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Gastrointestinal Cancer

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

^aNational Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China; ^bDivision of Oncology & Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; ^cDivision of Colorectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China

Key Words. Colorectal carcinoma • Glutamine • Neuropathy • Oxaliplatin

Correspondence: Po-Min Chen, M.D., Ph.D., Division of Oncology & Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China. Telephone: 886-2-2875-7528; Fax: 886-2-2873-2184; e-mail: pmchen{at}vghtpe.gov.tw

Oxaliplatin 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/m², days 1 and 15) plus weekly bolus 5-fluorouracil (5-FU; 500 mg/m²) and folinic acid (FA; 20 mg/m²) on days 1, 8, and 15 were given every 28 days as first-line 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-cate that oral glutamine significantly reduces the incidence and severity of peripheral neuropathy of MCRC patients receiving oxaliplatin without affecting response to chemotherapy and survival.

Disclosure of potential conflicts of interest is found at the end of this article.

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