Evidence Explorer / MS-N035

ANTIOXIDANTS & NEUROPATHY

Intravenous glutathione to prevent platinum neuropathy

Evidence label: Positive small-trial signal / insufficient for routine use · Clinical goal: prevent oxaliplatin- or cisplatin-associated peripheral neuropathy

Evidence at a glance

• Population: adults receiving platinum chemotherapy, including 52 people on an oxaliplatin regimen for advanced colorectal cancer.
• Intervention: reduced glutathione 1,500 mg/m² by 15-minute intravenous infusion immediately before oxaliplatin versus saline.
• Result: less grade 2–4 neuropathy in a small trial, but contemporary guidelines do not establish a routine preventive agent.

What was studied

The double-blind 52-person trial assessed neurologic examinations and nerve conduction after four, eight and twelve cycles. Other small trials evaluated glutathione before cisplatin or adjuvant FOLFOX.

After eight cycles, 2 participants in the glutathione arm and 11 in placebo had grade 2–4 neuropathy (P=.003). After 12 cycles, the counts were 3 and 8 (P=.004).

What the evidence shows

The signal is clinically interesting but comes from small older studies. Response rate in the 52-person trial was 26.9% with glutathione and 23.1% with placebo, but this is too small to establish that tumor control is unaffected.

ASCO’s adult chemotherapy-induced neuropathy guideline does not recommend a pharmacologic agent for routine prevention. Glutathione therefore remains investigational for this purpose.

Limits and uncertainty

The trials predate modern patient-reported neuropathy measures and were underpowered for cancer outcomes. Small event counts exaggerate uncertainty.

Intravenous glutathione is not equivalent to oral glutathione, N-acetylcysteine or other antioxidant supplements.

Safety and practical context

This is an intravenous medical intervention requiring sterile preparation, infusion oversight and coordination with chemotherapy. It should not be obtained from an unregulated infusion clinic.

Potential concerns include infusion reactions, product quality and theoretical interference with treatment. The available small response-rate comparison does not prove long-term cancer safety.

Questions for the care team

• Is there a clinical trial or institutional protocol for this exact platinum regimen?
• How will neuropathy be measured and chemotherapy adjusted if symptoms emerge?
• What is known—and not known—about tumor response and long-term outcomes?

Sources

• Oxaliplatin randomized double-blind trial (PMID 12177109)
• Adjuvant FOLFOX pharmacokinetic and neuropathy trial (PMID 19287306)
• Cisplatin randomized trial (PMID 7799029)
• ASCO chemotherapy-induced peripheral neuropathy guideline update (PMID 32663120)

Literature searched: October 15, 2026 · Record appraised: October 15, 2026

Educational evidence summary, not personal medical advice. Research regimens describe what was studied; they are not personal prescribing instructions and should not replace cancer treatment or individualized supportive care.