Precision Medicine: Biomarkers and Risk Prediction in Chemotherapy Induced Peripheral Neuropathy

Why do some patients develop severe chemotherapy-induced peripheral neuropathy (CIPN) while others receiving the same treatment experience little or no nerve damage?

In this episode, Drs. Paola Alberti and Susanna Park welcome Professor Roser Velasco, neurologist, neuro-oncology researcher, and internationally recognized expert in treatment-related neurotoxicity. The discussion explores the rapidly evolving field of precision medicine in CIPN, with a focus on biomarkers that may help predict risk, monitor nerve injury, and support personalized treatment strategies.

Professor Velasco reviews the current state of biomarker research, including clinical risk factors, neurophysiological testing, blood-based biomarkers such as neurofilament light chain (NfL), imaging approaches, and emerging multimodal prediction models designed to identify patients at greatest risk for long-term neuropathy.

References & Resources:

• Plasma neurofilament light chain levels in chemotherapy-induced peripheral neurotoxicity according to type of anticancer drug. Velasco R, Marco C, Domingo-Domenech E, Stradella A, Santos C, Laquente B, Ferrer G, Argyriou AA, Bruna J. Eur J Neurol. 2024 Sep;31(9):e16369.
• Serum neurofilament levels correlate with electrodiagnostic evidence of axonal loss in paclitaxel-induced peripheral neurotoxicity. Velasco R, Argyriou AA, Marco C, Mariotto S, Stradella A, Hernández J, Pernas S, Ferrari S, Bruna J. J Neurol. 2023 Jan;270(1):531-537.
• Prospectively assessing serum neurofilament light chain levels as a biomarker of paclitaxel-induced peripheral neurotoxicity in breast cancer patients. Karteri S, Bruna J, Argyriou AA, Mariotto S, Velasco R, Alemany M, Kalofonou F, Alberti P, Dinoto A, Velissaris D, Stradella A, Cavaletti G, Ferrari S, Kalofonos HP. J Peripher Nerv Syst. 2022 Jun;27(2):166-174.
• Serum neurofilament light chain (sNFL) as a predictive biomarker for Chemotherapy-induced peripheral neurotoxicity (CIPN): consideration of current evidence, validation steps, and barriers to CIPN biomarker implementation in clinical practice-a narrative review. Alberti P, Faithfull S, Argyriou AA, Balayssac D, Hertz DL, Lustberg M, Park SB, Li T, Tanay M, Jabaley T, Worthen-Chaudhari L, Smith EML; MASCC Neurological complications study group. Support Care Cancer. 2026 May 7;34(6):508.
• Sarcopenia in Patients With Cancer and Its Association With Chemotherapy-Induced Peripheral Neurotoxicity. Velasco R, Besora S, Bellver M, Peiró I, Marco C, Domingo-Domenech E, Santos C, Stradella A, Laquente B, Rodriguez S, Argyriou AA, Arribas L, Bruna J. Neurology. 2026 May 26;106(10):e214987.
• Incidence and risk factors for developing chemotherapy-induced neuropathic pain in 500 cancer patients: A file-based observational study. Argyriou AA, Bruna J, Kalofonou F, Velasco R, Litsardopoulos P, Alemany M, Anastopoulou GG, Kalofonos HP. J Peripher Nerv Syst. 2024 Mar;29(1):38-46.
• Chemotherapy-induced peripheral neurotoxicity: management informed by pharmacogenetics. Argyriou AA, Bruna J, Genazzani AA, Cavaletti G. Nat Rev Neurol. 2017 Aug;13(8):492-504.
• Plasma Lipidomic Profiling Identifies Elevated Triglycerides as Potential Risk Factor in Chemotherapy-Induced Peripheral Neuropathy. Yeung N, Li T, Lin HM, Timmins HC, Goldstein D, Harrison M, Friedlander M, Mahon KL, Giles C, Meikle PJ, Park SB, Horvath LG. JCO Precis Oncol. 2024 Apr;8:e2300690.
• Predictive Biomarkers of Oxaliplatin-Induced Peripheral Neurotoxicity. Velasco R, Alemany M, Villagrán M, Argyriou AA. J Pers Med. 2021 Jul 16;11(7):669.