Oral glutamine reduces the duration and severity of stomatitis after cytotoxic cancer chemotherapy

Abstract

Supported by grants from the Viking's Children's Fund, Hedberg Foundation, Children's Cancer Research Fund, and Mayo Clinic Cancer Center.Drs. Anderson and Skubitz currently are developing a glutamine suspension product for commercial use in the treatment of mucositis.The authors thank Gary Carlson of the University of Minnesota Investigational Pharmacy for his assistance in the formulation of a palatable, sweet suspension that was acceptable to patients, especially children who had prior mouth sores. The assistance of Darlette Luke and Deb Landrith of the University of Minnesota Investigational Pharmacy and Kevin Graner and Brad Christianson of the Mayo Clinic Pharmacy are recognized and appreciated. The authors also are grateful for the encouragement to pursue these studies by numerous pediatric oncologists in the Children's Oncology Group of the Upper Midwest including Dr. Bruce Bostrom. The authors also thank Les Robison, Ph.D., for study design suggestions and Dr. Charles Loprinzi for review of the article.

Oral glutamine in paediatric oncology patients: a dose finding study

“…There was a significant reduction in the duration and severity of chemotherapy-associated stomatitis. This study also demonstrated that glutamine is well tolerated at this dose (Anderson et al, 1998).…”

“…Doses of glutamine given to adult patients vary from 0.2 to 0.57 g glutamine=kg=day (Ziegler et al, 1992;Skubitz & Anderson, 1996;Jebb et al, 1995;Schloerb & Skikne, 1999). There is only one published study of oral glutamine involving paediatric oncology patients (Anderson et al, 1998). In this randomized double-blind cross-over study 16 children were given a much smaller dose of 2 g=m 2 glutamine or placebo twice daily for 14 days.…”

Dietary Supplement Use in Cancer Care: Help or Harm

“…Only one subject reported any mucositis (grade I), with a good response to chemotherapy for eight of the nine subjects and without any glutamine related toxicity. Similarly, a placebo controlled trial of adults and children using glutamine (2 g/m 2 twice a day during chemotoxic therapy) showed significant reductions in both severity (P ¼ .002) and duration of mucosisits pain (decreased by 4.5 days, P ¼ .0005) [114]. Even subjects who had pre-existing mucositis developed during an initial course of chemotherapy responded well when 4-gm glutamine twice a day was given in subsequent sessions [115].…”

Symposium 4: Hot topics in parenteral nutrition A review of the use of glutamine supplementation in the nutritional support of patients undergoing bone-marrow transplantation and traditional cancer therapy

“…A brief search of PubMed has revealed nine randomised controlled trials that administered glutamine to patients receiving chemotherapy and/or radiotherapy (11)(12)(13)(14)(15)(16)(17)(18)(19) . These studies are summarised in Table 1.…”

“…Unfortunately, the majority of the studies were small and had poor methodological reporting. Three studies report reduced mucositis with glutamine (11)(12)(13) , while two report reduced subjective measures of mucositis (gut absorbtive capacity and endoscopic appearances) but no reduction in subjective symptoms of mucositis (14,15) . Three studies report no change in mucositis (16,17,19) .…”