Oral Glutamine Is Effective for Preventing Oxaliplatin-Induced Neuropathy in Colorectal Cancer Patients

Abstract

LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Identify the clinical features of oxaliplatin-induced neuropathy.2. Discuss the current approaches for managing chemotherapy-induced neuropathy.3. Explain the rationale for using glutamine in preventing oxaliplatin-induced neuropathy.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTOxaliplatin is effective in the treatment of metastatic colorectal cancer (MCRC) patients; however, severe neurotoxicity develops frequently. To assess the efficacy of oral glutamine for preventing neuropathy induced by oxaliplatin, a pilot study was performed. A total of 86 patients with MCRC treated at Taipei Veterans General Hospital were enrolled. Oxaliplatin (85 mg/m 2 , days 1 and 15) plus weekly bolus 5-fluorouracil (5-FU; 500 mg/m 2 ) and folinic acid (FA; 20 mg/m 2 ) on days 1, 8, and 15 were given every 28 days as firstline treatment. Patients were randomized to receive (glutamine group; n ‫؍‬ 42) or not receive (control group; n ‫؍‬ 44) glutamine (15 g twice a day for seven consecutive days every 2 weeks starting on the day of oxaliplatin infusion). Efficacy of chemotherapy, neurological toxicity, and electrophysiological alterations were assessed. A lower percentage of grade 1-2 peripheral neuropathy was observed in the glutamine group (16.7% versus 38.6%) after two cycles of treatment, and a significantly lower incidence of grade 3-4 neuropathy was noted in the glutamine group after four cycles (4.8% versus 18.2%) and six cycles (11.9% versus 31.8%). By adding glutamine, interference with activities of daily living was lower (16.7% versus 40.9%), and need for oxaliplatin dose reduction was lower (7.1% versus 27.3%). There were no significant between-group differences in response to chemotherapy (52.4% versus 47.8%), electrophysiological abnormalities, grade 3-4 non-neurological toxicities (26.2% versus 22.8%), or survival. These data indi- Disclosure of potential conflicts of interest is found at the end of this article.

In Reply

“…In our previous study, we noticed no significant between-group differences in electrophysiological studies of patients receiving glutamine supplements or not [7]. In this study, electrophysiological examinations were performed in 28 patients.…”

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electrophysiological examination is not always available in the general oncology practice; however, oncologists should be aware that, particularly, the estimation of vibration perception, deep tendon reflexes, and sural sensory action potential is mandatory in the follow-up course of CIPN [7].

REFERENCES

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The Usefulness of Nerve Conduction Studies in Objectively Assessing Oxaliplatin-Induced Peripheral Neuropathy

“…In our opinion, Wang et al [1] should provide further explanation to justify this inconsistency. Their claim that the non-placebo controlled, unblinded study design might be the cause of this discrepancy is not sufficient.…”

Dietary Supplement Use in Cancer Care: Help or Harm

“…Nonstatistically significant improvements were seen in compound motor action potential and sensor nerve action potential measurement in the treatment group. Eighty-six metastatic colon cancer patients in a pilot study of the effect of glutamine on the neurotoxicity of oxaliplatin/5-FU chemotherapy showed that glutamine (n ¼ 44), given at a dose of 15 g twice a day for the first 7 days of chemotherapy, reduced the incidence of moderate grade neuropathy after two (17% versus 39%), four (5% versus 18%), and six cycles (12% versus 32%) of treatment [150]. The benefit continued to accrue to the glutamine group despite a lack of difference in elecrophysiologic abnormalities, which translated into less interference with activities of daily living (17% versus 41%) and less reduction in chemotherapy (7% versus 27%) because of neuropathy.…”