Role of magnesium as a protective agent in cisplatin-induced nephrotoxicity in head and neck cancer

PURPOSE: This study seeks to evaluate the safety and efficacy of magnesium (MgSO4) as a protective agent against cisplatin-induced nephrotoxicity (CIN) in cases with head and neck cancers (HNC). METHODS: One-hundred newly diagnosed squamous cell carcinoma HNC were randomly allocated into 4 groups: 25 cases in each. Group 1 (control group) received cisplatin 40 mg/m2 for 7 cycles (each cycle is 1 week). Group 2 received cisplatin 40 mg/m2 and 1 g of parenteral MgSO4 intravenous infusion (IVI) for 7 cycles. Group 3 received cisplatin 40 mg/m2 and 2 g of parenteral MgSO4 IVI for 7 cycles. Group 4 received cisplatin 40 mg/m2 and 3 g of parenteral MgSO4 for 7 cycles. All four groups received radiotherapy concurrent with cisplatin for 7 cycles. RESULTS: The groups containing Mg IVI as (MgSO4) had a significant improvement (lower level) in Urine kidney injury molecule-1 (KIM-1) and Urine Neutrophil gelatinase associated lipocalin (NGAL) than Group I (control group) (P < 0.05). Serum soluble Fas ligand (sFasL) and Malondialdehyde (MDA) after the end cycle (7 cycle) was significantly decreased in Group IV than group I (control group) (P < 0.05), MgSo4 was significantly decreased in Group IV (3 g Mg) than Group III (2 g Mg) (P < 0.001) and Group II (1 g Mg). CONCLUSIONS: Mg can serve as a protective agent against CIN, as it reduces renal injury biomarkers, including urinary KIM-1, urinary NGAL, serum sFasL, and serum MDA when incorporated into treatment regimens at different doses, compared to cisplatin alone. Moreover, Mg had a promising role in the improvement of quality of life in cases with HNC receiving cisplatin.