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

Abstract

BACKGROUND

Mouth sores and/or difficulty swallowing are common and painful consequences of cytotoxic chemotherapy for cancer. In previous studies oral glutamine was found to protect animals from the effects of whole abdominal radiation and methotrexate-induced enteritis. Glutamine also was found to reduce oral mucositis in a nonrandomized pilot study in humans. Therefore, the authors attempted to determine the efficacy of oral glutamine in a randomized, double blind, crossover trial in cancer patients receiving chemotherapy.

METHODS

Twenty-four patients (16 children and 8 adults) received glutamine or placebo (glycine) suspension (2 g amino acid/M2/dose twice daily) to swish and swallow on days of chemotherapy administration and for at least 14 additional days. Patients completed a calendar indicating days of mouth pain associated with each chemotherapy course and the effect of mouth pain on oral intake.

RESULTS

Paired data indicated significant amelioration of stomatitis associated with glutamine administration after chemotherapy. The duration of mouth pain was 4.5 days less in chemotherapy courses in which glutamine supplementation was compared with placebo (Wilcoxon's signed rank test, P=0.0005). The severity of oral pain also was reduced significantly when glutamine was provided with chemotherapy (the amount of days mucositis restricted oral intake to soft foods [> or =Grade 2; Modified Eastern Cooperative Oncology Group grading system] was 4 days less with glutamine compared with placebo; Wilcoxon's signed rank test, P=0.002).

CONCLUSIONS

Low dose oral glutamine supplementation during and after chemotherapy significantly reduced both the duration and severity of chemotherapy-associated stomatitis. Oral glutamine appears to be a simple and useful measure to increase the comfort of many patients at high risk of developing mouth sores as a consequence of intensive cancer chemotherapy.

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  • Authors+Show Affiliations

    ,

    Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.

    ,

    Source

    Cancer 83:7 1998 Oct 01 pg 1433-9

    MeSH

    Administration, Oral
    Adolescent
    Adult
    Antineoplastic Agents
    Child
    Child, Preschool
    Cross-Over Studies
    Double-Blind Method
    Glutamine
    Humans
    Middle Aged
    Stomatitis
    Suspensions
    Treatment Outcome

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    9762946

    Citation

    Anderson, P M., et al. "Oral Glutamine Reduces the Duration and Severity of Stomatitis After Cytotoxic Cancer Chemotherapy." Cancer, vol. 83, no. 7, 1998, pp. 1433-9.
    Anderson PM, Schroeder G, Skubitz KM. Oral glutamine reduces the duration and severity of stomatitis after cytotoxic cancer chemotherapy. Cancer. 1998;83(7):1433-9.
    Anderson, P. M., Schroeder, G., & Skubitz, K. M. (1998). Oral glutamine reduces the duration and severity of stomatitis after cytotoxic cancer chemotherapy. Cancer, 83(7), pp. 1433-9.
    Anderson PM, Schroeder G, Skubitz KM. Oral Glutamine Reduces the Duration and Severity of Stomatitis After Cytotoxic Cancer Chemotherapy. Cancer. 1998 Oct 1;83(7):1433-9. PubMed PMID: 9762946.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Oral glutamine reduces the duration and severity of stomatitis after cytotoxic cancer chemotherapy. AU - Anderson,P M, AU - Schroeder,G, AU - Skubitz,K M, PY - 1998/10/8/pubmed PY - 2000/6/20/medline PY - 1998/10/8/entrez SP - 1433 EP - 9 JF - Cancer JO - Cancer VL - 83 IS - 7 N2 - BACKGROUND: Mouth sores and/or difficulty swallowing are common and painful consequences of cytotoxic chemotherapy for cancer. In previous studies oral glutamine was found to protect animals from the effects of whole abdominal radiation and methotrexate-induced enteritis. Glutamine also was found to reduce oral mucositis in a nonrandomized pilot study in humans. Therefore, the authors attempted to determine the efficacy of oral glutamine in a randomized, double blind, crossover trial in cancer patients receiving chemotherapy. METHODS: Twenty-four patients (16 children and 8 adults) received glutamine or placebo (glycine) suspension (2 g amino acid/M2/dose twice daily) to swish and swallow on days of chemotherapy administration and for at least 14 additional days. Patients completed a calendar indicating days of mouth pain associated with each chemotherapy course and the effect of mouth pain on oral intake. RESULTS: Paired data indicated significant amelioration of stomatitis associated with glutamine administration after chemotherapy. The duration of mouth pain was 4.5 days less in chemotherapy courses in which glutamine supplementation was compared with placebo (Wilcoxon's signed rank test, P=0.0005). The severity of oral pain also was reduced significantly when glutamine was provided with chemotherapy (the amount of days mucositis restricted oral intake to soft foods [> or =Grade 2; Modified Eastern Cooperative Oncology Group grading system] was 4 days less with glutamine compared with placebo; Wilcoxon's signed rank test, P=0.002). CONCLUSIONS: Low dose oral glutamine supplementation during and after chemotherapy significantly reduced both the duration and severity of chemotherapy-associated stomatitis. Oral glutamine appears to be a simple and useful measure to increase the comfort of many patients at high risk of developing mouth sores as a consequence of intensive cancer chemotherapy. SN - 0008-543X UR - https://www.unboundmedicine.com/medline/citation/9762946/Oral_glutamine_reduces_the_duration_and_severity_of_stomatitis_after_cytotoxic_cancer_chemotherapy_ L2 - http://www.diseaseinfosearch.org/result/5395 DB - PRIME DP - Unbound Medicine ER -