[shay]

Alpha lipoic acid (ALA) and Kyprolis (carfilzomib)

by shay on Thu May 29, 2014 6:44 am

Hi all,

After two cycles of Revlimid / carfilzomib [Kyprolis] / dex I've started to experienced mild peripheral neuropathy in my foot, similar to what I had few years ago when I was under Velcade / thalidomide / dex. From time to time I also have quite severe cramps in my foot and ankles at nights.

In order to try and reduce the PN effects, I'm taking E400 and B complex (and magnesium against the cramps).

My questions: I also read that alpha lipoic acid (ALA) can help to reduce the PN effect but I remember that when I was under the Velcade (bortezomib) regimen, I was advised not to take the alpha lipoic acid because of possible contradiction.

Since the carfilzomib is the successor of the Velcade and from the same "family", I was wondering if this limitation is known and stands for the carfilzomib as well? I couldn’t find any relevant material on the web.

Any advice / information will be welcomed.

[Cheryl G]

Re: Alpha lipoic acid (ALA) and Kyprolis (carfilzomib)

by Cheryl G on Thu May 29, 2014 10:43 am

That's a good question, Shay.

Here is a link to the abstract for the research study that most people point to when they say it's not a good idea to take alpha lipoic acid (ALA) at the same time as treatment with Velcade.

https://ash.confex.com/ash/2009/webprogram/Paper19795.html

The researchers found that ALA reduced the ability of Velcade to kill myeloma cells.

Note, however, that the researchers also found that ALA generally tended to increase the growth of myeloma cells. "The exposure of cells to ALA alone had a stimulatory effect on the growth of both multiple myeloma cell lines."

That's not a finding that I've seen mentioned before, and it makes me wonder how advisable it is for myeloma patients to take ALA at any time.

From what I have read other places, it seems that ALA reduces "oxidative stress" on cells in the body, and one of the ways that Velcade works against myeloma is by increasing oxidative stress. This is discussed, for example, in this paper:

http://cancerres.aacrjournals.org/content/early/2013/03/09/0008-5472.CAN-12-4370.full.pdf

and also in detail in this paper:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2842131/

Now, more specifically to your question, I've not been able to find anything that clearly indicates, one way or another, that Kyprolis works against myeloma through "oxidative stress". My impression from what I've seen is that oxidative stress is one of the ways that Kyprolis works, but it is not as dominant a way as it is is Velcade. But that's just my impression.

One other thing. Revlimid also can cause peripheral neuropathy. It doesn't happen as often as it does with Velcade, but it can happen. So it's possible that the neuropathy you're experiencing is due to the Revlimid you're taking, not the Kyprolis.

[aussiegirl]

Re: Alpha lipoic acid (ALA) and Kyprolis (carfilzomib)

by aussiegirl on Thu May 29, 2014 12:43 pm

When I was on Velcade I was advised to take the alpha lipoic acid tablets every day EXCEPT on days I got treatment. Now I'm on Kyprolis and the doctor said I shouldn't need them, so I have stopped taking them. I still get the occasional tingling in fingers but not as bad as before.

[fetalsono]

Re: Alpha lipoic acid (ALA) and Kyprolis (carfilzomib)

by fetalsono on Fri May 30, 2014 12:27 am

I saw the paper (poster) by the group in Los Angeles and wrote one of the authors an email asking him a question regarding ALA and Velcade. He was kind enough to write back and this is what he said:

We have no clinical data to show its impact on the efficacy of Velcade.

In our clinic, we only tell patients not to take alpha lipoic acid on Velcade days. You can go up to as high as 1800 mg/d.

I think it helps a lot.

[faithoverfear]

Re: Alpha lipoic acid (ALA) and Kyprolis (carfilzomib)

by faithoverfear on Tue Nov 22, 2016 11:02 am

I went through three rounds of cyclo­phos­phamide, Vel­cade, and dexa­metha­sone (CyBorD), three rounds of Velcade, Revlimid, and dexa­metha­sone (VRD), one round of VRD-PACE, and an autologous stem cell transplant. Very little peripheral neuropathy. One year later, no pe­riph­er­al neuropathy at all. I credit that result to the Dana Farber recommended supplements, which included ALA.

I just read a bunch of journal articles on ALA. ALA is rapidly absorbed and processed. So, skipping ALA on treatment days would avoid the potential for conflict.

The key take-away from the articles is that ALA is needed for glutathione synthesis. And that plays a major anti-oxidant role, benefiting general health and heart health in particular.

The liquid R form in capsules appears to be more bioactive than the form in tablets.

Hope this helps, even though this is an old conversation.

Reference:

Shay, KP, et al, "Alpha-lipoic acid as a dietary supplement: Molecular mechanisms and therapeutic potential," Biochimica et Biophysica Acta, Oct 2009 (abstract; full text at Pubmed Central)