Cancer Treatment Side Effects & Supportive and Palliative Care
L-Glutamine for prevention and treatment of neuropathy
Glutamine has been shown to up-regulate nerve growth factor in animal models and it is thought to have similar effects in humans.
A recent study involving 86 patients with metastatic colorectal cancer has shown that oral l-glutamine (15 g twice a day for seven consecutive days every 2 weeks starting on the day of oxaliplatin infusion) was effective in the prevention of oxaliplatin-induced neuropathy.
A trial of 12 women with advanced breast cancer on a high dose regime of paclitaxel, using glutamine 10 g daily for four days starting 24 hours after completion of paclitaxel indicated that participants who received glutamine had fewer symptoms, with only 8% of women reporting dysesthesias in the fingers and toes, as compared to 40% of the women who did not receive glutamine.
Another trial examined the neuroprotective effect of glutamine on 46 patients scheduled to receive high-dose paclitaxel prior to stem cell transplantation. Seventeen patients received 10 g of glutamine three times daily for a total of four days beginning 24 hours after completion of paclitaxel. The remaining 29 patients made up the control group. Results of neurologic symptom questions and electrodiagnostic testing indicated that those who received glutamine developed less weakness, loss of vibratory sensation, and toe numbness as compared to the control group. Larger, randomized, placebo controlled trials are necessary to assess the efficacy of glutamine for the prevention and treatment of neuropathy.
Safety
L-glutamine has been shown to be safe at oral doses of 10 g daily in oncology patients.
Although no specific dosing studies have been reported, most clinical research has used between 250 mg and 1 g of the powdered root in capsules, taken one to four times daily.
Recommendation
L-glutamine is recommended for the prevention and co-management of chemotherapy-related neuropathy in oncology patients.
References - Hide References
- Vahdat, L., Papadopoulos, K., Lange, D., Leuin, S., Kaufman, E.,Donovan, D., et al. (2001). Reduction of paclitaxel-induced peripheral neuropathy with glutamine. Clinical Cancer Research,7, 1192Ð1197.
- Visovsky C, Collins M, Abbott L, Aschenbrenner J, Hart C. Putting evidence into practice: evidence-based interventions for chemotherapy-induced peripheral neuropathy.Clin J Oncol Nurs. 2007 Dec;11(6):901-13. Review.
- Wang WS, Lin JK, Lin TC, Chen WS, Jiang JK, Wang HS, Chiou TJ, Liu JH, Yen CC,Chen PM. Oral glutamine is effective for preventing oxaliplatin-induced neuropathy in colorectal cancer patients.Oncologist. 2007 Mar;12(3):312-9.
- Stubblefield MD, Vahdat LT, Balmaceda CM, Troxel AB, Hesdorffer CS, Gooch CL.
- Glutamine as a neuroprotective agent in high-dose paclitaxel-induced peripheral neuropathy: a clinical and electrophysiologic study. Clin Oncol (R Coll Radiol). 2005 Jun;17(4):271-6.
- Makino H.Treatment and care of neurotoxicity from taxane anticancer agents. Breast Cancer. 2004;11(1):100-4. Review.
- Savarese DM, Savy G, Vahdat L, Wischmeyer PE, Corey B. Prevention of chemotherapy and radiation toxicity with glutamine. Cancer Treat Rev. 2003 Dec;29(6):501-13. Review.