Neurologic complications of cancer therapy

Patients with cancer often take multiple medications. These medications may be directed at underlying neoplasms (eg, chemotherapy, hormonal agents, biologic modifiers) or at secondary symptoms such as cerebral edema or seizures (eg, corticosteroids, anticonvulsants). Given that chemotherapeutic agents are active against rapidly dividing cells and that they are frequently excluded from the central nervous system (CNS) by the blood-brain barrier (BBB), it is surprising that many medications have adverse effects on the nervous system. The various mechanisms underlying neurotoxicity are an area of active investigation in neuro-oncology. The pace of drug development has progressed rapidly during the past decade. When a patient with cancer presents with new neurologic symptoms, one must consider neurotoxicity related to cancer treatment. The goal of this review is to describe the neurotoxicity associated with established chemotherapeutic agents and with some of newer medications used in the treatment of cancer (Table 1). A number of excellent reviews have been published previously [1-9].