N-acetylcysteine prevents oxaliplatin-induced neurotoxicity in colorectal, gastric cancer patients

N-acetylcysteine provides a protective effect on chemotherapy-induced neuropathy by reducing its incidence and delaying its occurrence in patients with gastric or colorectal cancers, a study has shown.

This randomized, double‐blinded, placebo‐controlled clinical trial was performed to examine the preventive effect of N-acetylcysteine effervescent tablets on neuropathy occurrence in comparison with placebo, according to the authors.

Thirty-two patients with colorectal or gastric cancer were randomly assigned to receive N-acetylcysteine (two 600-mg tablets) or placebo 1 hour before receiving oxaliplatin in dose in XELOX (oxaliplatin and capecitabine regimen) for eight courses of chemotherapy.

The authors evaluated neuropathy severity after eight courses of chemotherapy based on National Cancer Institute Common Terminology for Adverse Events (NCI-CTCAE) criteria neuropathy grading scale. In addition, a neurologist carried out sensory and motor electrophysiological assessments.

Cancer patients in the intervention group had significantly lower NCI-CTCAE scale grade than those in the placebo group following eight courses of oxaliplatin (p=0.01). On the other hand, no significant difference was observed in the sensory electrophysiological assessment result (p=0.501). Moreover, motor electrophysiological changes were not seen among patients in both groups.

“Neuropathy is one of the most prevalent and dose-limiting side effects of platinum chemotherapeutic agents,” the authors said. “N-acetylcysteine is an antioxidant thiol which is able to increase whole blood concentration of glutathione, which may be protective against chemotherapy-induced neuropathy.”