Leprosy Series: A Spectrum of Challenges: Understanding Classification and Immunology in Leprosy

In this episode of the Peripheral Nerve Podcast series on inflammatory neuropathies, hosts Professor Hebatallah R Rashed and Dr. Roberto Bellanti welcome Dr. Divyanshu Dubey of Mayo Clinic to discuss paraneoplastic nerve disorders. Dr. Dubey explores the clinical red flags that should raise suspicion for a paraneoplastic neuropathy, including rapidly progressive, painful, asymmetric, or non-length-dependent presentations and accompanying autonomic or central nervous system involvement. The discussion examines how clinical phenotype, electrophysiology, neural autoantibody testing, and cancer screening work together to support diagnosis, including important considerations when antibody results are low-titer, discordant, or negative. Dr. Dubey also reviews treatment considerations, the importance of early recognition, and the growing complexity of neuropathies associated with immune checkpoint inhibitors and other emerging cancer therapies. Throughout the episode, he emphasizes a central clinical principle: **treat the patient and the phenotype, not the antibody result alone.

After exploring the science of chemotherapy-induced peripheral neuropathy (CIPN) throughout this podcast series, the final episode brings listeners the perspective that matters most—that of someone living with the condition every day. Professor Susanna Park and Dr. Paola Alberti speak with retired physical therapist Jayne Schak, who developed severe CIPN following treatment for breast cancer. Although cancer-free since 2022, Jayne continues to experience debilitating neuropathic pain that has reshaped her daily life. She shares her personal journey navigating the healthcare system, finding support through the Foundation for Peripheral Neuropathy, and becoming a passionate advocate for patients living with peripheral neuropathy. The Foundation for Peripheral Neuropathy (FPN) The Foundation for Peripheral Neuropathy is the leading nonprofit organization dedicated to improving the lives of individuals affected by peripheral neuropathy through awareness, research, advocacy, and education. By connecting patients, caregivers, clinicians, and scientists, FPN advances awareness of peripheral neuropathy and supports access to reliable information and resources. In addition, FPN funds innovative research aimed at better understanding the causes of neuropathy and developing more effective treatments and preventive strategies. The Goal of the Foundation for Peripheral Neuropathy is to one day cure this devastating condition. Research is essential to addressing chemotherapy-induced peripheral neuropathy (CIPN), one of the most common and debilitating side effects of cancer treatment. Despite its significant impact on quality of life and cancer survivorship, there are currently limited options to prevent or effectively treat CIPN. Research priorities include: (1) identifying the biological mechanisms underlying nerve injury; (2) discovering biomarkers to predict individual risk; (3) developing strategies to prevent neuropathy (without compromising cancer treatment efficacy); and (4) advancing targeted therapies that restore nerve function and reduce symptoms. Continued investment in collaborative, patient-centered research is critical to improving outcomes for cancer survivors living with CIPN. More information available at https://www.foundationforpn.org/

Chemotherapy-induced peripheral neuropathy (CIPN) is increasingly recognized as more than a direct neurotoxic injury. Emerging research suggests that complex interactions between the nervous system and the immune system play a central role in the development, persistence, and potential recovery from CIPN. In this episode, Professor Susanna Park and Dr. Paola Alberti welcome Assistant Professor Grace Shin, whose translational research bridges neuroscience, immunology, and dermatology to better understand the biological mechanisms underlying chemotherapy-induced nerve injury. Together they explore the evolving science of neuroimmune crosstalk, discuss how the skin serves as an active neuroimmune organ, and examine how these discoveries may lead to more precise biomarkers and future therapies.

Chemotherapy-induced peripheral neuropathy (CIPN) remains one of the most common and challenging complications of cancer treatment. While significant progress has been made in understanding the condition, measuring treatment success and developing effective therapies continue to present important challenges. In this episode, Professor Susanna Park and Dr. Paola Alberti welcome Associate Professor Jennifer Gewandter, an internationally recognized expert in pain research, peripheral neuropathy, and clinical trial methodology. Together they explore how researchers evaluate CIPN and examine how clinical trials can better reflect what matters most to patients. References: Ventzel L, Bruna J, Cavaletti G. Concerns About Conclusions of the POLAR Trial. JAMA Oncol. 2025 Sep 1;11(9):1097-1098. doi: 10.1001/jamaoncol.2025.2355. PMID: 40742580. https://pnsociety.com/wp-content/uploads/Saab_2025_personalized-outcomes.pdf https://pnsociety.com/wp-content/uploads/Gewandter_CIPN-trial-design_Neurology.pdf

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.