Platinum compounds are a class of
chemotherapy agents that posses a broad spectrum of activity against several solid
malignancies.
Oxaliplatin (
OXL) is a third-generation organoplatinum compound with significant activity mainly against
colorectal cancer (CRC).
Peripheral neuropathy is a well recognized toxicity of
OXL, usually resulting in dose modification.
OXL induces two types of
peripheral neuropathy; acute and chronic. The acute
oxaliplatin-induced
peripheral neuropathy (OXLIPN) may be linked to the rapid chelation of
calcium by
OXL-induced
oxalate and
OXL is capable of altering the
voltage-gated sodium channels through a pathway involving
calcium ions. On the other hand, decreased cellular metabolism and axoplasmatic transport resulting from the accumulation of
OXL in the dorsal root ganglia cells is the most widely accepted mechanism of chronic
oxaliplatin-induced
peripheral neuropathy (OXLIPN). As a result,
OXL produces a symmetric, axonal, sensory distal primary neuronopathy without motor involvement. The incidence of OXLIPN is usually related to various risk factors, including treatment schedule, dosage, cumulative dose and time of infusion. The assessment of OXLIPN is primarily based on neurologic clinical examination and quantitative methods, such as nerve conduction study. To date, several
neuroprotective agents including
thiols,
neurotrophic factors,
anticonvulsants and
antioxidants have been tested for their ability to prevent OXLIPN. However, the clinical data are still controversial. We herein review and discuss the pathogenesis, incidence, risk factors, diagnosis, characteristics and management of OXLIPN. We also highlight areas of future research.