Results of one randomized controlled trial of neutral quality, found that vitamin E supplementation (300 mg/day from the first day of chemotherapy and continued for three months after the suspension of treatment) significantly protects against cisplatin-induced peripheral neurotoxicity and reduces the incidence and intensity of neuropathic signs and symptoms. Vitamin E supplementation had no significant effect on either clinical response or systemic toxicities.  Larger RCTs are required to validate these findings.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Two studies of positive quality, one PRCT and one prospective, randomized, controlled, crossover study assessed the role of selenium related to cisplatin toxicity in female patients treated for ovarian cancer and various tumors, respectively. Both studies found selenium supplementation reduced bone marrow suppression. Investigators also found reduced nephrotoxicity, activation of selenium-dependent enzymes glutathione peroxidase and malondialdehyde and a reduction in side effects caused by chemotherapy. These studies indicate that there may be beneficial effects associated with the ingestion of supplemental selenium during chemotherapy.  Both studies were conducted in geographic areas with low selenium levels in the food supply and neither study reported baseline serum selenium levels.  One study reported baseline selenium levels of 70.4 ± 22 nanograms/ml and the other article did not report baseline serum selenium levels.  Further research is needed to confirm these findings in varying cancers and to determine the optimal dosage of selenium as a chemoprotector of cisplatin-based chemotherapy.

Note:  According to the DRI for Vitamin C, Vitamin E, Selenium and Carotenoids, 7-9 (mcg/dL (70-90 nanograms/ml is considered the minimum level of plasma selenium required for selenoprotein synthesis.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

Results of two reports, one of neutral and one of negative quality from one RCT found with supplementation with 2,000 mg vitamin C (L-ascorbic acid), 800 mg of vitamin E (dl-a-tocopherol-acetate) and 200 mcg selenium (sodium selenite) had no effect on cisplatin-based chemotherapy toxicity.  Caution must be taken when interpreting these results because in both studies, patient compliance with the milky beverages containing supplements was poor and sample sizes were small.  Further RCTs are required to validate these findings.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

One positive quality RCT found supplementation with high-dose multiple antioxidants vitamin C (6100 mg/day), vitamin E (1050 mg/day) and synthetic beta carotene (60 mg/day) did not significantly influence response to treatment, survival, survival time and toxicity in patients receiving chemotherapy (paclitaxel and carboplatin) for advanced stage (IIIb and IV) non-small-cell lung cancer.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.

In one RCT of neutral quality, antioxidant vitamin E (600 mg/day), vitamin C (1 gm/day, given only on days in which therapy was applied) and N-acetylcysteine (200mg/day, given only on days in which therapy was applied) offered a cardioprotective effect measured via left ventricular ejection fraction for patients undergoing chemotherapy and radiotherapy for neoplastic disease.  Further research is needed to confirm these findings.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.