Peripheral Neuropathy Home
Preventing / Treating Possible Chemotherapy
Induced Peripheral Neuropathy
Introduction
There are two main toxicities to
the extremities -- skin and nails and peripheral neuropathy - nerves.
The definition list attempts to make the distinction clear.
Definitions
Nail Toxicity - this might manifest itself in
various ways such as hyperpigmentation, splinter hemorrhage, subungual
hematoma, cessation of nail growth, orange discoloration, etc. There is
also
Onycholysis - the loosening or separation of a
fingernail or toenail from its nail bed - manifested in 2-3% of
patients(1,2).
Hand-Foot Syndrome - this is uncommon, but
appears as a discoloration of the skin that progresses to blisters and
shedding of outer layers of skin (desquamation.)
Peripheral Neuropathy (often abbreviated as P/N) - damage to the nerves
that transmit signals from the extremities to the central nervous system.
There is both motor neuropathy and sensory neuropathy. P/N can be
dose limiting and can decrease the quality of life.
Nail and Skin Toxicity
Frozen gloves and foot covers can help here. There is also skin toxicity that frozen gloves may help minimize. An writeup of this study is at
http://www.cancer.gov/clinicaltrials/results/frozen-glove0805.
A
paper presented at the 2007 ASCO Annual Meeting (Abstract
# 9059) gives the results for a study of frozen socks on prevention of
skin and nail toxicities.
Some peripheral
neuropathy/nail toxicity anecdotal reports will give you an idea as to
what other patients are doing (mostly related to cooling techniques.)
Whether or not cooling the hands and feet
in this way affects peripheral neuropathy development is not known --
there is no mention of peripheral neuropathy in the above papers on frozen
gloves/socks.
The type of nail changes that might occur depend on
the number of cycles of chemotherapy administered.
Peripheral Neuropathy Treatment
and Prevention (5)
Among the currently available taxane therapies, paclitaxel and
docetaxel can both cause distal neuropathy that is usually sensory in
nature. Motorsensory neuropathy has also been reported.
Paclitaxel is more neurotoxic than docetaxel. Affected patients
commonly experience paresthesias in the hands and feet, impaired
cutaneous sensation, and a diminished sense of position that can
result in significant sensory ataxia. Individual
drug dose as well as total cumulative dose appear to affect
neuropathy.
Paresthesias - a sensation of tingling, pricking,
or numbness of a person's skin.
Sensory ataxia - sensitivity to joint and body part
position.
Using Glutamine for Protection Against Chemotherapy
Toxicity. By taking glutamine, it might be possible to prevent/delay
the onset of peripheral neuropathy due to taxane (and other) chemotherapy.
Peripheral Neuropathy
(polyneuropathy)... a common side-effect of chemotherapy--is there
any solution?
There are also two very good review articles
that anyone wanting more information is encouraged to obtain and read.
These are
Two Patient Care Abstracts on
P/N from ASCO 2007
Melatonin(ASCO
2007 abstract # 19640.) Pre-clinical data had shown that
melatonin might be neuroprotective, hence this study in breast cancer
patients receiving taxane chemotherapy.
-
Dose & Schedule. 21mg at bedtime
beginning on day 1 and continuing for 28 days after last taxane dose.
-
Results. 11 patients reported at
ASCO of planned 50. No grade 3 or 4 P/N (historical controls
suggest that 22-33% develop grade 3 or 4 P/N) with half experiencing
NO P/N and the other half experiencing no worse than grade 1 or 2 P/N.
Patient quality of life was maintained.
Vitamin E - (ASCO
2007 abstract # 9114.) This study was of cisplatin induced P/N
and ototoxicity (inner ear).
-
Dose & Schedule. 400mg
Vitamin E in the form of α - tocopherol, daily or a placebo.
Note: 400mg, not IU. 400mg is roughly 600 IU, using a conversion
factor found on the web for this form of vitamin E.
-
Results. 11 patients vitamin E,
14 patients placebo of planned 81 in this interim analysis.
Statistical analysis showed a significant difference (p<0.05) between
the vitamin E group which had a "Total Neuropathy Score(TNS)" of 1 vs
the placebo group which had a TNS of 5.
For another study on the use of
vitamin E for prevention of P/N, see
Argyriou AA, Chroni E, Koutras A, Ellul J,
Papapetropoulos S, Katsoulas G, Iconomou G, Kalofonos HP, Vitamin E for
prophylaxis against chemotherapy-induced neuropathy: a randomized
controlled trial, Neurology. 2005 Jan 11;64(1):26-31.
Comment in: Neurology. 2005 Aug 9;65(3):501-2; author reply 501-2.
This study used 600mg vitamin E (alpha-tocopherol.)
Treating Peripheral
Neuropathy(3)
Anti-depressant drugs can help with
treating pain due to P/N. One such drug is Effexor.
Drugs developed for treating
diabetic related neuropathy also might be useful to treat pain due to
P/N
from taxanes. See www.lyrica.com
for information on the drug Lyrica, which is fairly new on the market.
It is FDA approved for diabetic nerve pain and pain after shingles.
Neurontin(gabapentin), an
anti-seizure drug, has also been used for treating P/N pain. See
the
WEBMd page on treating nerve pain which includes Neurontin.
Recovery from P/N is often slow and
some may remain as a long term problem. Here are some additional
steps that you might try to reduce pain and/or possibly aid in nerve
regeneration.
-
Acupuncture. May relieve
pain and numbness.
-
Massage. May relieve pain by
increasing blood flow.
-
Physical Therapy. Strengthen
muscles.
-
TNS(Transcutaneous nerve
stimulation.) Used to evaluate nerve damage, but it can provide pain
relief and also might help with nerve regeneration.
References
(1) Vanhooteghem O, Richert B,
Vindevoghel A, Vandenbossche L, Vandeveire A, de la Brassinne M.,
Subungual abscess: a new ungual side-effect related to docetaxel
therapy, Br J Dermatol. 2000 Aug;143(2):462-4.
(2) Florian Scottá et al, Multicenter Study of
Frozen Glove to Prevent Docetaxel-Induced Onycholysis and Cutaneous Toxicity of the Hand, J. Clin. Oncol
23:4423-4429, July 1, 2005.
(3) The Mayo Clinic website provides the following
information.
http://www.mayoclinic.com/health/peripheral-neuropathy/BN00046
(4) The University of Michigan
website also has information.
