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A 2014 mouse study found that NAC and vitamin E accelerated lung tumor progression and reduced survival.41 A 2015 melanoma mouse study found that NAC increased lymph node metastases in mice with malignant melanoma.42 A 2019 mouse study reported that NAC protected against emphysema-related lung damage but also induced lung adenocarcinoma in some mice.43 And a 2021 hepatocellular carcinoma study found that antioxidant supplements including NAC promoted tumor formation, growth, and drug resistance in experimental models by reducing intracellular ROS.3 Newer human data add another layer of complexity

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For the primary analysis of the primary efficacy endpoint, no imputation is needed and the analysis will be based on observed cases

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