Guardians of Sensation: Evaluating Metformin's Power Against Chemotherapy-Induced Neuropathy

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating complication of cancer treatment, particularly with agents like paclitaxel. Effective preventive measures for CIPN are limited. Metformin, an antihyperglycemic agent with neuroprotective properties, has shown promise in preclinical studies; however, its clinical utility in preventing CIPN remains underexplored. Objective: This study evaluates the preventive effects of metformin on paclitaxel-induced peripheral neuropathy in breast cancer patients. Methods: A randomized, controlled study was conducted involving 60 breast cancer patients receiving paclitaxel chemotherapy. Patients were assigned to an intervention group receiving metformin (500 mg twice daily) or a control group without metformin. Peripheral nerve function was assessed using nerve conduction studies (NCSs), measuring sensory nerve action potential (SNAP) amplitude, compound muscle action potential (CMAP) amplitude, and distal latency (DL). Clinical neurological symptoms and adverse effects of metformin were monitored throughout the study. Results: Of the 60 enrolled patients, 47 completed the study (26 control and 21 intervention). The incidence of CIPN was lower in the metformin group compared to the control group, although this difference did not reach statistical significance. Metformin was well-tolerated, with mild gastrointestinal side effects being the most common adverse events. No significant differences between the groups were observed in SNAP amplitude, CMAP amplitude, or DL. Conclusion: Metformin may modestly reduce the incidence of CIPN in patients receiving paclitaxel chemotherapy, although the observed effect was not statistically significant. Given its safety profile and potential neuroprotective benefits, metformin warrants further investigation in larger, multicenter trials to confirm its role in CIPN prevention.