Vitamin E Protects Patients from Cisplatin-induced Neuropathy in a Randomized Trial

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Reference

Pace A, Giannarelli D, Galie E, et al. Vitamin E neuroprotection for cisplatin neuropathy. Neurology. 2010;74:762-766.

Design

Randomized, double-blind intervention trial

Participants

Of 108 patients initially randomized in the trial, 41 were treated with cisplatin exceeding 300 mg/m2. Of these 41 subjects, 17 had been given vitamin E and 24 had been given placebo.

Study Medication and Dosage

596 IU d-alpha tocopherol or placebo daily, begun 1 to 8 days before the start of cisplatin therapy and continued for 3 months following discontinuation of cisplatin therapy

Outcome Measures

Development of peripheral neuropathy as a result of cisplatin therapy and measurement of the severity of the neurological damage through the use of total neuropathy score (TNS)

Key Findings

Neurotoxicity occurred in 6% in the vitamin E group versus 42% in the placebo group (P<0.01). The severity of neurological damage was also far lower in the vitamin E group (1.4 TNS vs. 4.1; P<0.01).

Practice Implications

Cisplatin use is limited by severe neurotoxicity. When the cumulative dose exceeds 300 mg/m2, in some reports most patients suffer significant neurological damage. Cisplatin is known to increase oxidative stress; vitamin E is an antioxidant, and current evidence suggests that the antioxidant actions of vitamin E do not interfere with the therapeutic effect of chemotherapy.1 Neuropathy has been reported to occur as part of the presentation of vitamin E deficiency. As a result, researchers are interested in exploring the ability of vitamin E to protect against cisplatin-induced neuropathies.

Researchers are interested in exploring the ability of vitamin E to protect against cisplatin-induced neuropathies.

In 2007, a Cochrane review concluded that previous evidence linking the use of vitamin E to protection against neuropathy in patients given cisplatin was encouraging but needed additional support from randomized clinical trials.2 The findings of the new trial take us a significant step in that direction. Until more is known, all patients given cisplatin should concomitantly take vitamin E supplements beginning several days before the start of the chemotherapy.

About the Author

Steve Austin, ND, is a naturopathic physician and co-author of the A-Z Guide to Drug-Herb-Vitamin Interactions; Breast Cancer: What You Should Know (But May Not Be Told) About Prevention, Diagnosis, and Treatment and The Natural Pharmacy, now in its second edition. Dr. Austin was the founding Chief Science Officer for the Healthnotes team of writers. He is also former Professor of Nutrition at National College of Naturopathic Medicine, in Portland, Oregon. Previously, Dr. Austin headed the nutrition departments at Bastyr University in Seattle and Western States Chiropractic College in Portland, and has been on the faculties of four of the five naturopathic colleges in North America. He is a contributor to the Textbook of Natural Medicine, and was nutrition editor of the Quarterly Review of Natural Medicine and the Healthnotes Review of Natural Medicine. Dr. Austin is also an international lecturer on topics related to clinical nutrition.

References

1. Leonetti C, Biroccio A, Gabellini C, et al. Alpha-tocopherol protects against cisplatin-induced toxicity without interfering with antitumor efficacy. Int J Cancer. 2003;104(2):243-250.

2. Albers J, Chaudhry V, Cavaletti G, Donehower R. Interventions for preventing neuropathy caused by cisplatin and related compounds. Cochrane Database Syst Rev. 2007;(1):CD005228.