PREVENTION OF PACLITAXEL-INDUCED MOTOR NEUROPATHY OF FIBULAR AND TIBIAL NERVES WITH ALPHA-LIPOIC ACID AND IPIDACRIN HYDROCHLORIDE IN BREAST CANCER PATIENTS.

I Holotiuk, A Kryzhanivska, S Holotiuk, T Teren, H Hirna
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Abstract

Aim: To investigate neurofunctional parameters of motor nerves in breast cancer (BCa) patients with paclitaxelinduced peripheral neuropathy (PIPN) and to determine the feasibility of using alpha-lipoic acid (ALA) in combination with ipidacrine hydrochloride (IPD) for PIPN prevention.

Materials and methods: The study included 100 patients with BCa stages II-IV, who were treated with polychemotherapy (PCT) according to the AT (paclitaxel, doxorubicin) or ET (paclitaxel, epirubicin) scheme in the neoadjuvant, adjuvant, or palliative regimens. Patients were randomized into two groups (n = 50 in each): group I received PCT only; group II - PCT in combination with ALA + IPD. Electroneuromyographic (ENMG) studies of the motor fibular and tibial nerves were performed before the start of chemotherapy and after the 3rd and 6th cycles of PCT.

Results: Comparison of ENMG parameters of the motor nerves of the lower extremities of BCa patients before the start of PCT with these parameters after 3 and 6 PCT cycles indicated a slightly pronounced but significant decrease in the M-response and partly the nerve conduction velocity, which progressed with an increase in the cumulative dose of paclitaxel. Despite this, the average values of ENMG parameters remained within normal limits even after 6 cycles of PCT. The detected changes indicated a tendency toward axonal damage and mild myelinopathy. Significantly higher M-response rates of motor nerves were found in patients of group II compared to group I only after 6 cycles of PCT with paclitaxel.

Conclusion: The use of ALA and IPD improves the functional state of the axons in patients with BCa treated with paclitaxel.

目的:观察乳腺癌(BCa)伴紫杉醇性周围神经病变(PIPN)患者运动神经的神经功能参数,探讨α -硫辛酸(ALA)联合盐酸ipidacrine (IPD)预防PIPN的可行性。材料和方法:该研究纳入100例BCa II-IV期患者,根据AT(紫杉醇、阿霉素)或ET(紫杉醇、表柔比星)方案在新辅助、辅助或姑息方案中接受多化疗(PCT)治疗。患者随机分为两组(每组50例):第一组仅接受PCT治疗;II组- PCT联合ALA + IPD。化疗开始前和第3、6周期化疗后分别行腓骨和胫骨运动神经的神经肌电图(ENMG)检查。BCa患者开始PCT前的下肢运动神经ENMG参数与PCT 3、6个周期后的ENMG参数的比较显示,m反应和部分神经传导速度略有明显但显著降低,并随着紫杉醇累积剂量的增加而进展。尽管如此,即使在PCT 6个周期后,ENMG参数的平均值仍在正常范围内,检测到的变化表明轴突损伤和轻度髓鞘病的趋势。仅在紫杉醇联合PCT治疗6个周期后,II组患者的运动神经m反应率明显高于I组。结论:ALA和IPD的使用改善了紫杉醇治疗BCa患者轴突的功能状态。
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