Chemotherapy-induced Peripheral Neuropathy: Clinical Features, Differential Diagnosis and Prevention

Abstract

Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent and clinically significant adverse effect associated with several commonly used chemotherapeutic agents, including platinum compounds, taxanes, vinca alkaloids, and proteasome inhibitors (Cavaletti and Marmiroli, 2010, Park et al., 2013, Seretny et al., 2014). CIPN predominantly presents as a length-dependent sensory neuropathy affecting the distal extremities and may persist long after completion of chemotherapy, resulting in chronic pain, functional impairment, and diminished quality of life (Mols et al., 2014, Winters-Stone et al., 2017, Eckhoff et al., 2015). Despite increasing understanding of the underlying pathophysiological mechanisms, effective preventive strategies remain limited, and no pharmacologic agent has demonstrated consistent benefit for routine prophylaxis. Current management primarily focuses on early recognition, symptom control, and dose modification (Loprinzi et al., 2020, Hershman et al., 2014). Accurate diagnosis requires careful clinical evaluation, supported by neurological examination and nerve conduction studies. Important differential diagnoses such as diabetic neuropathy, vitamin B12 deficiency, paraneoplastic neuropathy, and critical illness neuropathy should be excluded. This narrative review provides a comprehensive overview of the epidemiology, clinical features, diagnostic approaches, differential diagnosis, and prevention strategies for CIPN, with emphasis on current clinical evidence and future research directions.