Cisplatin neuropathy is a form of nerve damage that can occur as a side effect of cisplatin, a chemotherapy drug commonly used in cancer treatment. This condition specifically affects the peripheral nervous system, which includes the nerves outside the brain and spinal cord. It can significantly impact a patient’s quality of life during treatment, and its development is a recognized complication.
Understanding Cisplatin Neuropathy
Cisplatin neuropathy arises from how the chemotherapy drug interacts with and damages nerve cells. The drug forms DNA adducts, particularly in the mitochondria of neurons, especially those in the dorsal root ganglia (DRG). These adducts disrupt mitochondrial DNA function, impairing protein synthesis and the respiratory chain. This can lead to reduced cellular metabolism and increased oxidative stress.
The damage extends beyond DNA, also affecting other cellular components. Cisplatin can disrupt microtubules, structural elements within nerve cells involved in transporting substances along the axon. It can also impair ion channel function, which transmits electrical signals in nerves, leading to neuronal hyperexcitability. This cellular disruption contributes to progressive nerve damage, with severity often increasing with higher cumulative doses and longer exposure to cisplatin.
Recognizing the Symptoms
Patients experiencing cisplatin neuropathy report a range of symptoms, primarily affecting sensory nerves, though motor and autonomic nerves can also be involved. Initial manifestations appear as sensory changes in the extremities, following a “stocking and glove” distribution. This means symptoms start in the fingers and toes before potentially spreading to the arms and legs. Many individuals describe a tingling or “pins and needles” sensation, particularly in the hands and feet.
Numbness is another common sensory symptom, where affected areas feel “asleep” or less responsive to touch. Patients may also experience burning, shooting, or electric shock-like pain, even without apparent cause. Sensitivity to temperature, such as cold or heat, can also be heightened, making everyday activities uncomfortable. Beyond sensory issues, motor symptoms can include difficulty with balance, weakness in the limbs, and problems with fine motor skills, like buttoning a shirt. In some cases, patients may experience a “coasting phenomenon,” where symptoms worsen even after chemotherapy has concluded.
Managing and Mitigating Neuropathy
Managing cisplatin neuropathy involves strategies to alleviate existing symptoms and, where possible, reduce its risk or severity. For symptom relief, healthcare providers may consider various approaches. Medications include antiseizure drugs or antidepressants, which manage neuropathic pain by interfering with pain signals or addressing associated mood disturbances. Topical treatments with agents like lidocaine or capsaicin can also be applied directly to affected areas for localized relief.
Physical therapy and occupational therapy are also important components of management, helping address soreness, stiffness, and functional limitations from nerve damage. These therapies can improve balance, strength, and coordination, helping patients maintain daily activities. Healthcare providers may also explore strategies to mitigate neuropathy during treatment, such as adjusting cisplatin dosage or considering alternative drug delivery methods. While there is no definitive treatment to reverse nerve damage, some interventions like amifostine, calcium and magnesium, and glutathione have shown modest, though not consistently proven, benefits in reducing neurotoxicity in some studies.