The Effect of Nutraceuticals on Incidence and Severity of Chemotherapy-Induced Peripheral Neuropathy: A Narrative Review

Abstract

Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of cancer treatments involving platinum and taxane agents such as paclitaxel, cisplatin, and oxaliplatin. This review evaluates the efficacy of three natural health products (NHPs)—omega-3 fatty acids, l-glutamine, and melatonin—on the incidence and severity of CIPN symptoms.

Methods: A search of PubMed was conducted from inception to October 2024. Inclusion criteria were human trials assessing the effect of either omega-3s, l-glutamine or melatonin on the incidence or severity of CIPN as a primary outcome, caused by platinum and taxane chemotherapy, with outcomes measured by clinical evaluations and scoring tools.

Results: Six clinical trials met the inclusion criteria. Of the included studies, three randomized controlled trials (RCTs) examined the effect of omega-3s, one RCT and one non-randomized trial examined l-glutamine, and one open-label pilot trial assessed melatonin. The participants enrolled in the studies did not have CIPN at baseline, with NHP administration starting during chemotherapy with some extending shortly after. Therefore, studies evaluated the effect of the NHPs on the incidence or severity of CIPN symptoms. Supplementation with omega-3 fatty acids and l-glutamine demonstrated statistically significant reductions in the incidence and severity of CIPN across multiple studies involving patients on paclitaxel and oxaliplatin regimens. In a small single-arm pilot study, melatonin use was associated with a lower neuropathy incidence, compared with historical incidence rates.

Discussion: Omega-3 fatty acids and l-glutamine, when used individually, may reduce the incidence and severity of neuropathic pain while supporting nerve function. However, a small number of relevant studies were identified, including small sample sizes and methodological limitations. Future research should include more human trials and further explore supplement safety, efficacy, and underlying mechanisms to establish integrative protocols for reducing the risk and severity of chemotherapy-induced neuropathy in cancer patients.