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Oral glutamine to prevent chemotherapy induced stomatitis: a pilot study.

Abstract

Mucositis is a common toxicity of cancer chemotherapy. Glutamine appears to be the major energy source for intestinal epithelium, and animal studies have suggested that dietary supplementation with glutamine may protect the gut from both radiation and chemotherapy. Patients experiencing stomatitis after a course of chemotherapy were offered the opportunity to enter the current study if no clinical parameters precluded receiving the same chemotherapy doses during the next course of treatment. Patients received the same chemotherapy regimen as during the previous treatment but in addition received a suspension of L-glutamine, 4 gm swish and swallow twice a day, from day 1 of chemotherapy for 28 days or for 4 days past the resolution of any post-chemotherapy mucositis. Twelve patients receiving doxorubicin, 1 receiving etoposide, and 1 receiving ifosfamide, etoposide, and carboplatinum were entered into the study. The maximum grade (CALGB criteria) of mucositis decreased in 12 of 14 patients with glutamine supplementation (median score 2A vs 0.5, p < 0.001). Similarly, after glutamine supplementation, the total number of days of mucositis was decreased in 13 of 14 patients (2.7 +/- 0.8 (mean +/- SEM) vs 9.9 +/- 1.1, p > or = 0.001). Thirteen of the 14 patients felt that the mucositis was less severe with the addition of glutamine. No change in the nadir neutrophil count was noted with glutamine, and no toxicity of glutamine was observed. We conclude that oral supplementation with glutamine can significantly decrease the severity of chemotherapy-induced stomatitis, an important cause of morbidity in the treatment of patients with cancer. Glutamine supplementation in patients receiving therapy for cancer warrants further study.

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  • Authors+Show Affiliations

    ,

    Department of Medicine, University of Minnesota Medical School, Minneapolis, USA.

    Source

    MeSH

    Acquired Immunodeficiency Syndrome
    Administration, Oral
    Antineoplastic Combined Chemotherapy Protocols
    Bleomycin
    Carboplatin
    Cyclophosphamide
    Dacarbazine
    Double-Blind Method
    Doxorubicin
    Etoposide
    Female
    Fluorouracil
    Glutamine
    Humans
    Ifosfamide
    Male
    Neoplasms
    Pilot Projects
    Placebos
    Sarcoma, Kaposi
    Stomatitis
    Vincristine

    Pub Type(s)

    Clinical Trial
    Comparative Study
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    8636652

    Citation

    Skubitz, K M., and P M. Anderson. "Oral Glutamine to Prevent Chemotherapy Induced Stomatitis: a Pilot Study." The Journal of Laboratory and Clinical Medicine, vol. 127, no. 2, 1996, pp. 223-8.
    Skubitz KM, Anderson PM. Oral glutamine to prevent chemotherapy induced stomatitis: a pilot study. J Lab Clin Med. 1996;127(2):223-8.
    Skubitz, K. M., & Anderson, P. M. (1996). Oral glutamine to prevent chemotherapy induced stomatitis: a pilot study. The Journal of Laboratory and Clinical Medicine, 127(2), pp. 223-8.
    Skubitz KM, Anderson PM. Oral Glutamine to Prevent Chemotherapy Induced Stomatitis: a Pilot Study. J Lab Clin Med. 1996;127(2):223-8. PubMed PMID: 8636652.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Oral glutamine to prevent chemotherapy induced stomatitis: a pilot study. AU - Skubitz,K M, AU - Anderson,P M, PY - 1996/2/1/pubmed PY - 1996/2/1/medline PY - 1996/2/1/entrez SP - 223 EP - 8 JF - The Journal of laboratory and clinical medicine JO - J. Lab. Clin. Med. VL - 127 IS - 2 N2 - Mucositis is a common toxicity of cancer chemotherapy. Glutamine appears to be the major energy source for intestinal epithelium, and animal studies have suggested that dietary supplementation with glutamine may protect the gut from both radiation and chemotherapy. Patients experiencing stomatitis after a course of chemotherapy were offered the opportunity to enter the current study if no clinical parameters precluded receiving the same chemotherapy doses during the next course of treatment. Patients received the same chemotherapy regimen as during the previous treatment but in addition received a suspension of L-glutamine, 4 gm swish and swallow twice a day, from day 1 of chemotherapy for 28 days or for 4 days past the resolution of any post-chemotherapy mucositis. Twelve patients receiving doxorubicin, 1 receiving etoposide, and 1 receiving ifosfamide, etoposide, and carboplatinum were entered into the study. The maximum grade (CALGB criteria) of mucositis decreased in 12 of 14 patients with glutamine supplementation (median score 2A vs 0.5, p < 0.001). Similarly, after glutamine supplementation, the total number of days of mucositis was decreased in 13 of 14 patients (2.7 +/- 0.8 (mean +/- SEM) vs 9.9 +/- 1.1, p > or = 0.001). Thirteen of the 14 patients felt that the mucositis was less severe with the addition of glutamine. No change in the nadir neutrophil count was noted with glutamine, and no toxicity of glutamine was observed. We conclude that oral supplementation with glutamine can significantly decrease the severity of chemotherapy-induced stomatitis, an important cause of morbidity in the treatment of patients with cancer. Glutamine supplementation in patients receiving therapy for cancer warrants further study. SN - 0022-2143 UR - https://www.unboundmedicine.com/medline/citation/8636652/Oral_glutamine_to_prevent_chemotherapy_induced_stomatitis:_a_pilot_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-2143(96)90082-7 DB - PRIME DP - Unbound Medicine ER -