Central nervous system toxicities of chemotherapeutic agents

Abstract

Although there has been a significant progress in the recognition and management of the most common chemotherapy side effects, there is limited data on CNS toxicities. Since CNS toxicities can cause significant morbidity and delay or interruption of potentially effective therapies, there is a need for better understanding, early detection, prompt discontinuation of the offending drug, and use of antidotes when available. This review describes neurological toxicities from some of the commonly used chemotherapy agents.

Keywords::

• antidotes
• CNS
• posterior reversible encephalopathic syndrome
• chemotherapy
• encephalopathy

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Several commonly used chemotherapy drugs can cause CNS toxicity.

• Although most toxicities are transient and reversible, some may cause permanent disability or death.

• The development of CNS toxicity may prevent further administration of a potentially effective therapy.

• Rapid recognition of CNS toxicities with discontinuation of the offending drugs is essential for the decrease of long-term complications.

• Antidotes are available for certain chemotherapy-induced neurological toxicities.

• Further studies are necessary for a better understanding of the mechanisms underlying the neurological toxicities and development of specific antidotes.

• Methylene blue has been used successfully for the treatment of ifosfamide-induced encephalopathy.

• Glucarpidase has been recently approved for the treatment of methotrexate toxicity.

Notes