Chemotherapy: neurologic complications

Eudocia Quant Lee MD MPH (Dr. Lee of Harvard Medical School and Brigham and Women’s Hospital received consulting fees from Genentech/Roche.)
Jorg Dietrich MD PhD (Dr. Dietrich of Harvard Medical School and Massachusetts General Hospital received consulting fees from Monteris Medical Corporation.)
Patrick Y Wen MD (Dr. Wen of Harvard Medical School and Brigham and Women’s Hospital received research grants from Acerta, Angiochem, GlaxoSmithKline, Merck, Novartis Oncoceutics, Sanofi-Aventis, and Vascular Biogenics for research support; research grants and consulting fees from Agios, Astra Zeneca, and Genentech/Roche for research support; honorariums from Cavion, Cortice Biosciences, Foundation Medicine, Insys, Monteris, and Vascular Biogenics for service on an advisory board; and honorariums from Merck for service on a Speaker's Bureau.)
Edward J Dropcho MD, editor. (Dr. Dropcho of Indiana University Medical Center has no relevant financial relationships to disclose.)
Originally released December 10, 1996; last updated January 29, 2017; expires January 29, 2020

This article includes discussion of chemotherapy: neurologic complications and neurologic complications of systemic anticancer therapies. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Patients with cancer are living longer due to earlier diagnoses and remarkable improvements in treatments. Unfortunately, neurologic complications from chemotherapy remain a significant cause of morbidity and may play a role in limiting potential treatments. In addition, novel therapies such as small molecule tyrosine kinase inhibitors, immunotherapy, and various monoclonal antibodies have also been associated with neurologic complications. Because treatments for therapy-induced neurotoxicity are limited, awareness of common neurologic complications is important to prevent permanent damage. The authors review common neurologic complications of both conventional chemotherapy and novel systemic agents in this article. This article has been updated to include neurologic complications of newer immunotherapies including ipilimumab, pembrolizumab, and nivolumab.

Key points

 

• Neurologic complications from chemotherapy impact quality of life and remain an important source of dose-limiting toxicity.

 

• The neurotoxicities of chemotherapy are widely known, but several targeted agents such as bortezomib, ipilimumab, and bevacizumab and immunotherapies such as ipilimumab, pembrolizumab, and nivolumab are also associated with neurologic complications.

 

• Early recognition and prevention may help avoid permanent neurologic damage.

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