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Losartan reduces incidence and delays onset of paclitaxel-induced peripheral neuropathy in women with early-stage breast cancerLosartan may reduce nerve pain from breast cancer chemotherapy in small trial

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Key Takeaway
Consider losartan as a potential prophylactic for paclitaxel-induced neuropathy, pending validation in larger trials.

This single-center, open-label randomized controlled trial evaluated the efficacy of losartan in preventing paclitaxel-induced peripheral neuropathy (PIPN) among 89 women with early-stage breast cancer receiving weekly paclitaxel. Participants were randomized to receive losartan 100 mg once daily plus standard care or standard care alone. The primary outcome was the incidence of grade 2 or higher neuropathy assessed via NCI-CTCAE v5.0, with secondary outcomes including time to neuropathy, quality of life, pain intensity, and serum nerve growth factor levels. Follow-up occurred over 12 weeks.

Results demonstrated a favorable effect for losartan across multiple metrics. The incidence of grade 2 or higher neuropathy was 33.3% (15/45) in the losartan group versus 86.4% (38/44) in the control group (p < 0.001). Time to neuropathy onset was delayed in the losartan group (median 73.27 days) compared to control (43.75 days), with a hazard ratio of 0.2 (95% CI: 0.11-0.35). Patient-reported quality of life scores were superior in the losartan group (31.87 ± 6.43 vs 15.45 ± 10.04; p < 0.001), and median pain intensity was lower (3 vs 8; p < 0.001). Serum nerve growth factor levels showed no significant difference between groups.

Safety profiles were similar between groups regarding adverse events, with no serious adverse events or discontinuations reported. However, the study was open-label, which may introduce bias in patient-reported outcomes. The sample size of 89 patients is relatively small, and long-term effects beyond 12 weeks were not assessed. These findings support the potential repurposing of losartan as a low-cost prophylactic agent for PIPN, but validation in larger, multicenter trials is required before widespread adoption.

Researchers studied whether losartan, a common blood pressure medication, could help prevent nerve pain caused by paclitaxel chemotherapy in women with early-stage breast cancer. The trial included 89 women at one medical center who were scheduled for weekly paclitaxel treatment. Half received losartan daily along with their standard care, while the other half received standard care alone.

After 12 weeks, the group taking losartan had much lower rates of moderate-to-severe nerve pain (33% vs. 86% in the control group). They also reported better quality of life, less pain intensity, and took longer to develop neuropathy symptoms. Safety appeared similar between groups, though detailed safety information wasn't fully reported.

This was a small, single-center study where both patients and doctors knew who was receiving losartan, which could influence how symptoms were reported. The results are promising but preliminary. Larger studies at multiple centers are needed to confirm whether losartan truly helps prevent this chemotherapy side effect before doctors can recommend it routinely.

What this means for you:
Small study suggests losartan may help prevent chemo nerve pain, but more research is needed.

Study Details

Study typeRct
Sample sizen = 89
EvidenceLevel 2
PublishedApr 2026
View Original Abstract ↓
BACKGROUND: Paclitaxel-induced peripheral neuropathy (PIPN) is a condition that persists chronically in more than 60% of affected individuals, and currently there are no proven PIPN prophylaxis. Pre-clinical data suggest the angiotensin-II-receptor blocker losartan may attenuate neuro-inflammation and nerve injury. This study was conducted to assess losartan's neuroprotective effect against PIPN in patients with breast cancer. METHODS: In this single-center, open-label, randomized, controlled trial, women with early-stage breast cancer scheduled for weekly paclitaxel (80 mg/mg or 12 doses) were enrolled and randomized 1:1 to losartan 100 mg once daily plus standard care or standard care alone. The primary end point was incidence of grade 2 or higher neuropathy, per National Cancer Institute Common Terminology Criteria of Adverse Events (NCI-CTCAE v5.0). Secondary end points included time-to-neuropathy (in days), patient quality of life (QoL) assessed by Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-NTX), pain intensity using visual-analogue scale (VAS), serum nerve growth factor (NGF) levels, and safety. RESULTS: Between December 2023 and December 2024, 89 Patients Were Randomized (Losartan, n = 45; Control, n = 44). Losartan Significantly Reduced Grade ≥ 2 Neuropathy Incidence (33.3% vs. 86.4%, p < 0.001) and Delayed Its Onset (73.27 vs. 43.75 Days; Hazards Ratio [HR] = 0.2, 95% Confidence Interval [CI]: 0.11-0.35) Compared With Standard Care Alone, Respectively. At 12 Weeks, Patients Treated With Losartan Reported Superior QoL (FACT/GOG-NTX: 31.87 ± 6.43 vs. 15.45 ± 10.04; p < 0.001) and Reduced Pain Scores (Median VAS 3 vs. 8; p < 0.001) Compared With Standard Care Alone, Respectively. NGF Levels Were Comparable and Adverse Events Were Similar Between Groups. CONCLUSIONS: Daily losartan reduced and delayed clinically significant paclitaxel-induced neuropathy while improving patient-reported outcomes, without additional toxicity. These findings support repurposing losartan as a low-cost PIPN prophylactic and justify validation in larger, multicenter trials. TRIAL REGISTRATION: ClinicalTrials.gov (NCT06135493).
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