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Metabolic and lifestyle risk factors for chemotherapy-induced peripheral neuropathy in taxane and platinum-treated patients: a systematic review

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Abstract

Purpose

Chemotherapy-induced peripheral neurotoxicity (CIPN) is a common dose-limiting toxicity of cancer treatment causing functional impairment and impacting quality of life. Effective prevention and treatment of CIPN are lacking, and CIPN risk factors remain ill-defined. Metabolic syndrome and associated conditions have emerged as potential risk factors, due to their high prevalence and independent association with nerve dysfunction. This systematic review aimed to investigate the association between these common metabolic-lifestyle factors and CIPN.

Methods

Searches were undertaken using Medline, Embase, CINAHL, Scopus, and Web of Science databases, with additional studies identified from bibliographic references cited by original and review articles. Articles that analyzed metabolic-lifestyle risk factors associated with CIPN for patients treated with platinum- or taxane-based chemotherapy were included.

Results

Searches identified 6897 titles; 44 articles had full text review, with 26 studies included. Overall incidence of neuropathy ranged from 16.9 to 89.4%. Obesity had the most consistent patient-oriented evidence as a risk factor for CIPN, with moderate evidence suggesting diabetes did not increase CIPN incidence or severity. A limited number of studies supported an association with low physical activity and greater CIPN risk.

Conclusions

Comorbidities and lifestyle factors, particularly obesity and low physical activity, may contribute to the development of CIPN. The implementation of sensitive outcome measures in large-scale clinical trials is required to further elucidate CIPN risk factors and evaluate if changes in lifestyle would improve long-term CIPN outcomes for cancer survivors.

Implications for Cancer Survivors

Better understanding of CIPN risk profiles may inform personalized medicine strategies and help elucidate pathophysiological mechanisms which could be targeted for neuroprotection.

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Data availability

All data generated or analyzed during this study are included in this published article.

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Funding

This study was supported by a Cancer Institute NSW Program Grant (14/TPG/1-05) and a National Health and Medical Research Council of Australia (NHMRC) Project Grant (#1080521). SBP is supported by an NHMRC Career Development Fellowship (#1148595). MCK was supported by an NHMRC Practitioner Fellowship (1156093) and by ForeFront, a large collaborative research group dedicated to the study of neurodegenerative diseases and funded by the National Health and Medical Research Council of Australia Program Grant (#1132524).

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Authors and Affiliations

  1. Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia

    Hannah C. Timmins, Tiffany Li, Matthew C. Kiernan & Susanna B. Park

  2. Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia

    David Mizrahi & David Goldstein

  3. Sydney Medical School, The University of Sydney, Sydney, Australia

    Matthew C. Kiernan

  4. Royal Prince Alfred Hospital, Camperdown, Australia

    Matthew C. Kiernan

  5. Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia

    David Goldstein

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Timmins, H.C., Mizrahi, D., Li, T. et al. Metabolic and lifestyle risk factors for chemotherapy-induced peripheral neuropathy in taxane and platinum-treated patients: a systematic review. J Cancer Surviv 17, 222–236 (2023). https://doi.org/10.1007/s11764-021-00988-x

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