Curcumin reduces vincristine-induced neuropathy in paediatric ALL

A double-blind randomized controlled trial (RCT) reports a significantly lower incidence of vincristine-induced peripheral neuropathy (VIPN) in paediatric acute lymphoblastic leukaemia (ALL) patients who received curcumin vs placebo.

Vincristine is a mainstay treatment for paediatric cancers, particularly ALL. [Clin Neurophysiol 2023;154:157-168] It is associated with VIPN, which occurs in >90 percent of patients and can manifest as pain, reduced sensitivity, areflexia, paresthesia, and muscle weakness. [Neth J Med 2012;70:18-25] Since conventional analgesics, such as NSAIDs and opioids, are ineffective at reducing VIPN, alternative approaches are required. Based on the finding that curcumin supplementation reduced the severity of diabetic sensorimotor polyneuropathy in another RCT, researchers from Iran sought to evaluate curcumin’s efficacy in preventing VIPN. [Complement Ther Med 2019;43:253-260]

Paediatric patients with ALL (n=141; age range, 5–15 years) received weekly vincristine 1.5 mg/m², with one group (n=71; male, 57.5 percent) taking 3 mg/kg oral curcumin capsules BID and another group (n=70; male, 48.6 percent) taking placebo capsules BID for 3 months. Before starting treatment with vincristine, the presence or absence of neuropathy was evaluated by electrophysiological nerve conduction studies (NCS), which was repeated after completion of 3-month treatment with curcumin or placebo. The patients also underwent Total Neuropathy Score Pediatric Vincristine (TNS-PV) evaluation. [BMC Cancer 2025;25:344]

According to NCS, 62.1 percent of patients in the curcumin group and 82.5 percent of patients in the placebo group developed VIPN. As per TNS-PV evaluation criteria, VIPN was present in 42.6 percent of patients in the curcumin group and 66.4 percent of patients in the placebo group. Both sets of criteria for VIPN were satisfied by 39.4 and 70.0 percent of patients in the curcumin and placebo groups, respectively (p<0.001). There was no significant difference in the prevalence of VIPN between males and females (p>0.05).

According to the researchers, attenuation of VIPN could be due to curcumin’s antinociceptive, calcium-inhibitory, and antioxidant effects. [Pharm Biol 2015;53:838-848] Another study in a mouse model suggests that curcumin-mediated reduction of neuropathic pain could be by means of tumor necrosis factor-α and nitric oxide inhibition. [Eur J Pharmacol 2006;536:256-261] “In another study, curcumin administration reduced neuropathic pain in diabetic rats through inhibition of NADPH oxidase,” added the researchers. [Neurosci Lett 2014;560:81-85]

The incidence of damaged motor vs sensory nerves was significantly higher in both the curcumin (10.5 vs 4.9 percent; p=0.02) and placebo (19.2 vs 3.5 percent; p<0.001) groups. The predominance of motor vs sensory VIPN is consistent with previous studies. [Clin Neurophysiol 2023;154:157-168; Muscle Nerve 2015;52:981-985] A significantly higher frequency of abnormalities in all types of nerves was observed in the placebo group vs curcumin group (p=0.012). “Curcumin demonstrated a protective effect against motor and sensory nerve damage, with a significant reduction in motor nerve abnormalities,” wrote the researchers.

“Given its strong antioxidant and anti-inflammatory properties, curcumin may serve as a promising adjunct therapy for mitigating chemotherapy-induced neuropathy,” they concluded.