Chemotherapy induced peripheral neuropathy

gdpawel said:

Peripheral Neuropathy
There are three major groups of nerves in the human body.

1. The peripheral nerves that carry information to and from the limbs.

2. The nerves that supply the bowels and other internal organs.

3. The nerves of the head which connect to the ears, eyes, taste buds, etc.

Nerves in any or all of these major groups can be affected by certain chemotherapy drugs.

Nerves are vulnerable to many kinds of damage. They can be damaged by certain cancers. This may be caused by the cancer cells producing a particular kind of biological agent that interferes with the function of the nerves.

Sometimes, they can be damaged by drugs used in chemotherapy treatment. The chemotherapy drugs that most likely cause nerve damage are the vinca alkaloids, platinum drugs and the taxanes. These drugs have the potential of interfering with nerve function.

You may notice symptoms in different areas of your body depending on which groups of nerves are affected.

Symptoms in the hands and feet happen when peripheral nerve damage happens. The first sign of nerve damage is usually a feeling of tingling and numbness like what you experience when your foot goes to sleep after you've been sitting for a long time in an uncomfortable position.

If the problem progresses further, it often produces weakness of the muscles, resulting in loss of strength at the wrist or the ankle. You will notice difficulty in doing up buttons and picking up coins. You may notice that you will tend to trip while walking up stairs or dragging your feet and tend to have a wide-based gait. In severe cases, the weakness may be so severe that you will need a wheelchair.

When the nerves in the bowel are affected, constipation is the earliest sign. In a few people, the abdomen becomes bloated with a distended bowel that is basically paralyzed.

Some of the nerves in the head can also be affected. Platinum drugs can affect the auditory nerve and cause loss of hearing and tinnitus(ringing in the ears). Vision can very occasionally be affected.

A lot depends on how quickly your cancer treatment can be stopped. Sometimes the need for treatment is more urgent then the residual nerve damage. Sometimes, the balance between benefit from the drug and the side effect of nerve damage is more finely balanced.

Once treatment has been stopped, recovery is usually slow. It may take months to get even partial improvement and often there will be some residual impairment, either a motor weakness or a sensory numbness or both. Recovery is slower in the feet and legs than in the hands and arms.

There is no specific treatment that enhances nerve recovery. There are no drugs that will directly stimulate nerve regeneration or recovery. If you have severe and prolonged pain, then the pain may require narcotics often combined with antidepressants. In some cases, certain types of anticonvulsants would be helpful.

Treatment options are subjects that you should discuss with your doctor, so you have accurate expectations of potential benefits and side effects.

Chemotherapy drugs that can cause neuropathy. NCI lists these as most likely to do so:

Cisplatinum (Platinol)
Carboplatin (Paraplatin)
Vincristine (Oncovin)
Vinblastine (Velban)
Etoposide/VP-16 (VePesid)
Cytarabine (Cytosar, Ara-C)
Hexamethylmelamine (Hexalen)
Suramin
Paclitaxel (Taxol) and Docetaxel (Taxotere)
Other medications reported to contribute to neuropathy include oxaliplatin (Eloxatin), gemcitibine (Gemzar) and thalidomide (Thalomid).

gdpawel said:

Neuropathy
As seen many times in cancer medicine, oncologists are paid to treat. Many times in this overzealous need to treat, they overlook the side effects that can occur from particularly overtreatment. This is not what oncologists do. They don't know how to treat the side effects of their treatments.

Cancer patients need to add to their repertoire of specialists for their disease. A Physical Medicine and Rehabilitation Specialist for neuropathy, a Pulmonary Specialist for radiation pneumonitis, a Neurologist for leukoencephalopathy or worse, radiation-induced necrosis, or an Endocrinology & Metabolism Specialist, depending on what actually could be wrong with the patient.

While there is no specific treatment that enhances nerve recovery or regeneration, pain may be tolerated by narcotics, antidepressants or anticonvulsants.

I've written before on the boards that anecdotally, drugs like Neurontin are used off-label. Most drugs are prescribed off-label. One must be cautious that off-label remedies are fully discussed with patients and must not do any harm. A number of practioners like to use Neurontin (gabapentin) for all neuropathy. It is already used for diabetic neuropathy and neuropathic pain and (after a work-up and ruling out other causes) they found this to work. But again, do no harm.

As far as I know, there hasn't been any studies of taxane-induced neuropathy. However, recently, there is a SWOG trial aimed at studying neuropathy. It is a Phase III trial that just started in September 2009 that will involve 380 participants and is available at 180 locations.

Acetyl-L-Carnitine in Preventing Neuropathy in Women With Stage I, Stage II, or Stage IIIA Breast Cancer Undergoing Chemotherapy

http://clinicaltrials.gov/ct/show/NCT00775645

Unfortunately, it excludes those with prior taxane therapy! I came across a Yale School of Medicine study that apparently found a molecular basis for the peripheral pain caused by taxanes. It appears to be caused when the drug binds to a protein and initiates improper calcium signaling. This response leads to side effects such as acute hypersensitivity, slower heart rhythms, tingling, numbness, and other symptoms (PNAS 104: 11103-11108 June 20, 2007)

I remember writing five years ago about Bionumerik boosting about its new drug Tavocept, that was aimed at preventing or reducing common and serious side effects, particularly nerve and kidney damage, associated with taxane and platinum drugs. Very little had been accomplished to prevent or reduce chemotherapy-induced toxicities, but they had a new product and began testing it.

gdpawel said:

Neuropathy
As seen many times in cancer medicine, oncologists are paid to treat. Many times in this overzealous need to treat, they overlook the side effects that can occur from particularly overtreatment. This is not what oncologists do. They don't know how to treat the side effects of their treatments.

Cancer patients need to add to their repertoire of specialists for their disease. A Physical Medicine and Rehabilitation Specialist for neuropathy, a Pulmonary Specialist for radiation pneumonitis, a Neurologist for leukoencephalopathy or worse, radiation-induced necrosis, or an Endocrinology & Metabolism Specialist, depending on what actually could be wrong with the patient.

While there is no specific treatment that enhances nerve recovery or regeneration, pain may be tolerated by narcotics, antidepressants or anticonvulsants.

I've written before on the boards that anecdotally, drugs like Neurontin are used off-label. Most drugs are prescribed off-label. One must be cautious that off-label remedies are fully discussed with patients and must not do any harm. A number of practioners like to use Neurontin (gabapentin) for all neuropathy. It is already used for diabetic neuropathy and neuropathic pain and (after a work-up and ruling out other causes) they found this to work. But again, do no harm.

As far as I know, there hasn't been any studies of taxane-induced neuropathy. However, recently, there is a SWOG trial aimed at studying neuropathy. It is a Phase III trial that just started in September 2009 that will involve 380 participants and is available at 180 locations.

Acetyl-L-Carnitine in Preventing Neuropathy in Women With Stage I, Stage II, or Stage IIIA Breast Cancer Undergoing Chemotherapy

http://clinicaltrials.gov/ct/show/NCT00775645

Unfortunately, it excludes those with prior taxane therapy! I came across a Yale School of Medicine study that apparently found a molecular basis for the peripheral pain caused by taxanes. It appears to be caused when the drug binds to a protein and initiates improper calcium signaling. This response leads to side effects such as acute hypersensitivity, slower heart rhythms, tingling, numbness, and other symptoms (PNAS 104: 11103-11108 June 20, 2007)

I remember writing five years ago about Bionumerik boosting about its new drug Tavocept, that was aimed at preventing or reducing common and serious side effects, particularly nerve and kidney damage, associated with taxane and platinum drugs. Very little had been accomplished to prevent or reduce chemotherapy-induced toxicities, but they had a new product and began testing it.

abrub said:

Ask about adding Alpha Lipoic Acid
Taking Alpha Lipoic Acid (600 mg/day) helped me greatly - my feet felt lots better. I had Folfox plus Avastin, and the neuropathy remained severe for over a year, until I started with the ALA. Ask if it's okay to take while on your current regimen.

RoseyR said:

In addition, for neuropathy


Thanks for all your information.

Would also suggest from own online research, checking out the following:

bentofiamine (a derivative of vitamin B1) including a product called "Nerve Support Forumula"
vitamin D3 levels (should be at least 35-45; if lower, take liqui-D drops under doctor's care)
vitamin B12 levels (should be at least 500)
alpha-lipoic acid
vitamin E succinate (400-600 mgs a day)
a really good fish oil (2-4 teaspoons a day in two doses, more absorbable as liquid than capsules, no bad taste)

check out as well Life Extension's web site; go to "ailments" and look at the research on supplements that may help from their board of advisors, all well credentialed doctors.

Hope this helps,
Rosey R

jazzy1 said:

Drugs?
Hum...isn't marijuana a drug? Also many alternatives which do help the neuropathy.