"Evaluation of The Effect of N-Acetyl cysteine in the Prevention of Paclitaxel-Induced Peripheral Neuropathy in Cancer Patients"

Abstract

Breast cancer is the most common cancer diagnosed in women after skin cancer, in the United States. About one in eight women are diagnosed with breast cancer during their life time. Increasing in breast cancer awareness and research funding has helped in more advances in the diagnosis and treatment of breast cancer. Breast cancer survival rates have increased, and the number of deaths is declining, largely due to factors such as earlier detection, a new personalized approach to treatment and a better understanding of the disease. Treatment of breast cancer is determined according to tumor size, stage and grade. Surgery is the most common treatment for breast cancer. Many women have additional treatments, such as chemotherapy, targeted therapy, radiation, or hormone therapy. Paclitaxel is one of the anti-neoplastic agents used to treat ESBC to reduce the risk of breast cancer recurrence or spreading. One of the major side effects of paclitaxel in breast cancer patient is peripheral neuropathy. Chemotherapy-induced peripheral neuropathy can be defined as a disturbance of the structure and function of peripheral motor, sensory, and autonomic nerves due to chemotherapy causing peripheral neuropathic symptoms and signs. The majority of signs and symptoms due to CIPN arise from damage to dorsal root ganglion neurons or their axons, leading to sensory loss, and sometimes sensory ataxia. Motor, autonomic, and cranial nerve symptoms also may occur, but are less common. For some individuals, severe and disabling CIPN symptoms become chronic, impairing daily function and diminishing the QOL. The development of CIPN may result in chemotherapy dosage reductions and/or treatment delays, resulting in sub-therapeutic cancer treatment. Neuronal damage seems to have a major role in paclitaxel induced neuropathic pain, through the formation of ROS (superoxide, hydroxyl radical, nitric oxide and hydrogen peroxide) in neuronal mitochondria that are involved in nerve injury. N-acetylcysteine is a cysteine pro-drug and GSH precursor which detoxifies and scavenges ROS. It seems to help normalize the oxidative status. Hence, it might play a role in prevention and amelioration of PIPN. N-acetyl cysteine is known to be a safe drug with tolerable side effects.