What are the best supplements for chemotherapy-induced peripheral neuropathy (CIPN)?

From the Guidelines

For chemotherapy-associated polyneuropathy, the most effective supplement is L-carnosine, which has shown promise in reducing neuropathy symptoms, particularly with oxaliplatin-based chemotherapies, as evidenced by a randomized controlled pilot trial 1. The use of L-carnosine at 500mg daily may help prevent or reduce symptoms of neuropathy. Other supplements such as vitamin B complex, particularly B1, B6, and B12, may support nerve health, but their effectiveness in chemotherapy-associated polyneuropathy is not as well-established. It's essential to discuss any supplement regimen with your oncologist before starting, as some may interact with chemotherapy or other medications. Key points to consider:

• L-carnosine has shown potential in reducing neuropathy symptoms, particularly with oxaliplatin-based chemotherapies 1.
• Vitamin B complex, particularly B1, B6, and B12, may support nerve health, but its effectiveness in chemotherapy-associated polyneuropathy is not as well-established.
• Acetyl-L-carnitine should not be offered for the prevention of CIPN in patients with cancer, as it may cause harm 1.
• Alpha-lipoic acid does not appear to prevent neuropathy, and its use is not recommended 1.
• Glutamine, omega-3 fatty acids, and vitamin E may provide modest benefits, but the evidence is not strong enough to support their use as a primary treatment for chemotherapy-associated polyneuropathy 1.

From the Research

Chemotherapy-Induced Peripheral Neuropathy (CIPN) Supplements

The following supplements have been studied for their potential in treating or preventing CIPN:

• Glutamine: shown potential as a treatment option for CIPN 2
• Omega-3 fatty acids: present potential as treatment options for CIPN 2
• Vitamin E: evidence is inconclusive, and some forms of vitamin B, such as B6 or B12, await confirmation of their potential to offer protection from CIPN 2
• Alpha-lipoic acid: has been demonstrated to be a promising preventive drug, but clinical outcomes are highly dependent on the route of administration 3
• Acetyl-L-carnitine: has demonstrated beneficial effects on both in vitro and in animal studies, but clinical trials have shown controversies, and its use should be limited to patients treated with chemotherapy protocols that are Taxane-free 3
• Calcium/Magnesium (Ca2+/Mg2+): less robust evidence was found for these nutrients in treating CIPN 2
• Glutathione: less robust evidence was found for this nutrient in treating CIPN 2

Clinical Trials and Studies

Several clinical trials and studies have investigated the use of supplements in treating or preventing CIPN:

• A randomized, double-blind, placebo-controlled trial found that oral alpha-lipoic acid was ineffective in preventing neurotoxicity caused by oxaliplatin or cisplatin 4
• A systematic review found that vitamin E, L-Glutamine, goshajinkigan, and omega-3 are promising in preventing or treating CIPN, while acetyl-L-carnitine may worsen CIPN 5
• A systematic review found that no agent has shown solid beneficial evidence to be recommended for the treatment or prophylaxis of CIPN, and the management of CIPN remains an important challenge 6

Limitations and Future Research

The current evidence on the use of supplements in treating or preventing CIPN is limited, and further research is warranted:

• Many studies have methodological limitations and inconsistencies in their findings 2, 3, 6
• The mechanisms of toxicity triggered by each single drug need to be deeply explored to better identify effective compounds to prevent or treat CIPN 3
• Additional experiments are mandatory to establish effective doses and length of treatment for each clinical situation 3