الفهرس 
Breast cancerOnly 14 pages are availabe for public view
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Abstract
Breast cancer is the most common cancer diagnosed in women after skin cancer, in the United States. About one in eight women are diagnosed with breast cancer during their life time. Increasing in breast cancer awareness and research funding has helped in more advances in the diagnosis and treatment of breast cancer. Breast cancer survival rates have increased, and the number of deaths is declining, largely due to factors such as earlier detection, a new personalized approach to treatment and a better understanding of the disease. Treatment of breast cancer is determined according to tumor size, stage and grade. Surgery is the most common treatment for breast cancer. Many women have additional treatments, such as chemotherapy, targeted therapy, radiation, or hormone therapy. Paclitaxel is one of the anti-neoplastic agents used to treat ESBC to reduce the risk of breast cancer recurrence or spreading. One of the major side effects of paclitaxel in breast cancer patient is peripheral neuropathy.
Chemotherapy-induced peripheral neuropathy can be defined as a disturbance of the structure and function of peripheral motor, sensory, and autonomic nerves due to chemotherapy causing peripheral neuropathic symptoms and signs. The majority of signs and symptoms due to CIPN arise from damage to dorsal root ganglion neurons or their axons, leading to sensory loss, and sometimes sensory ataxia. Motor, autonomic, and cranial nerve symptoms also may occur, but are less common. For some individuals, severe and disabling CIPN symptoms become chronic, impairing daily function and diminishing the QOL. The development of CIPN may result in chemotherapy dosage reductions and/or treatment delays, resulting in sub-therapeutic cancer treatment.
Neuronal damage seems to have a major role in paclitaxel induced neuropathic pain, through the formation of ROS (superoxide, hydroxyl radical, nitric oxide and hydrogen peroxide) in neuronal mitochondria that are involved in nerve injury. N-acetylcysteine is a cysteine pro-drug and GSH precursor which detoxifies and scavenges ROS. It seems to help normalize the oxidative status. Hence, it might play a role in prevention and amelioration of PIPN. N-acetyl cysteine is known to be a safe drug with tolerable side effects.
This study was designed to evaluate the effect of NAC in the prevention and amelioration of PIPN in ESBC. The study was conducted at the oncology center, Nasser Institute for research and treatment on 75 Egyptian women that was randomly assigned to:
Low dose group (25 patients) who received paclitaxel in addition to NAC 600mg twice daily for 12 weeks; High dose group (25 patients) who received paclitaxel in addition to NAC 1200 mg twice daily for 12 weeks or Control group (25 patients) who received paclitaxel only.
All patients were subjected to history taking, baseline evaluation, and the following parameters were assessed during the study:
1. Assessing incidence and grading of PIPN using common terminology criteria for adverse effects (CTCAE) weekly.
2. Assessing severity of PIPN using the modified total neuropathy score (mTNS) at baseline, 6 and 12 weeks.
3. Assessing time to develop grade 2, 3 peripheral neuropathies.
4. Assessing patient’s QOL using the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT-GOG-NTX) weekly
5. Assessing serum biomarkers as nerve growth factor (NGF) and malondialdehyde (MDA) at baseline and after 12 weeks.
6. Evaluating safety and tolerability of NAC.
The results of the study were as follow:
• It was found at the end of the 12week period that the incidence of grade (2, 3) peripheral neuropathy was significantly lower in the high dose group compared to the low dose group.
• A significant improvement in the mTNS was observed after 6 and 12week in the high dose and low dose group compared to control group.
• A significant improvement in patient’s QOL scores was observed after 6 and 12 weeks in the high dose group and the low dose group compared to the control.
• A significantly higher levels of serum NGF in the high dose group and lower level of serum MDA in the high dose and the low dose group were observed compared to the control group.