Vitamine E and cisplatin 

One of the most used anti-cancer agents, and often a component of chemotherapy is cisplatin. Chemotherapy with cisplatin is limited by severe neuropathy which occurs as a dose limiting side effect. In 108 patients undergoing cisplatin chemotherapy  Vitamin E was given as  supplementation via alpha-tocopherol 400 mg / day, or they received a placebo. The treatment started one day before the chemotherapy and was continued for 3 months. The results were clear, neurotoxicity was significantly lower in patients who received vitamin E as a protective agent. But there were some methodological weaknesses in the study, and the study was relative small:

Of 108 randomized patients, 68 received at least one clinical and neurophysiologic examination after cisplatin CT; 41 patients received a cumulative dose of cisplatin higher than 300 mg/m(2) and were eligible for statistical analysis: 17 in the vitamin E group (group 1) and 24 in the placebo group (group 2). Het was dus geen ITT analyse, maar een per protocol analyse.

The conclusion of the authors was:

This phase III study confirms the neuroprotective role of vitamin E against cisplatin peripheral neurotoxicity. Vitamin E supplementation should be adopted in patients receiving cisplatin-based chemotherapy. Classification of evidence: This study provides Class II evidence that vitamin E supplementation significantly reduces the relative risk of developing signs or symptoms of neurotoxicity (relative risk = 0.14) (95% confidence interval = 0.02-1.00, p < 0.05). ^[1]

March 2010, prof.dr. Jan M. Keppel Hesselink, MD, PhD

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