NEUROTOXICITY OF ANTINEOPLASTIC AGENTS

Purpose: to review the neurotoxicity associated with antineoplastic agents. Methods: four hundred articles, abstracts and book chapters were selected for review. One hundred and ninety (articles, book chapters and abstracts) were identified as representative of the important aspects of neurotoxicity to be presented in this review. Results: in general the dose, schedule and route of administration significantly determine the incidence and outcome of antineoplastic agents neurotoxicity. An updated and detailed review of neurotoxicity is provided with special attention to vinca alkaloids, cisplatin and biologic response modifiers. The neurotoxic side effects of some of the new approaches in cancer therapy and some of the investigational agents are discussed. Guidelines for the prevention and management of this toxicity are presented. In addition, suggestions are made in regard to the preclinical and clinical screening of new agents for neurotoxicity. Conclusion: quality of life issues have become a focal point in many clinical trials. Neurotoxicity associated with antineoplastic therapy clearly has an impact on the short and long term quality of the life of cancer patients. A better understanding of this toxicity requires developing reliable and predictive models to screen new agents prior to their introduction into clinical trials; a more detailed and uniform grading system; and the prospective evaluation of neurotoxicity in clinical trials of new antineoplastic agents. © 1993.