Combined Intravenous Selenium, Zinc, and Magnesium Therapy for Refractory Chemotherapy- Induced Peripheral Neuropathy: A Case Report

Abstract

Chemotherapy-induced peripheral neuropathy (CIPN) is a doselimiting toxicity with limited treatment options. We report a 68-year-old female with Anaplastic Lymphoma Kinase (ALK)-mutant non-small cell lung cancer who developed severe, refractory CIPN (numeric rating scale [NRS] 9/10) and sensory ataxia following paclitaxel and carboplatin therapy. Conventional medications, including duloxetine, were ineffective and poorly tolerated. Nutrient analysis revealed low-normal selenium and magnesium alongside zinc deficiency. An intravenous nutrient cocktail of sodium selenite, zinc sulfate, and magnesium sulfate was initiated. Over five months, the patient achieved complete pain relief (NRS 0/10) and nearcomplete restoration of hand function and proprioception. Mechanistically, selenium stabilizes mitochondria and reduces oxidative stress; zinc inhibits transient receptor potential vanilloid 1 (TRPV1)-mediated nociception; and magnesium acts as an N-methyl-D-aspartate (NMDA) receptor antagonist. This case suggests that intravenous nutrient cocktail therapy is a safe and effective adjunct for managing severe, refractory CIPN, warranting further clinical validation.