Chemotherapy: neurologic complications

Overview
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By Eudocia Quant MD, Jorg Dietrich MD PhD, and Patrick Y Wen MD

Neurologic complications of chemotherapy have been reported with increasing frequency in cancer patients as a result of aggressive antineoplastic therapy with neurotoxic agents and prolonged patient survival. These complications may result from the direct toxic effects of the drug on the nervous system or indirectly from metabolic derangements or cerebrovascular disorders induced by the drugs. Recognition of these complications is important because they may be confused with metastatic or recurrent disease and because discontinuation of the drug may prevent irreversible injury.

The neurologic complications of the more commonly used chemotherapeutic agents, hormones, biological response modifiers, and targeted molecular agents in cancer patients will be discussed. This topic is reviewed in greater detail in a number of reviews (Forsyth and Cascino 1995; Posner 1995; Gilbert 1998; Hammack and Cascino 1998; Keime-Guibert et al 1998; Paleologos 1998; Postma et al 1998; Windebank 1999; Wen 2001; Collins and Amato 2002; Briemberg and Amato 2003; Plotkin and Wen 2003; Verstappen et al 2003; Schiff et al 2009).

The neurologic complications of the most common chemotherapeutic drugs are summarized in Table 1.

Table 1. Neurologic Complications of Chemotherapy

Acute encephalopathy

• Asparaginase

• 5-Azacytidine

• BCNU

• Chlorambucil

• Cisplatin

• Corticosteroids

• Cyclophosphamide

• Cytosine arabinoside

• Dacarbazine

• Doxorubicin

• Etoposide

• Fludarabine

• 5-Fluorouracil

• Gemcitabine

• Hexamethylmelamine

• Hydroxyurea

• Ibritumomab

• Ifosfamide

• Imatinib

• Interferons

• Interleukins 1 and 2

• Mechlorethamine

• Methotrexate

• Misonidazole

• Mitomycin C

• Nelarabine

• Paclitaxel

• Pentostatin

• Procarbazine

• Suramin

• Tamoxifen

• Thalidomide

• Thiotepa

• Tumor necrosis factor

• Vinca alkaloids

• Zarnestra

 

Dementia

• BCNU

• Carmofur

• Cisplatin

• Corticosteroids

• Cytosine arabinoside

• Dacarbazine

• Fludarabine

• 5-Fluorouracil

• Interferon

• Levamisole

• Methotrexate

 

Cranial neuropathy

• BCNU

• Cisplatin

• Cytosine arabinoside

• Ifosfamide

• Methotrexate

• Nelarabine

• Vincristine

 

Acute cerebellar syndrome

• Cytosine arabinoside

• 5-Fluorouracil

• Hexamethylmelamine

• Ifosfamide

• Interleukin-2

• Procarbazine

• Tamoxifen

• Thalidomide

• Vinca alkaloids

• Zarnestra

 

Leukoencephalopathy

• Bevacizumab

• Capecitabine

• Cisplatin

• Cytosine arabinoside

• Cyclosporin-A

• 5-Fluorouracil

• G-CSF/GM-CSF

• Methotrexate

• Nelarabine

• Oxaliplatin

• Sorafenib

• Sunitinib malate

• Vinca alkaloids

Headache

• Asparaginase

• BCNU

• Capecitabine

• Cetuximab

• Cisplatin

• Corticosteroids

• Cytosine arabinoside

• Danazol

• Estramustine

• Etoposide

• Fludarabine

• Gefitinib

• Gemcitabine

• Hexamethylmelamine

• Hydroxyurea

• Ibritumomab

• Imatinib

• Interferons

• Interleukins

• Leuprolide

• Levamisole

• Mechlorethamine

• Methotrexate

• Mitomycin

• Mitotane

• Nelarabine

• Octreotide

• Oprelvekin

• Plicamycin

• Procarbazine

• Rituximab

• Retinoic acid

• SU-5416

• Tamoxifen

• Temozolomide

• Thalidomide

• Thiotepa

• Tumor necrosis factor

• Topotecan

• Tositumomab

• Trastuzumab

• ZD-1839

 

Aseptic meningitis

• Cytosine arabinoside

• Levamisole

• Methotrexate

• Thiotepa

 

Myelopathy

• Cisplatin

• Cladaribine

• Corticosteroids

• Cytosine arabinoside

• Docetaxel

• Doxorubicin

• DFMO

• Fludarabine

• Interferon alpha

• Methotrexate

• Mitoxantrone

• Taxotere

• Thiotepa

• Vincristine

 

Vasculopathy and stroke

• Asparaginase

• BCNU

• Bevacizumab

• Bleomycin

• Carboplatin

• Cisplatin

• Danazol

• Doxorubicin

• Erlotinib

• Erythropoietin

• Estramustine

• 5-Fluorouracil

• Interleukin

• Imatinib mesylate

• Methotrexate

• Mitomycin

• Nelarabine

• Tamoxifen

Seizures

• Amifostine

• Asparaginase

• BCNU

• Busulfan

• Chlorambucil

• Cisplatin

• Corticosteroids

• Cyclophosphamide

• Cytosine arabinoside

• Dacarbazine

• Docetaxel

• Erythropoietin

• Etanercept

• Etoposide

• 5-Fluorouracil

• Gemcitabine

• Hexamethylamine

• Hydroxyurea

• Ifosfamide

• Interferon

• Interleukin-2

• Letrozole

• Leuprolide

• Levamisole

• Mechlorethamine

• Methotrexate

• Octreotide

• Paclitaxel

• Pentostatin

• Suramin

• Temozolomide

• Teniposide

• Thalidomide

• Vinca alkaloids

 

Visual loss

• BCNU

• Carboplatin

• Chlorambucil

• Cisplatin

• Cytosine arabinoside

• Etanercept

• Etoposide

• Fludarabine

• 5-Fluorouracil

• Methotrexate

• Paclitaxel

• Pentostatin

• Retinoic acid

• Tamoxifen

• Suramin

• Vinca alkaloids

 

Neuropathy

• 5-Azacytidine

• Bortezomib

• Capecitabine

• Carboplatin

• Cetuximab

• Cisplatin

• Cytosine arabinoside

• Docetaxel

• Etoposide

• 5-FU

• Gemcitabine

• Hexamethylmelamine

• Ifosfamide

• Interferon-alpha

• Misonidazole

• Nelarabine

• Oprelvekin

• Oxaliplatin

• Paclitaxel

• Pemetrexed

• Procarbazine

• Purine analogs (fludarabine, cladribine, pentostatin)

• Sorafenib

• Sunitinib malate

• Suramin

• Taxanes

• Teniposide (VM-26)

• Thalidomide

• Tumor necrosis factor

• Vinca alkaloids

• Zarnestra

 

Syncope

• Bevacizumab

• Erlotinib

• Nelarabine

In This Article

Introduction
Overview
Drugs that commonly cause neurotoxicity
Drugs that occasionally cause neurotoxicity
Drugs that rarely cause neurotoxicity
Hormonal therapy
Biological response modifiers
Growth factors
Monoclonal antibodies
Targeted molecular agents
Other agents
References cited
Contributors