Platinum-based
chemotherapy is commonly associated with toxic sensory neuropathies, but also, although rarely, with
Guillain-Barré syndrome (GBS). We describe five patients who developed GBS while receiving
platinum-based
chemotherapy for a solid
tumor and report the five cases published so far. Most patients had received cumulative
platinum doses below known neurotoxic levels, and all of them had an optimal outcome after
platinum discontinuation, associated in most cases with administration of
intravenous immunoglobulin. Clinical presentation, electroneuromyography, and cerebrospinal fluid analysis help clinicians to differentiate GBS from toxic neuropathy.
Platinum compounds are the only chemotherapeutic agents used for solid
tumors that have been associated to GBS. Thus, we propose that GBS may constitute a non-dose-dependent side effect of
platinum drugs and that awareness needs to be raised among oncologists on this rare but potentially life-threatening complication of
platinum chemotherapy. IMPLICATIONS FOR PRACTICE: Many patients on
platinum-based
chemotherapy for solid
tumors develop sensory neuropathy, a common dose-dependent side effect. The authors propose that
Guillain-Barré syndrome may constitute an immune-mediated, non-dose-related side effect of
platinum-based
chemotherapy. Prompt diagnosis of
Guillain-Barré syndrome and distinction from classical toxic neuropathy are crucial for optimal treatment.
Platinum discontinuation, associated if needed to
intravenous immunoglobulin administration, radically changes the course of the disease and minimizes neurological sequelae.