Chemotherapy-induced peripheral
neuropathic pain (CIPNP)-a severe adverse effect observed in up to 80% of patients during treatment with
antineoplastic drugs-limits the tolerable dose of
cytostatics, and can lead to discontinuation of
chemotherapy. Many drugs that are approved for the treatment of other
neuropathic pain states have shown little or no
analgesic effect on CIPNP in large randomized, placebo-controlled clinical trials. Here, we review the known mechanisms of CIPNP induced by the three most commonly used
cytostatics:
paclitaxel,
oxaliplatin and
vincristine. These substances have distinct neurotoxic and neuroinflammatory properties, but they also have overlapping contributions to pathogenesis of CIPNP that could potentially be targeted for prevention or treatment of CIPNP. We discuss the failure of previously tested
antioxidants,
neuroprotective agents,
anticonvulsants and
antidepressants as therapeutic or preventative strategies, and suggest individualized, mechanism-based therapeutic options for CIPNP associated with each of the three main
drug groups. We point out the necessity to assess
drug efficacy in CIPNP independently of other
neuropathic pain states, and emphasize the need for delineation of subpopulations of patients with CIPNP for more-efficient treatment. Finally, we discuss novel therapeutic strategies and recent progress in treatment of CIPNP, and evaluate the potential benefits of these recent proceedings for future
therapies.