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N-acetylcysteine has neuroprotective effects against oxaliplatin-based adjuvant chemotherapy in colon cancer patients: preliminary data

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Abstract

Although adding oxaliplatin to fluorouracil and leucovorin in adjuvant chemotherapy for colon cancer may improve disease-free survival, grade 3–4 sensory neuropathy also increases. To determine whether oral N-acetylcysteine is neuroprotective against oxaliplatin-induced neuropathy, we did a pilot study. Fourteen stage III colon cancer patients with 4 or more regional lymph nodes metastasis (N2 disease) receiving adjuvant biweekly oxaliplatin (85 mg/m2) plus weekly fluorouracil boluses and low-dose leucovorin were randomized to oral N-acetylcysteine (1,200 mg) (arm A) or placebo (arm B). Clinical neurological and electrophysiological evaluations were performed at baseline and after 4, 8, and 12 treatment cycles. Treatment-related toxicity was evaluated based on National Cancer Institute (NCI) Criteria. After four cycles of chemotherapy, seven of nine patients in arm B and two of five in arm A experienced grade 1 sensory neuropathy. After eight cycles, five experienced sensory neuropathy (grade 2–4 toxicity) in arm B; none in arm A (p<0.05). After 12 cycles, grade 2–4 sensory neuropathy was observed in eight patients in arm B, one in arm A (p<0.05). There were no significant electrophysiological changes in arm A after 4, 8, or 12 cycles of chemotherapy. We concluded that oral N-acetylcysteine reduces the incidence of oxaliplatin-induced neuropathy in colon cancer patients receiving oxaliplatin-based adjuvant chemotherapy.

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Acknowledgements

The authors would like to thank the Taiwan Cancer Foundation and Taipei Veterans General Hospital for support.

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Authors and Affiliations

  1. Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China

    Peng-Chan Lin, Ming-Yang Lee, Wei-Shu Wang, Chueh-Chuan Yen, Ta-Chung Chao, Liang-Tsai Hsiao, Muh-Hwa Yang, Po-Min Chen & Tzeon-Jye Chiou

  2. Division of Neurology, Institute of Neurological Taipei Science Veterans General Hospital, Taipei, Taiwan, Republic of China

    Kon-Ping Lin

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  1. Peng-Chan Lin
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  2. Ming-Yang Lee
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  3. Wei-Shu Wang
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  4. Chueh-Chuan Yen
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  5. Ta-Chung Chao
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  6. Liang-Tsai Hsiao
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  7. Muh-Hwa Yang
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  8. Po-Min Chen
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  9. Kon-Ping Lin
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  10. Tzeon-Jye Chiou
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Correspondence to Tzeon-Jye Chiou.

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Lin, PC., Lee, MY., Wang, WS. et al. N-acetylcysteine has neuroprotective effects against oxaliplatin-based adjuvant chemotherapy in colon cancer patients: preliminary data. Support Care Cancer 14, 484–487 (2006). https://doi.org/10.1007/s00520-006-0018-9

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  • DOI: https://doi.org/10.1007/s00520-006-0018-9

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