Table 4.

Treatment-induced Peripheral Neuropathy

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