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

Support Care Cancer. 2006 May;14(5):484-7. doi: 10.1007/s00520-006-0018-9. Epub 2006 Feb 1.


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/m(2)) 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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetylcysteine / therapeutic use*
  • Adult
  • Aged
  • Antineoplastic Agents / adverse effects*
  • Chemotherapy, Adjuvant / adverse effects*
  • Colorectal Neoplasms / drug therapy*
  • Colorectal Neoplasms / surgery
  • Female
  • Free Radical Scavengers / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Neuroprotective Agents / therapeutic use*
  • Organoplatinum Compounds / adverse effects*
  • Oxaliplatin
  • Pilot Projects
  • Postoperative Care


  • Antineoplastic Agents
  • Free Radical Scavengers
  • Neuroprotective Agents
  • Organoplatinum Compounds
  • Oxaliplatin
  • Acetylcysteine