, Volume 63, Issue 15, pp 1549–1563 | Cite as

Neurotoxic Complications of Chemotherapy in Patients with Cancer

Clinical Signs and Optimal Management
  • Carla C. P. Verstappen
  • Jan J. Heimans
  • Klaas Hoekman
  • Tjeerd J. Postma
Therapy In Practice


Neurotoxic side effects of chemotherapy occur frequently and are often a reason to limit the dose of chemotherapy. Since bone marrow toxicity, as the major limiting factor in most chemotherapeutic regimens, can be overcome with growth factors or bone marrow transplantation, the use of higher doses of chemotherapy is possible, which increases the risk of neurotoxicity.

Chemotherapy may cause both peripheral neurotoxicity, consisting mainly of a peripheral neuropathy, and central neurotoxicity, ranging from minor cognitive deficits to encephalopathy with dementia or even coma.

In this article we describe the neurological adverse effects of the most commonly used chemotherapeutic agents.

The vinca-alkaloids, cisplatin and the taxanes are amongst the most important drugs inducing peripheral neurotoxicity. These drugs are widely used for various malignancies such as ovarian and breast cancer, and haematological cancers. Chemotherapy-induced neuropathy is clearly related to cumulative dose or dose-intensities. Patients who already have neuropathic symptoms due to diabetes mellitus, hereditary neuropathies or earlier treatment with neurotoxic chemotherapy are thought to be more vulnerable for the development of chemotherapy-induced peripheral neuropathy.

Methotrexate, cytarabine (cytosine arabinoside) and ifosfamide are primarily known for their central neurotoxic side effects. Central neurotoxicity ranges from acute toxicity such as aseptic meningitis, to delayed toxicities comprising cognitive deficits, hemiparesis, aphasia and progressive dementia. Risk factors are high doses, frequent administration and radiotherapy preceding methotrexate chemotherapy, which appears to be more neurotoxic than methotrexate as single modality.

Data on management and neuroprotective agents are discussed. Management mainly consists of cumulative dose-reduction or lower dose-intensities, especially in patients who are at higher risk to develop neurotoxic side effects. None of the neuroprotective agents described in this article can be recommended for standard use in daily practise at this moment, and further studies are needed to confirm some of the beneficial effects described.


Paclitaxel Peripheral Nervous System Cytarabine Ifosfamide Amifostine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors have provided no information on sources of funding or on conflicts of interest directly relevant to the content of this review.


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Copyright information

© Adis Data Information BV 2003

Authors and Affiliations

  • Carla C. P. Verstappen
    • 1
  • Jan J. Heimans
    • 1
  • Klaas Hoekman
    • 2
  • Tjeerd J. Postma
    • 1
  1. 1.Department of NeurologyVrije Universiteit Medical CenterAmsterdamThe Netherlands
  2. 2.Medical OncologyVU University Medical CenterAmsterdamThe Netherlands

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