Chemotherapy: Open Access
Open Access

Chemotherapy-Induced Neurotoxicity: Understanding the Effects on the Nervous System

Mathieu Lyratzopoulos^{* *}Correspondence: Mathieu Lyratzopoulos, Department of General Practice, University of Melbourne, Melbourne, Australia, Email:

Author info »

Description

Chemotherapy-induced neurotoxicity refers to the damage that chemotherapy drugs cause to the nervous system. Neurotoxicity can manifest as either peripheral neuropathy (damage to the peripheral nerves) or central neurotoxicity (damage to the brain and spinal cord). Both types can result in symptoms ranging from mild tingling sensations to more severe neurological deficits such as motor dysfunction and cognitive decline. Chemotherapy drugs, particularly platinum-based agents, taxanes and vinca alkaloids, are known to have neurotoxic effects. These drugs work by targeting rapidly dividing cells, but they also affect healthy cells, including neurons, which are particularly vulnerable to damage.

Mechanisms of chemotherapy-induced neurotoxicity

Direct toxicity to neurons: Chemotherapy drugs can interfere with the normal functioning of nerve cells. For example, platinum-based drugs form Deoxyribose Nucleic Acid (DNA) that cause DNA damage in neurons, while taxanes disrupt microtubules, which are critical for cell structure and function.

Inflammation: Chemotherapy can trigger an inflammatory response in the nervous system, leading to the release of pro-inflammatory cytokines and oxidative stress. This inflammation may contribute to nerve injury and exacerbate neurotoxicity.

Disruption of axonal transport: Many chemotherapy drugs interfere with the transportation of nutrients and signals along the axons of nerve cells. This disruption can impair nerve function and lead to peripheral neuropathy, characterized by pain, tingling and loss of sensation in the hands and feet.

Mitochondrial dysfunction: Chemotherapy drugs may also affect the mitochondria, the energy-producing centers of cells. Neurons are highly dependent on mitochondrial function and damage to these structures can lead to cell death and contribute to neurotoxicity.

Symptoms of chemotherapy-induced neurotoxicity

Peripheral neuropathy: This includes numbness, tingling, burning sensations or pain in the hands and feet. Patients may have difficulty walking or gripping objects due to motor dysfunction.Peripheral neuropathy: This includes numbness, tingling, burning sensations or pain in the hands and feet. Patients may have difficulty walking or gripping objects due to motor dysfunction.

Cognitive dysfunction (Chemobrain): Cognitive problems, often referred to as "chemobrain," may include difficulty with concentration, memory and processing speed. This can severely impact a patient’s ability to perform daily tasks.

Balance and coordination issues: Chemotherapy can affect motor control and coordination, leading to difficulty walking and an increased risk of falls.

Mood disorders: Some patients experience depression, anxiety or mood swings due to the effects of chemotherapy on the brain and nervous system.

Autonomic dysfunction: Damage to the autonomic nervous system may result in problems with blood pressure regulation, digestion and other involuntary functions.

Management and prevention of chemotherapy-induced neurotoxicity

Dose modification: Adjusting the dose of chemotherapy drugs or delaying treatment can reduce the risk of neurotoxicity. In some cases, doctors may switch to less neurotoxic agents.

Neuroprotective agents: Investigation is ongoing to identify drugs that can protect neurons from chemotherapy-induced damage. Some promising agents, such as antioxidants or agents that reduce inflammation, are being studied.

Symptom management: Pain relievers, antidepressants and anticonvulsants may be prescribed to manage neuropathy symptoms. Physical therapy and occupational therapy can help patients cope with motor impairments and improve quality of life.

Post-treatment rehabilitation: For patients experiencing long-term effects, rehabilitation programs focusing on cognitive function and physical mobility can be beneficial in helping them regain function and independence.

Conclusion

Chemotherapy-induced neurotoxicity is a significant challenge for cancer patients undergoing chemotherapy. Although neurotoxicity can be debilitating, advancements in understanding its mechanisms and risk factors have led to improved management strategies. By combining dose adjustments, neuroprotective measures and symptom management, healthcare providers can mitigate the effects of neurotoxicity and improve the quality of life for patients. Continued examination into the causes and prevention of chemotherapy-induced neurotoxicity is essential for ensuring better outcomes for cancer patients.