Table 4.
Class | Agent | Modalities Affected |
Notes | Outcome |
---|---|---|---|---|
Platinum-based agents |
Carboplatin Cisplatin Oxaliplatin |
Sensory Sensory Autonomic Sensory |
Infrequent neuropathy, incidence increased when combined with paclitaxel (reaches 20% incidence) Symptoms may progress despite cessation of treatment Acute dysesthesias (particularly of the face, mouth, and throat), persistent sensory neuropathy |
May progress after discontinuation. Sensory ataxia common May be permanent Acute changes resolve within days, there may be a subacute neuropathy for approximately 3 months |
Vinca alkaloids | Vinblastine Vincristine Vindesine Vinorelbine |
Sensory Motor Autonomic |
Predominantly affects legs, possible weakness, decreased/absent reflexes, constipation, orthostatic hypotension. Vincristine is the most neurotoxic. |
Symptoms resolve within 3 months, but may be permanent. A dose-limiting toxicity, particularly in older patients |
Taxanes | Cabazitaxel Docetaxel Nabpaclitaxel Paclitaxel |
Sensory Motor |
Feet more affected than hands, painful paresthesias mild weakness, myalgias |
Symptoms improve after treatment discontinuation, but may persist after 1 year |
Alkylators | Ifosfamide Procarbazine |
Sensory | Gradual onset of paresthesias in feet with loss of deep tendon reflexes |
Slow recovery after treatment Usually mild and rarely problematic |
Anti-metabolites | Cytarabine Gemcitabine Nelarabine |
Sensory Sensory, autonomic Sensory, Motor |
Rare Rare |
|
Epothilones | Ixabepilone Eribulin |
Sensory Motor Autonomic |
Painful paresthesias, 10– 16% weakness, rare autonomic changes |
Resolves with drug discontinuation |
Hormonal agents | Anastrozole Exemestane Letrozole |
Sensory | Carpal tunnel syndrome |