Causes

Neuropathy occurs in cancer patients for a number of reasons. The cancer itself may be infiltrating the nerves. Patients may have other diseases such as diabetes, nutritional imbalances, alcoholism, and kidney failure, which may also cause neuropathy. It is important for the physician to distinguish which factor is responsible, so the appropriate treatment can be initiated. The most common cause in cancer patients, however, is chemotherapy drugs. Neuropathy occurs in approximately 10-20% of cancer patients receiving chemotherapy. The most common chemotherapy drugs that cause neuropathy include:

• platinum compounds (e.g., cisplatin , carboplatin)
• taxanes (e.g., docetaxel and paclitaxel)
• vincristine.

The following chemotherapy agents can also cause neuropathy, but the incidence is relatively small compared to the prior ones listed. These include:

• procarbazine
• cytosine Arabinoside (Ara C or cytarabine);
• metronidazole

Treatments

Not long ago, few options were available to prevent or stop the progress of peripheral neuropathy. Treatments are now available that can halt the development of chemotherapy-caused neuropathy or at least diminish its effects.

The only effective preventive therapy is the use of amifostine (Ethyol). Some of the side effects of this medication include temporary low blood pressure, and nausea and vomiting . Patients should have adequate fluid intake before and during the 15-minute intravenous administration of amifostine. Blood pressure readings should be taken every five minutes during the infusion. Chemotherapy is administered shortly after giving the amifostine so that the maximum amount of the drug is in the cells before the chemotherapy is started.

If neuropathy does develop, it may be necessary to discontinue the suspected chemotherapy drug causing it. Administration of amifostine may reverse the neuropathy or lessen its symptoms.

A variety of medications are available that can ease symptoms for those suffering from neuropathy. These medications include:

• Pain relievers. Pain medicines available over-the-counter, such as acetaminophen (Tylenol), and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin IB, Nuprin), can help to alleviate mild symptoms. For more severe symptoms, the physician may recommend a prescription NSAID.
• Tricyclic antidepressants. Certain antidepressant medications, including amitriptyline (Elavil), nortriptyline (Pamelor), desipramine (Norpramin) and imipramine (Tofranil), can help with mild to moderate symptoms.
• Antiseizure medications. Certain drugs intended to treat epilepsy, such as carbamazepine (Tegretol) and phenytoin (Dilantin), can be effective in treating jabbing, shooting pain.
• Other drugs. Mexiletine (Mexitil), a drug normally used to treat irregular heart rhythms, may help to relieve burning pain.

The physician or pharmacist should be consulted regarding potential side effects or interactions with other medications.

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