New pharmacological effect of fulvestrant to prevent oxaliplatin-induced peripheral neuropathy

Abstract

The anti-cancer drug oxaliplatin frequently causes peripheral neuropathy. Commonly described neuropathic symptoms include aberrant sensations such as mechanical allodynia (hypersensitivity to normally innocuous stimuli). Although oxaliplatin neuropathy is a dose-limiting toxicity, preventive strategies against its side effects have not been established. We screened several sets of small-molecule chemical libraries (more than 3,000 compounds in total) using a newly established in vitro high-throughput phenotypic assay, and identified fulvestrant, a clinically approved drug for the treatment of breast cancer in postmenopausal women, as having a protective effect on oxaliplatin-induced neuronal damage. Furthermore, using a rat model of oxaliplatin neuropathy, we demonstrated the in vivo efficacy of fulvestrant to prevent oxaliplatin-induced axonal degeneration of the sciatic nerve and mechanical allodynia in histological and behavioural analyses. Thus, our findings reveal a previously unrecognised pharmacological effect of fulvestrant to prevent oxaliplatin-induced painful peripheral neuropathy and may represent a novel prophylactic option for patients receiving oxaliplatin chemotherapy.