Presentation (CTI)

OBJECTIVES: While cisplatin remains a cornerstone antineoplastic regimen for diverse malignancies, its clinical utility is severely constrained by dose-limiting nephrotoxicity. Ample clinical literature suggests that exogenous antioxidant administration may safeguard renal function against cisplatin-induced nephrotoxicity (CIN). Nonetheless, ongoing disparities across published findings have historically prevented researchers from establishing definitive, high-level evidence regarding the preventative value of antioxidants in this oncology cohort. This investigation sought to definitively determine the therapeutic efficacy and protective capacity of antioxidant supplementation against CIN by conducting a rigorous, comprehensive meta-analysis pooling data exclusively from randomized controlled trials.
METHODS: Two independent investigators systematically searched medical databases including PubMed, EMBASE, Cochrane Library, Conference Proceedings Citation Index-Science (CPCI-S), International Clinical Trials Registry Platform (ICTRP), and Google Scholar—from inception through February 2017. The primary endpoints extracted and evaluated for pooling included serum creatinine levels, blood urea nitrogen (BUN) concentrations, estimated glomerular filtration rate (eGFR), creatinine clearance rates, and the overall clinical incidence of CIN. All statistical modeling and pooling were executed utilizing RevMan Version 5.3 software.
RESULTS: A total of 10 randomized trials met the inclusion criteria, encompassing an aggregate cohort of 672 oncology patients, of whom 330 (49.10%) were allocated to active antioxidant intervention arms. Compared to standard control groups, adjunctive antioxidant therapy demonstrated a statistically significant and substantial reduction in post-treatment serum creatinine [SMD: -2.85, 95% CI: -4.38 to -1.32, P = 0.001], BUN [SMD = -4.12, 95% CI: -7.20 to -1.04, P = 0.009], and eGFR decline [SMD = -2.98, 95% CI: -4.91 to -1.05; P = 0.002].
CONCLUSIONS: Interventional antioxidant supplementation effectively mitigates the risk and severity of CIN. These data offer critical clinical utility, particularly as a viable secondary nephroprotective strategy for high-risk patients who show suboptimal responses to conventional supportive care protocols like aggressive saline hydration, forced diuresis, or magnesium supplementation.