L-glutamine Supplementation to Alleviate Symptoms of Taxane-Induced Neuropathy in Patients With Breast Cancer

The purpose of the study is to determine whether daily, high-dose administration of l-glutamine can reduce numbness and tingling caused by a taxane chemotherapy in patients with breast cancer.

Study Overview

• Status: Withdrawn
• Conditions: Peripheral Neuropathy
• Intervention / Treatment: Dietary supplement: L-glutamine

Detailed Description

L-glutamine has previously been shown to help reduce the incidence of numbness and tingling in patients with breast cancer who are receiving taxane chemotherapies. However, no study to date looks at the effect of l-glutamine given after this numbness and tingling (called 'perihperhal neuropathy') has already occurred. We hypothesize that administration of this amino acid in l-glutamine naïve patients will result in a measureable reduction of their taxane-induced neuropathy.

• Study Type: Interventional
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19124
      • Eastern Regional Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Biopsy proven adenocarcinoma of the breast
• Received at least one prior taxane-containing chemotherapy regimen which resulted in persistent taxane-induced peripheral neuropathy
• Anticipated survival of at least 6 months
• Eastern Cooperative Oncology Group (ECOG) performance status (PS) = 0, 1, or 2
• The patient must have screening laboratory: Transaminases<2.5 x upper limit of normal; total bilirubin <2.0; creatinine <1.5
• Neuropathy onset from taxane administration no more than 18 months from date enrolled in trial
• Willingness to adhere to supplemental regimen of l-glutamine 10,000mg taken orally twice daily, with one potential dose escalation to 10,000mg taken orally three times daily.
• Grade I-III sensory peripheral neuropathy related to prior taxane use as assessed by their treating oncologist at Eastern Regional Medical Center
• Able to give informed consent for protocol participation

Exclusion Criteria:

• Participants are not able to understand or provide written informed consent.
• The research team deems that the participant may not be able to follow the study protocol.
• Current diagnosis of bipolar disorder or other manic state
• Prior use of l-glutamine for prevention or empirical treatment of taxane-induced sensory peripheral neuropathy
• Prior treatment with a platinum chemotherapy
• Concurrent use of physical therapy interventions such as the 'Rebuilder', chiropractic care, acupuncture, or other modalities specifically targeting peripheral neuropathy
• Concomitant use of nutraceutical supplements which may mitigate symptoms of taxane-induced peripheral neuropathy including B-Complex vitamins, alpha-lipoic acid, vitamin E, acetyl-l-carnitine, intramuscular B12 injections, fish oil, etc… during study
• Renal insufficiency : serum creatinine of >1.5 mg /dl
• Hepatic insufficiency: transaminases > 2.5 x upper limit of normal due to isolated reports of possible hepatic encephalopathy
• New prescription or dose adjustment of current medication for the treatment of peripheral neuropathy such as gabapentin or Lyrica within the past 30 days.
• Pre-existing sensory peripheral neuropathy from other comorbid conditions such as diabetes or alcoholism
• Current serious infection or other serious medical condition
• Currently active second malignancy other than nonmelanatous skin cancer or carcinoma in situ of the cervix
• Pregnant or lactating female (pre-menopausal females will undergo pregnancy test prior to administration of protocol drugs throughout treatment cycles during this study)
• Acetaminophen use exceeding 2 g per day-includes use of acetaminophen-containing pain medications such as Percocet.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: L-Glutamine; All patients will receive 20-30 grams of l-glutamine daily for 9 weeks (+/- 1 week)	Dietary supplement: L-glutamine; 10,000mg by mouth, twice daily for nine weeks (± 7 days) with one permitted dose escalation to a maximum of 10,000mg by mouth three times daily.; Other Names: Glutamine

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Total sensory neuropathy (area under the curve [AUC]) as measured by the EORTC QLQ-CIPN20 at baseline and week 9	nine weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Assess Quality of Life	Motor neuropathy as measured by the EORTC QLQ-CIPN20 at baseline and week 9; Autonomic symptoms and functioning as measured by the EORTC QLQ-CIPN20 at baseline and week 9; Overall quality of life as measured by the EORTC-30 questionnaire at baseline, 3 weeks, 6 weeks, and week 9; Pain severity as measured by the Visual Analog Numeric Pain Scale at baseline, week 3, week 6 and week 9; Objective assessment performed by Physical Therapy Department as measured by the Functional Gait Assessment at baseline and week 9; Frequency and severity of adverse events reported by the patient in the Symptom Experience Diary and evaluated through clinical assessment by NCI CTCAE v3.0	nine weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Observe progression-free survival for 36 months post-intervention with l-glutamine supplementation	Quarterly record review to determine progression-free survival for 36 months post-l-glutamine intervention	40 months

Collaborators and Investigators

• Sponsor: Eastern Regional Medical Center
• Collaborators: TSPC America, Inc.
• Investigators: Study Director: Jack Medendorp, Eastern Regional Medical Center

Publications and helpful links

General Publications

• Stubblefield MD, Vahdat LT, Balmaceda CM, Troxel AB, Hesdorffer CS, Gooch CL. Glutamine as a neuroprotective agent in high-dose paclitaxel-induced peripheral neuropathy: a clinical and electrophysiologic study. Clin Oncol (R Coll Radiol). 2005 Jun;17(4):271-6. doi: 10.1016/j.clon.2004.11.014.
• Vahdat L, Papadopoulos K, Lange D, Leuin S, Kaufman E, Donovan D, Frederick D, Bagiella E, Tiersten A, Nichols G, Garrett T, Savage D, Antman K, Hesdorffer CS, Balmaceda C. Reduction of paclitaxel-induced peripheral neuropathy with glutamine. Clin Cancer Res. 2001 May;7(5):1192-7.

Study record dates

Study Major Dates

• Study Start: August 1, 2014
• Primary Completion (Actual): April 1, 2015
• Study Completion (Actual): April 1, 2015

Study Registration Dates

• First Submitted: August 11, 2014
• First Submitted That Met QC Criteria: August 11, 2014
• First Posted (Estimate): August 13, 2014

Study Record Updates

• Last Update Posted (Actual): July 12, 2017
• Last Update Submitted That Met QC Criteria: July 10, 2017
• Last Verified: July 1, 2017

More Information

Terms related to this study

• Keywords: breast cancer; peripheral neuropathy; chemotherapy induced peripheral neuropathy; taxane induced peripheral neuropathy
• Additional Relevant MeSH Terms: Nervous System Diseases; Neuromuscular Diseases; Peripheral Nervous System Diseases
• Other Study ID Numbers: ERMC 13-32