| Ch 9 | Page 26 / 34 | |
| Cancer chemotherapy |
Chronic toxicities (3) | |
There are many different types of neurological complication:
Peripheral neuropathies
Related to Oncovin and other periwinkle alkaloids but also to cisplatin),
They are expressed by tingling, deep sensory disorders, tendon reflex abolition. Motor weakness is rare.
Evolution is slow and not always reversible despite vitamins, especially among aged patients,
Treatment should be stopped at the onset of alarm symptoms.
Cranial nerve paralysis
(related Oncovin or cisplatin),
They are more rarely observed, but there evolution is severe.
Cisplatin induced ear toxicity
Related to unitary and total dose, it has become one of this very powerful anticancer drug’s major toxicities.
Medullary and meningeal syndromes
Related to the intrathecal administration of methotrexate or cytosine arabinoside.
Encephalitic syndromes
They are rare but well documented for ifosfamide and cisplatin.
- Among women
Alkylating agents and most polychemotherapy regimens provoke amenorrhoea, which appears earlier and is more likely to be irreversible if the patient is approaching menopause. When it does occur, patients suffer from all the usual difficulties observed during premature menopause.
Some authors have proposed, when not contraindicated by the cancer pathology (breast carcinoma), systematic oestroprogestative treatment to avoid ovarian insufficiency.
Among patients who recover from amenorrhoea, pregnancies are possible without any particular risk of malformation.
- Among men
Anticancer drugs block spermatogenesis and provoke sterility which can be irreversible.
Alkylating agents are the most toxic agents, especially during Hodgkin’s disease (using the MOPP protocol).
Therefore, sperm conservation should be systematically proposed before treatment, provided that the sperm is of good quality, which is not always the case during the initial acute phase of cancer.
If spermatogenesis recovers, the risk of congenital malformation is no higher than in men never having suffered from cancer.
Endocrine functions are well preserved (with normal sexual functions).
Secondary cancers are frequently observed after treatment with anticancer drugs and especially with alkylating agents, when used as monochemotherapy for a long period of time (misulban, alkeran).
The association of radiotherapy and chemotherapy in Hodgkin’s disease may induce a cumulative risk of 5 to 10% of secondary leukaemia. Such forms of leukaemia are announced by a preleukaemic syndrome. Faced with such a risk, prescriptions tend to be more intense but for a shorter period.
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