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Symptom Management and Supportive Care

Prevention of Docetaxel- or Paclitaxel-Associated Taste Alterations in Cancer Patients with Oral Glutamine: A Randomized, Placebo-Controlled, Double-Blind Study

^aDivision of Oncology/Haematology, Department of Internal Medicine, and ^bSenology Centre, Department of Interdisciplinary Medical Services, Cantonal Hospital, St. Gallen, Switzerland; ^cStatistical Unit, Swiss Group for Clinical Cancer Research, Bern, Switzerland

Key Words. Glutamine • Paclitaxel • Docetaxel • Taste alterations • Neuropathy • Prevention

Correspondence: Florian Strasser, M.D., A.B.H.P.M., Oncology and Palliative Medicine, Division of Oncology/Haematology, Department of Internal Medicine and Palliative Care Centre, Cantonal Hospital, Rorschacherstrasse, 9007 St. Gallen, Switzerland. Telephone: 41-71-494-1111; Fax: 41-71-494-6425; e-mail: florian.strasser{at}kssg.ch or fstrasser{at}bluewin.ch

Disclosure: The article discusses glutamine manufactured by Baxter for prophylaxis of taste alterations. No other potential conflicts of interest were reported by the authors, planners, reviewers, or staff managers of this article.

Taste alteration (dysgeusia), an underrecognized toxicity associated with taxane-based chemotherapy (TaxCh), lacks standard treatment. We investigated prevention of dysgeusia with oral glutamine in patients undergoing first-time TaxCh.

Adult patients were randomized to receive either 30 g/day glutamine or placebo (maltodextrin) from day 1 of TaxCh. Dysgeusia was measured daily with a visual analogue scale (VAS). On each chemotherapy cycle, objective (sour, sweet, salty, bitter) and subjective (four-category scale) taste and toxicity (National Cancer Institute Common Toxicity Criteria, v.3) were assessed. Stomatitis and zinc deficiency were treated. For primary outcomes, repeated dysgeusia scores were analyzed with a linear mixed model. Repeated data on each objective or subjective taste item were analyzed with a generalized estimating equation.

Of 52 patients randomized, 41 completed treatment (median study duration, 74 days). At baseline, the glutamine (n = 21) and placebo (n = 20) groups were comparable for age (64 years), gender (32% men), tumor types, chemotherapy (docetaxel, 44%; paclitaxel, 56%), schedule (weekly, 78%; 3-weekly, 22%), treatment intention (15% adjuvant), dysgeusia (VAS, 11/100), and taste recognition (88%). Twenty-four patients had peripheral neuropathy grades 1–2; none had grade 3. Glutamine and placebo were not different for maximal dysgeusia and increase from baseline, with an insignificant linear time effect. Separate subgroup analyses for patients with baseline dysgeusia 11 or >11 did not alter the results. Objective or subjective taste tests were not different, neither were adverse events.

Compared with placebo, oral glutamine did not prevent or decrease subjective taste disturbances or altered taste perception associated with TaxCh. The role of glutamine in supportive care of taxane-associated dysgeusia seems limited.

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