Synopsis

Source of validity: Scientific
Rating (out of 5): 3

N-acetylcysteine (NAC) is a well-known antioxidant and precursor to glutathione, a critical cellular antioxidant. Its use in the context of chemotherapy is primarily to reduce or prevent the side effects associated with certain chemotherapeutic agents, particularly those related to oxidative stress and toxicity. The most robust scientific evidence exists for its use in preventing chemotherapy-induced nephrotoxicity (especially with cisplatin) and chemotherapy-induced hemorrhagic cystitis (notably with ifosfamide and cyclophosphamide). Several clinical trials and animal studies have shown that NAC can mitigate kidney and bladder damage without significantly reducing the anti-cancer efficacy of the chemotherapy drugs in question.

Additionally, NAC has been investigated for its potential to reduce mucositis, myelosuppression, and ototoxicity, although the evidence in these areas is less consistent or preliminary. Its antioxidant properties are believed to neutralize reactive oxygen species generated during chemotherapy, thereby protecting non-cancerous tissues.

However, the overall evidence supporting routine supplementation of NAC during chemotherapy is mixed and sometimes controversial, as there is concern that antioxidants might interfere with the effectiveness of some chemotherapeutic agents that rely on oxidative mechanisms to kill cancer cells. Thus, while there is scientific rationale and moderate clinical evidence for specific uses of NAC as a supportive agent in chemotherapy, routine use should be guided by an oncologist.

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