Comprehensive Assessment of the Effectiveness of the Use of Alpha-lipoic Acid and Ipidacrine Hydrochloride for the Prevention of Paclitaxel-indused Peripheral Neuropathy in Breast Cancer Patients

Abstract

Abstract. Almost 97% of women undergoing chemotherapy with paclitaxel for breast cancer suffer from symptoms of peripheral neuropathy, the severity of which directly depends on the single, cumulative dose and duration of infusion of the agent. Neurological manifestations of paclitaxel-induced peripheral neuropathy, such as bilateral numbness, neuropathic pain and paresthesias in the distal parts of the limbs, often lead to the need to reduce doses, up to the refusal of taxanes, which negatively affects the immediate and long-term results of treatment. Despite numerous scientific studies, there are no known means for prevention of chemotherapy-induced peripheral neuropathy. Of the more than 20 drugs studied so far for the prevention of chemotherapy-induced peripheral neuropathy, none has shown sustained and systemic clinically significant results.
 The aim of the study: to assess the effectiveness of the combination of alpha-lipoic acid and acetylcholinesterase inhibitor ipidacrine hydrochloride for the prevention of paclitaxel-induced peripheral neuropathy in breast cancer patients.
 Materials and methods of the study: a comprehensive assessment of clinical (survey regarding subjective symptoms and quality of life, neurological examination), neurophysiological (electroneuromyography) and morphological indices of paclitaxel-induced peripheral neuropathy in breast cancer patients who received polychemotherapy in neoadjuvant, adjuvant or palliative settings carried out according to the schemes of AT (paclitaxel, doxorubicin) or ET (paclitaxel, epirubicin) regimens with or without preventive treatment of neuropathy, has been performed.
 Results of the study. The use of the studied scheme for the prevention of paclitaxel-induced peripheral neuropathy led to a significant improvement in neurological manifestations, neurophysiological and morphometric parameters of peripheral nerves, as well as quality of life and the severity of subjective symptoms and their impact on daily life activities in comparison with patients who received chemotherapy without treatment for the prevention of neuropathy.
 Conclusions. The combination of alpha-lipoic acid and the acetylcholinesterase inhibitor - ipidacrine hydrochloride, could be recommended for prophylaxis of paclitaxel-induced peripheral neuropathy.
 Key words: breast cancer, chemotherapy, polyneuropathy, prevention, questionnaires, electroneuromyography, morphometric analysis.