Role of Anaplus HP in prevention of chemotherapy-induced peripheral neuropathy (CIPN) in patients affected by breast cancer treated with taxane-based adjuvant chemotherapy

Abstract

Background: Peripheral neuropathy is one of the main side effects of chemotherapy, especially taxane-based, greatly impairing patients' quality of life and often leading to dose delay, dose reduction or treatment discontinuation. Incidence of CIPN is 1-12%. Taxanes may induce sensory neuropathy with paresthesia and neuralgia, as they cause blockage of axonal microtubules and peripheral demyelination. AnaplusHP is a dietary supplement based on L-acetylcarnitine, N-acetyl-L-cysteine, inositol and a-lipoic acid, used to prevent and treat CIPN. This study was to evaluate the role of AnaplusHP in prevention of CIPN in patients affected by breast cancer treated with taxane-based adjuvant chemotherapy. Patients andmethods: Since September 2015 to January 2016, we administered 2 capsules per day of Anaplus HP to 25 patients affected by breast cancer treated with taxane- based adjuvant chemotherapy. Average age of enrolled patients was 60 ys (range 39-75 ys). 16 patients were undergone to 4 cycles of EC chemotherapy, followed by 12 weekly cycles of paclitaxel; the remaining 9 patients were undergone to 3 cycles of FEC chemotherapy, followed by 3 cycles of docetaxel, administered every three weeks. The 12 Her-2+ tumors were also treated with trastuzumab for one year. We evaluated incidence and severity of CIPN by administering patients the EORTC-QLQ-CIPN20 survey at the beginning of taxane treatment, after each cycle of chemotherapy with docetaxel or after each cycle of three paclitaxel weekly doses, and finally three and six months after the end of taxane treatment. Neurotoxicity was recorded according to CTC-NCI 3.0. Result(s): 3 patients (12%) treated with weekly paclitaxel showed G1-G2 paresthesia of the lower limbs. Paresthesia appeared between eighth and eleventh cycle of paclitaxel, resulted in no delays, no dose reductions, no additional therapies required and disappeared within three months after the end of chemotherapy. The remaining 22 patients (88%) didn't exhibit the typical symptoms of taxane-induced peripheral neuropathy (pain, numbness, paresthesia). Conclusion(s): Although enrolled patients are few, our experience highlighted the efficacy of Anaplus HP as prophylaxis of taxane-induced peripheral neuropathy in patients undergone to adjuvant chemotherapy for breast cancer. Because of small sample size and the absence of a control arm further randomized studies are needed to better assess the impact of Anaplus HP on CIPN.