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will receive chemotherapy (paclitaxel for 12 weeks) + Alpha Lipoic Acid for 14 weeks (one week before the start of paclitaxel and continue for one week after the end of paclitaxel).

will receive chemotherapy only (paclitaxel for 12 weeks).

Alpha Lipoic Acid 600 MG Oral Capsule

Shaimaa M Shaker, Pharmacist

Loay M Kassem, Physician

Manal H El Hamamsy, Doctorate

92 female cancer patients, aged from 18 to 75 years old (with a first diagnosis of breast cancer) who will receive Paclitaxel-based chemotherapy (12 weeks) as first line therapy, will be enrolled in the study and will be randomly assigned to either:

* Group I: will receive the chemotherapy protocol or
* Group II: will receive the chemotherapy protocol plus 600 mg daily dose of Alpha Lipoic Acid for 14 weeks (one week before the start of paclitaxel and continue till one week after the end of paclitaxel).

  \* Blood samples will be withdrawn 2 times (week 1 and week 12) to measure the following: (Stored in -80 C till the end of the study)
* Tumor Necrotizing Factor- alpha (TNF-α) by ELISA.
* Brain-Derived Neurotrophic Factor (BDNF) by ELISA.

  \* All patients will be subjected to 6 tests/questionnaires (week 1 - week 12 - week 24) to predict the functionality of the brain:
* Functional Assessment of Cancer Therapy-Cognitive (FACT-Cog) version 3
* Mini-Cog Test
* Mini Mental State Examination (MMSE)
* Controlled Oral Word Association Test (COWAT)
* Hopkins Verbal Learning Test (HVLT)
* Trail Making Test (TMT)

92 Female Cancer patients will be randomized to 2 groups, the first group will receive the alpha lipoic acid beside their chemotherapy regimen and the other group will only receive the chemotherapy regimen. Both groups will be watched for any changes in their neurological behaviors by asking and receiving answers on the questionnaires that were mentioned before. This will be done in 3 different time margins:

* Before starting the chemotherapeutic regimen
* after ending the chemotherapeutic regimen
* after 6 months of receiving the chemotherapeutic regimen this will show even the late symptoms and effects of the chemotherapy. Also serum biomarkers will be measured (TNF alpha and BDNF) 2 times; one before starting the chemotherapeutic regimen and the other after ending the treatment.

Throughout the treatment process, both groups will be monitored for any side effects concerning the alpha lipoic acid or the chemotherapeutic regimen.

Effect of Alpha Lipoic Acid on Chemotherapy Induced Neurological Changes in Breast Cancer Patients

Monitoring alpha lipoic acid related adverse reactions:

Headache, heartburn, nausea and vomiting are nearly the most common adverse effects concerning alpha lipoic acid.

National Cancer Institute common Terminology criteria for Adverse Effect grading: NCI-CTCAE version 4.0. for evaluation of chemotherapy toxicities.

Including chemotherapeutic agents and any other add-on medication.

All patients will be evaluated during the trial for 2 times via monitoring the Tumor Necrotizing Factor- alpha (TNF-α).

Evaluation of response will be done guided by the questionnaire to detect the neuropsychiatric panel.

FACT Cognitive function version 3 consists of questions regarding:

* Perceived cognitive impairments.
* Comments from others.
* Perceived cognitive abilities.
* Impact on quality of life. For every answered question, the patient receives points on a scale of scores. Those scales will be compared in every time the questionnaire is conducted to assess the functionality of the brain.

The scale of numbers of the answers is:

* Never = 0
* About once a week = 1
* Two to three times a week = 2
* Nearly every day = 3
* Several times a day = 4 It is better when the patient has low score.

Evaluation of response will be done guided by the questionnaire to detect the neuropsychiatric panel.

Mini-Cog Test consists of three steps:

* Three Word Registration: Telling the patient a list of words and ask him to memorize them.
* Clock Drawing: Asking the patient to draw the clock and record the time taken for drawing. Normal clock = 2 points. Inability or refusal to draw a clock (abnormal) = 0 points.
* Three-Word Recall: Asking the patient to recall the list of words done in step 1.

For every word recalled, patient receives a point. Total points will be compared in every time the questionnaire is done to assess the functionality of the brain.

Evaluation of response will be done guided by the questionnaire to detect the neuropsychiatric panel.

MMSE consists of questions regarding:

* Orientation to time (2 points, one for each question)
* Orientation to place (2 points, one for each question)
* Concentration and attention (2 questions and for each question this scale will be applied: No Errors - 2 points, 1 Error - 1 point, 2 or more Errors - 0 points)
* Delayed recall (3 points, one for each recalled word) For every answered question, the patient will get points. Those points will be compared in every phase the questionnaire is done for every patient.

Evaluation of response will be done guided by the questionnaire to detect the neuropsychiatric panel.

The patient is asked to tell words that begin with a certain alphabet in a certain time margin. This will be done for 4 different alphabets and words will be recorded to calculate the score.

Points of every alphabet will be compared in every time the questionnaire is conducted to assess the functionality of the brain.

The more words told in the same time margin, the better.

Evaluation of response will be done guided by the questionnaire to detect the neuropsychiatric panel.

The VMAT consists of 3 trials of delayed recall. Every trial has a list of words for which the patient will be asked to recall. For every recalled word the patient will have a point and those points will be compared in every time the questionnaire is conducted to assess the functionality of the brain.

The more words recalled, the better.

Evaluation of response will be done guided by the questionnaire to detect the neuropsychiatric panel.

TMT consists of 2 parts, A and B. Both parts of the Trail Making Test consist of 25 circles distributed over a sheet of paper. In Part A, the circles are numbered 1 - 25, and the patient should draw lines to connect the numbers in ascending order. In Part B, the circles include both numbers and letters; as in Part A, the patient draws lines to connect the circles in an ascending pattern, but with the added task of alternating between the numbers and letters (i.e., 1-A-2-B-3-C, etc.).

Results for both TMT A and B are reported as the number of seconds required to complete the task; therefore, higher scores reveal greater impairment.

All patients will be evaluated during the trial for 2 times via monitoring Brain-Derived Neurotrophic Factor (BDNF) serum levels.

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