Predictors of Chemotherapy-Induced Peripheral Neuropathy in Colorectal Cancer Patients

Abstract

Oxaliplatin-based chemotherapy remains central to curative and palliative treatment of colorectal cancer, but its use is limited by peripheral neuropathy, a biphasic toxicity comprising an acute, cold-triggered channelopathy and a separate, cumulative, dose-dependent chronic sensory neuropathy. This article synthesizes the published literature on who develops clinically significant chemotherapy-induced peripheral neuropathy (CIPN) in colorectal cancer specifically, and why. We trace the mechanistic basis of oxaliplatin neurotoxicity, the instruments used to grade it, and the three predictor categories the literature has converged on: demographic and clinical factors (older age, diabetes, elevated body mass index, smoking, and hypomagnesemia), treatment-related and dose-dependent factors (cumulative oxaliplatin dose and cold exposure), and genetic and biological markers, where the best-studied candidate, the GSTP1 polymorphism, has failed to show a reliable association across pooled analyses. Read together, the evidence supports a reasonably specific predictive picture built from routinely available clinical variables, while genetic and biomarker prediction, and validated prophylactic interventions for identified high-risk patients, remain considerably less mature and represent the clearest open directions for future research.