Predisposing Factors for the Development of Chemotherapy-Induced Peripheral Neuropathy (CIPN)

This chapter summarizes the current knowledge of predisposing factors of CIPN development. These predisposing factors can be classified as intrinsic (i.e., demographics, genetics) or extrinsic (i.e., lifestyle, neurotoxic treatment) to the patient. Intrinsic factors that increase a patient’s CIPN risk include older age, African American race, and diabetes. Other factors such as vitamin D deficiency and genetics may also increase risk but have not been validated. Objective and subjective indicators of CIPN prior to, or early in, treatment predict CIPN severity at the end of treatment but this information is not consistently used to inform patient management. Extrinsic factors including lifestyle and neurotoxic regimen affect CIPN risk. Healthy lifestyle choices including physical activity and better nutrition may protect against CIPN. The predominant predictor of CIPN is cumulative treatment with a neurotoxic chemotherapeutic agent. Different regimens have different CIPN risk, and in the case of paclitaxel there is strong evidence that systemic drug exposure is a major contributor to CIPN. Further research is needed to validate these predisposing factors and determine their effect on CIPN onset, severity, and duration. Prospective studies are also needed to test strategies to use these predictive factors to inform personalized treatment decisions to prevent severe, life altering CIPN and optimize long-term outcomes in patients with cancer.