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Vitamin E protects patients from cisplatin-induced neuropathy in a randomized trial.

Reference: Pace A, Giannarelli D, Galie E, et al. Vitamin E neuroprotection for cisplatin neuropathy. Neurology 2010;74:762-6.

Design: Randomized double blind intervention trial

Participants: Of 108 patients initially randomized in the trial, 41 were treated with cisplatin exceeding 300 mg/[m.sup.2]. 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 versus 4.1; p < 0.01).

Practice Implications: Cisplatin use is limited by severe neurotoxicity. When the cumulative dose exceeds 300 mg/[m.sup.2], 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 (Int J Cancer 2003;104:243-50). 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.

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 (Cochrane Database Syt Rev 2007;1:CD005228). 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.

by: Steve Austin, N.D.

Submitted by: Emerson Ecologics

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Title Annotation:Abstracts of Interest
Author:Austin, Steve
Publication:Original Internist
Geographic Code:1USA
Date:Sep 1, 2010
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