healthful diet and alcohol abstinence. […] There is inadequate evidence to recommend IV calcium/magnesium, cryotherapy, or venlafaxine for use in clinical practice. […] Nonpharmacologic treatment options include chemotherapy dose reduction, discontinuation of the offending chemotherapeutic agent(s), acupuncture, avoiding cold temperatures/maintaining warmth, physical activity, and massaging the affected areas. […] CIPN is a serious dose-limiting toxicity that requires individualized prevention and treatment strategies in patients with cancer in order to minimize negative impact on patient QOL.
#2 Study protocol: fish oil supplement in prevention of oxaliplatin-induced peripheral neuropathy in adjuvant colorectal cancer patients â a randomized controlled trial. (OxaNeuro) | BMC Cancer | Full Text
https://bmccancer.biomedcentral.com/articles/10.1186/s12885-024-11856-z
Oxaliplatin-induced peripheral neuropathy (OIPN) in general and painful OIPN in particular is a debilitating late effect that severely affects cancer survivors quality of life and causes premature cessation of potentially lifesaving treatment. […] One of several suggested mechanisms includes neuroinflammation as a contributing factor to OIPN. Fish oil containing long-chain n-3 polyunsaturated fatty acids (n-3 LCPUFAs) are precursors to specialized proresolving mediators that mediate the resolution of inflammation. Our primary hypothesis is that a high supplementation of n-3 LCPUFAs will lower the prevalence and severity of OIPN. […] If readily available fish oil supplementation alleviates OIPN prevalence and severity, it will significantly improve the lives of both cancer survivors and palliative cancer patients receiving oxaliplatin; it will improve their quality of life, optimize chemotherapeutic treatment plans by lowering the need for dose reduction or premature cessation, and potentially increase survival.
#3 Answers to 8 FAQ About Chemotherapy-Induced Peripheral Neuropathy (CIPN) | Memorial Sloan Kettering Cancer Center
https://www.mskcc.org/news/answers-faq-about-chemotherapy-induced-peripheral-neuropathy-cipn
Peripheral neuropathy can have many triggers not related to cancer treatment, including diabetes, immune disorders, alcohol abuse, and problems with the brain or spine, including tumors. […] Unfortunately, we don’t know of anything that can completely prevent the symptoms of peripheral neuropathy caused by chemotherapy. However, we believe that treating it early, before symptoms become too severe, can help reduce its effects. […] Some small studies have suggested that cryotherapy (wearing chilled socks and gloves) may reduce the occurrence of CIPN, particularly in people receiving taxane-based chemotherapy. […] Promising new research to learn more about how chemotherapy damages the nerves at the cellular level in order to find ways to prevent it is ongoing. We hope that in the future we will have drugs that reduce or eliminate this nerve damage.
#3 Peripheral Neuropathy Prevention | Coastal Integrative Healthcare | Florida
https://coastalintegrativehealthcare.com/peripheral-neuropathy-prevention/
Treatments for the various forms that peripheral neuropathy can take has substantially improved over recent years, but there are plenty of ways that people can help prevent the issue arising in the first case. […] Adopting a proactive and positive approach towards managing these is important and doing so will lessen the likelihood of developing peripheral neuropathy. Diabetes is the best and most common example. […] Frequent exercise is a fantastic way of boosting the blood flow that is essential to maintaining healthy nerves. […] Maintaining a healthy diet is also essential and should involve plenty of the nutrients and minerals that keep those nerves working smoothly. […] Cutting down on alcohol is also a proven way of lowering the chances of developing the symptoms of peripheral neuropathy.
#3 Updated ASCO Guideline Revisits Evidence on Prevention and Treatment of Chemotherapy-Induced Neuropathy – The ASCO Post
https://ascopost.com/issues/august-10-2020/updated-asco-guideline-revisits-evidence-on-prevention-and-treatment-of-chemotherapy-induced-neuropathy/
[Regarding prevention], what we said in 2014 was there was no evidence that anything works in this area despite multiple studies, and that still is the answer now, Dr. Loprinzi said. We have no evidence that something works to prevent neuropathy from happening, other than not giving the chemotherapy. However, there is some suggestive evidence there may be benefit from [certain preventive measures]. […] Such preventive measures, he said, include cryotherapy, which may reduce peripheral nerve damage by using cold temperatures to constrict blood flow; compression therapy, which similarly restricts blood vessels through applied pressure (eg, placement of tight surgical gloves on the hands); and exercise. Dr. Loprinzi emphasized that these options are not yet supported by convincing evidence and require more data, but they are used in clinical practice, by some clinicians, and are not likely to cause harm to many patients.
#3 Prevention of paclitaxel-induced peripheral neuropathy: literature review of potential pharmacological interventions | Future Journal of Pharmaceutical Sciences | Full Text
https://fjps.springeropen.com/articles/10.1186/s43094-024-00638-w
Another double-blinded RCT evaluated the use of glutathione for the prevention of paclitaxel/carboplatin-induced peripheral neuropathy. […] Cilostazol has been evaluated for its preventive effect on PIPN, and when comparing the cilostazol group to the control group, there was a significant difference in the occurrence of grade 2 and 3 peripheral neuropathies. […] A randomized double-blinded placebo-controlled study was conducted to assess the effect of ganglioside monosialic acid (GM1) in the prevention of PIPN, which showed that the GM1 group had a lower incidence of PN grade 1 or higher in CTCAE v4.0 grading.
#3 The prevention of chemotherapy induced peripheral neuropathy by concurrent treatment with drugs used for bipolar disease: a retrospective chart analysis in… | Oncotarget
https://www.oncotarget.com/article/23467/text/
Our analysis indicated that the data support furthering the investigation into the role of Li and VPA and their use in the prevention of CIPN. […] Among the 4 patients with concurrent treatment, none (0%) were found to have worsening of prior peripheral neuropathy or to have developed de novo CIPN. […] It is remarkable that the Li or VPA group did not have any reported cases of CIPN at all. […] Our results presented here suggest that concurrent use of Li or VPA with chemotherapeutic treatment regimens could reduce the risk of CIPN and therefore greatly improve patients quality of life during and after chemotherapy.
#3 Stopping neuropathy â one of chemotherapyâs most challenging side effects – Cancer Research UK – Cancer Newsfacebook icontwitter iconlinkedin iconfacebook icontwitter iconinstagram iconlinkedin iconyoutube iconfundraising regulator icon
https://news.cancerresearchuk.org/2023/05/22/stopping-chemotherapy-induced-peripheral-neuropathy/
The problem Andrea was â and, to some extent, still is â dealing with is a type of nerve damage called chemotherapy-induced peripheral neuropathy (CIPN, or neuropathy from chemo). […] To make things better, we need to find out more about how chemotherapy drugs affect nerve cells. Thatâs Lloydâs specialism. Her investigations have brought an almost unknown system in our bodies into the spotlight. They could give doctors a way to predict, treat and even prevent neuropathy from chemo. […] Understanding how to strengthen or close the blood-nerve barrier could help us stop chemotherapy-induced peripheral neuropathy. […] Because there arenât any tests for peripheral neuropathy today, all doctors like her can do is help patients talk about their symptoms. […] We have such great knowledge of so many things, and peripheral neuropathy doesnât seem to be insurmountable. […] Hopefully our fantastic research scientists will eventually breakthrough with a drug that can remove this very unpleasant side effect of these life saving drugs.
#3 Emerging Pharmacological and Non-Pharmacological Therapeutics for Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy
https://www.mdpi.com/2072-6694/13/4/766
According to the most recent 2020 American Society of Clinical Oncology (ASCO) CIPN guideline, no agents can be recommended for the prevention of CIPN due to lack of high-quality evidence in general, which remains unchanged since the initial 2014 guideline. […] Despite the extensive research effort focused on understanding mechanisms involved in the development of CIPN, the translation of this mechanistic understanding into rationally-designed, clinical intervention studies remains problematic. […] In the current article, we provide an overview of emerging therapeutics for the prevention and treatment of CIPN and focus on pharmacological strategies that are derived from novel mechanistic insights and have the potential to be translated into clinically beneficial approaches. […] There are two overarching approaches in CIPN management: to target the underlying pathologic mechanism responsible for CIPN or to address the CIPN symptoms themselves.
#3 Compression therapy for prevention of Chemotherapy-induced peripheral | JPR
https://www.dovepress.com/compression-therapy-for-prevention-of-chemotherapy-induced-peripheral–peer-reviewed-fulltext-article-JPR
Moderate certainty supports that compression therapy can significantly reduce the incidence of CIPN and has high adherence. Low certainty evidence supports that compression therapy can alleviate depressive symptoms in chemotherapy patients, and no significant association was found between compression therapy and other related outcomes, such as anxiety, sleep quality, and pain. The predominantly low to very low certainty of evidence suggests caution in interpreting current findings, highlighting the need for large-scale, methodologically rigorous randomized controlled trials.
#4 Peripheral Neuropathy Prevention | Coastal Integrative Healthcare | Florida
https://coastalintegrativehealthcare.com/peripheral-neuropathy-prevention/
Quitting smoking is essential as this severely constricts blood vessels to high-risk areas. […] Poor blood flow to the feet is one of the most common causes of peripheral neuropathy and there are plenty of ways to help stimulate this. […] Some medications are known to increase the risk of developing peripheral neuropathy and needless to say these are best avoided wherever possible.
#4 Emerging Pharmacological and Non-Pharmacological Therapeutics for Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy
https://www.mdpi.com/2072-6694/13/4/766
Recent progress in preclinical studies has identified several new preventative and therapeutic targets and pathways, which have the potential to be translated into the clinic for improved management of CIPN. […] Strategies targeting this pathway are of high interest, and several preclinical studies have been performed in connection with CIPN prevention. […] Several herbal medicines have generated interest, particularly among patients, as a potentially safe way for alternative intervention, and for some of these, a potential to prevent or treat CIPN has been documented. […] However, uncertainties regarding the use of single herbal medicines compared with the combination of multiple herbs, the absence of unequivocal information on the identity and content of active ingredients, and the lack of information on the mechanism of action have hindered proper clinical evaluation of their effectiveness.
#5 Emerging Pharmacological and Non-Pharmacological Therapeutics for Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy
https://www.mdpi.com/2072-6694/13/4/766
There is currently increasing interest in non-pharmacological strategies for the prevention or treatment of CIPN due to the anticipation that avoidance of drugs may allow for benign intervention approaches. […] However, phase III evidence of benefit for several of these approaches, including acupuncture, physical exercise, cryotherapy/compression, and scrambler therapy is not yet available, and further research in larger clinical trials is needed to better delineate their utility. […] Despite these study design problems, substantial progress has been made in recent years in our understanding of the pathogenesis for CIPN, and this work has provided important new mechanistic insights and a rationale for novel pharmacological and non-pharmacological strategies. […] Ultimately, such advances will help guide the care of millions of cancer survivors who are suffering from CIPN and its quality of life sequela.