N-acetylcysteine reduced oxaliplatin neuropathy scores in a small trial

Design

Randomised, placebo-controlled trial

Population

46 patients with stage II-III colorectal cancer on adjuvant mFOLFOX-6

Primary outcome

Neuropathy severity (FACT/GOG-NTX-12, NCI-CTCAE)

Effect

Lower neuropathy scores with N-acetylcysteine (P<0.05); pain severity unchanged

This randomised trial gave 46 patients receiving adjuvant modified FOLFOX-6 for stage II-III colorectal cancer either oral N-acetylcysteine 1200 mg or placebo an hour before each oxaliplatin infusion for four cycles. Published in Cancer Chemotherapy and Pharmacology on 23 October 2026.

Neuropathy scores on two standard scales were significantly lower with N-acetylcysteine after two cycles and at the end of treatment. Pain interference fell, but pain severity did not. Inflammatory markers also fell.

Oxaliplatin neuropathy limits treatment and can persist for years, and no preventive agent is recommended in guidelines. N-acetylcysteine is cheap and familiar, which makes this tempting.

The trial was small, short and from one setting, and the abstract does not give effect sizes or blinding details. It needs replication before use outside trials.

• Do not start N-acetylcysteine for neuropathy prevention outside a trial yet
• Ask about tingling, cold sensitivity and function before every oxaliplatin cycle
• Reduce or stop oxaliplatin early when neuropathy affects function, as guidelines advise
• Consider duloxetine for painful established neuropathy

Why it matters

A cheap, safe drug that prevented neuropathy would change adjuvant colorectal care, but one small trial cannot show that.

Don't overread it

Forty-six patients over four cycles; long-term neuropathy and cancer outcomes were not measured.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.