Can the neurological side effects of chemotherapy be prevented?

Chemotherapy is often associated with severe neurological side effects. The multicenter study PREPARE led by Charité – Universitätsmedizin Berlin now aims to find out whether preventive lithium administration during chemotherapy can alleviate or even entirely prevent neurological complications in breast cancer patients. The SPARK-BIH program of Charité BIH Innovation (CBI), the joint technology transfer office of Charité and the Berlin Institute of Health at Charité (BIH), provided extensive support in the preparatory phase of the study and helped secure funding from the BMBF.

An important therapeutic agent in the treatment of breast cancer is the drug paclitaxel, which is derived from the bark of the Pacific yew tree and is highly effective at inhibiting tumor growth. However, some patients experience neurological side effects or even long-term consequences: they suffer from loss of concentration and memory, they develop painful paresthesia in their hands and feet, and their fine motor skills or gait are impaired. Physicians call these side effects “chemotherapy-induced polyneuropathy” (CIPN), and they occur in more than half of breast cancer patients treated with paclitaxel. In addition to permanently limiting the patients’ quality of life, the development of CIPN often causes the treating physicians to reduce the administered dose of paclitaxel or even prematurely discontinue chemotherapy, which limits the success of treatment.

How can the neurological side effects of paclitaxel chemotherapy be reduced or, ideally, entirely prevented? This is the question being investigated by a research team at Charité led by Prof. Matthias Endres (NeuroCure PI), who is head of the university hospital’s Department of Neurology and Experimental Neurology. The PREPARE study is investigating whether lithium may be effective at preventing paclitaxel-related neurological side effects.

In previous laboratory tests, the team was able to show that the administration of paclitaxel leads to an increase in calcium in neurons, which triggers programmed cell death in these cells. This calcium increase can be reduced by lithium ions, which protect the neurons from paclitaxel-induced damage. The scientists were able to confirm in an animal model that the preventive administration of lithium carbonate prevented CIPN from developing. The SPARK-BIH program began funding these extensive laboratory studies back in 2018.

In the PREPARE study, scientists are now testing for the first time whether the administration of lithium carbonate also prevents the development of neuropathies in breast cancer patients receiving chemotherapy with paclitaxel. Dr. Petra Hühnchen and Dr. Wolfgang Böhmerle, also from the Department of Neurology and Experimental Neurology, are coordinating the study, which is taking place at several hospitals (multicenter) with patients who are randomly assigned to a study arm (randomized), and neither the physician nor the patient knows whether the administered drug is lithium or a placebo (double-blind placebo-controlled). Lithium carbonate has been used successfully for many decades, especially in the treatment of depression and bipolar disorder.

Coming off the success of the laboratory studies, the scientists led by Prof. Matthias Endres were then able to plan the PREPARE study and launch it in April of this year. “Thanks to the extensive funding provided by the SPARK-BIH program, we were able to conduct basic preliminary studies and show in the animal model that the administration of lithium carbonate can prevent neurological side effects from occurring during chemotherapy without affecting the efficacy of paclitaxel,” explains Endres. “The results were so promising that we can now enter the first clinical phase of our research. We believe lithium carbonate has great potential to change the medical practice of using chemotherapy with paclitaxel in breast cancer – and possibly in other cancers too – in the long term.”

About the PREPARE study

The PREPARE study is currently recruiting a total of 84 study participants at Charité – Universitätsmedizin Berlin and seven other sites in Germany (Cottbus, Greifswald, Hamburg, Hanover, Giessen, Essen, Dresden, Leipzig), in close collaboration between Charité’s Department of Neurology and Experimental Neurology and certified local breast centers. The German Federal Ministry of Education and Research (BMBF) is supporting the study, which will run until late March 2025, to the tune of €696,000 under its funding program “Funding of Clinical Trials of High Relevance to Patient Care.”

More information

About the SPARK-BIH program

SPARK-BIH is a mentoring program of Charité BIH Innovation. Originally established at Stanford University in 2006, SPARK is an initiative that supports clinicians and scientists through training, project management, mentoring, and milestone-based financial support. The aim is to foster outstanding applied medical research and to accelerate its translation into novel therapies, diagnostics, and medical devices.

 Source: Press release BIH

The study is supported by the NeuroCure Clinical Research Center (NCRC).

All information about the study as well as contact persons can be found here: PREPARE Study