I began to experience peripheral
neuropathy following the first Taxotere infusion, notwithstanding 20 mg
of Decadron IV as pre-medication. Paresthesia (burning, tingling) in my
legs/feet and hands began about 6 hours after infusion and escalated
with each treatment. I asked my medical oncologist and urologist about
drugs to lessen this toxicity and both said that there are none and if
the patient cannot tolerate it, the condition becomes dose- or
treatment-limiting.
However, after I was suffering from
deep nail neuropathy, a fellow PCa patient told me about glutamine as a
protectant against chemotherapy toxicities. Glutamine is a neutral
gluconeogenic amino acid that is vital in whole-body nitrogen metabolism
and it is depleted by many traumas such as surgery, infections, and
cancer. Replacement thereof is necessary for the body to function
properly. Powdered glutamine is readily available in drug stores and
health food stores and costs about $45 for 500 grams. Its most common
use is by body builders or athletes following a strenuous work-out.
A significant body of peer-reviewed
trials and reports exist detailing the chemoprotectant qualities of
glutamine. Saverese, et al. (1) reported that up to 75% of Taxol
patients experience myalgias (muscular pain) and arthralgias (joint
pain) and that 10 g p.o. t.i.d. (orally, 3 X/day) is a cost-effective,
nontoxic method of preventing/lessening these toxicities. Vahdat (2)
reported that 10 g p.o. t.i.d. for 4 days started 24 hours after chemo
infusion significantly reduced peripheral neuropathy, dysethesias
(numbness) in fingers/toes, deterioration of gait, and paresthesais
(burning, tingling) resulting from Taxol infusions. Fahr, et al. (3)
reported that glutamine may decrease tumor growth by enhancing NK
(natural killer) cells. Rouse K, et al. (4) reported that oral glutamine
enhances the selectivity of antitumor drugs by protecting normal tissues
and possibly sensitizing tumor cells to chemotherapy treatment related
injury.
(Note 1: added by Hansen: Bill
Aishman feels that the "24 hours after chemo" statement doesn't matter
-- his recommendation based on his own experience is to take it all the
time when on chemotherapy(7 days/week) or more specifically "my feet are
a mess and I definitely see a difference when I don't take it)."
(Note 2: glutamine is a
white powder that doesn't dissolve well. Stir well and use a cold to
warm to hot liquid when mixing it. The decomposition temperature of
glutamine is 185ºC -- well above the boiling point of water(100ºC.)
Thus, it would seem that glutamine is ok to mix with hot drinks. It has
no taste of its own.)
Klimberg, et al (5) reported that a
tumor acts as a ‘glutamine trap’ depleting the host of glutamine and
resulting in cachexia (weight loss); supplemental glutamine does not
make tumors grow, but in fact results in decreased growth through
stimulation of the immune system; and when given with chemotherapy,
glutamine protects the host and increases the selectivity of therapy for
the tumor. Anderson, et al (6) states that oral glutamine (as a
mouthwash) is simple to use and increases the comfort of many patients
at high risk of developing stomatitis (mouth sores) as a result of
intensive cancer chemotherapy. Miller (7) reported that the use of
glutamine seems to prevent gut and oral toxic side-effects, and may
increase the effectiveness of some chemotherapy drugs. Myers CE (8)
states that the body’s need for glutamine can increase dramatically
following injury, infection, or the progression of cancer and in these
cases, the need for glutamine can exceed the ability of the body to
supply it; glutamine is one of the major energy sources needed for the
gastrointestinal tract cells to recover from chemotherapy; a glutamine
mouthwash 2 X/day will dramatically lessen stomatitis (mouth sores) in
patients on chemotherapy; glutamine plays a critical role in the body’s
ability to defend itself against cancer.
In summary, significant benefits
are claimed in medical literature for glutamine supplementation during
chemotherapy (and during radiation): a.) it provides the necessary
energy-producing amino acid to replace that which is lost during
chemotherapy, b.) it minimizes chemotherapy side effects, including
neuropathy, arthralgia (joint pain), myalgia (muscular pain),
paresthesias (burning, tingling sensations), dysethesias (impairment of
sensation), and stomatitis (mouth sores); by eliminating or lessening
these side effects, it is possible to extend the duration or dose of
chemotherapy to induce apoptosis (cell death), c.) it prevents cachexia
(weight loss), and d.) it enhances the immune system to produce natural
killer (NK) cells, thus suppressing tumor growth.
If one collectively considers these
benefits it is reasonable to assume that there is a strong potential for
increased survival as a result of glutamine supplementation during
chemotherapy (or radiation).
However, two reports (9) state that
since tumors require glutamine, providing dietary glutamine may
stimulate growth in some tumors. Myers (8) addresses this issue by
stating that while glutamine is needed for tumor growth, it also plays a
critical role in the ability of our body to defend itself against
cancer. Myers continues with a caution to not treat yourself with
glutamine without first discussing this in detail with your doctor.
Obviously, I am taking oral
glutamine now and intend to notify my medical oncologist that I will be
taking 10 g X 4/day during any renewed chemotherapy treatments, since
there appears to be no side-effects. Glutamine is most effective in
powder form; it is odorless and tasteless and should be mixed with a
cool drink, as hot drinks lessen the effectiveness. A discussion of
glutamine (and other amino acids), suggested dosing schedules, and
suggested support additives thereto can be found in a book by Sahley, et
al. (10).
At the suggestion of a PCa friend I
also searched another chemo-protectant that seems to be very effective. I
found 22 trials and reports detailing the efficacy of Amifostine (Ethyol)
to relieve most toxicities from cancer chemotherapy. But after searching
and briefing the 22 reports, I retrieved the specification sheets
regarding the drug and decided that I definitely prefer glutamine as my
chemo-protectant. Amifostine is infused immediately before chemotherapy,
but you must have 2 pre-medicines to protect from the protectant; you
must be laying down (supine position) and your vital signs are checked
every 5 minutes; it can cause severe nausea and vomiting; systolic blood
pressure may decrease significantly and the infusion must be stopped;
you must drink sufficient liquids because amifostine causes severe
dehydration; you may experience hypocalcemia (burning, tingling, muscle
cramps) during infusion, dizziness, flushing, and/or hiccups.
While amifostine seems to be
effective in eliminating/reducing chemo-toxicity, this solution seems
worse than the effects of chemotherapy toxicities and I prefer glutamine
(simple to use, with no reported side-effects) as my chemo-protectant.
(Note by Hansen on 2/9/05): Since
Aishman wrote the above, oncologists have developed ways of giving
Ethyol safely -- by using lower doses and very short infusion times. For
example, here is one patients anecdotal report on his use of Ethyol at
the end of his chemotherapy:
"I have taken Ethyol(amifostine) 500 mg IV at the conclusion of my chemo for PN , primarily
at my toes bilaterally. I experienced no side effects and had a marked
improvement in the PN almost immediately which has remained static.")
Copyright © 2002 Bill Aishman
NOTE: I am not a doctor and can
not give medical advice. I am not a medical researcher. I am a prostate
cancer patient and I performed this layman’s analysis for my own
decision-making purposes. In conjunction with a medical team, every
cancer patient must make their own decisions regarding treatment
options. I make no claim that this analysis is definitive or complete.
Every HRPC patient should thoroughly review the Life Extension
Foundation’s web site www.lef.org Prostate Cancer-Late Stage. I invite
any and all additive contributions to my analysis that will provide
patients a framework which will enhance their ability to make informed
decisions regarding the use of chemotherapy protocols in their struggle
with prostate cancer.
References.
(1)
Saverese D, et al: Glutamine Treatment of
Paclitaxel-Induced Myalgias and Arthralgias. J Clin Oncol;Vol 16,No
12:3918-19, 1998.
(2) Vadhat L: Reduction of Paclitaxel-Induced Peripheral
Neuropathy With Glutamine. Chemotherapy Foundation Symposium XVII;Nov
8-11, 2000, abstract 41.
(3) Fahr MJ, et al.: Glutamine enhances immunoregulation
of tumor growth. JPEN J Parenter Entral Nutr 1994 Nov-Dec;18(6):471-6.
(4) Rouse K, et al.: Glutamine enhances selectivity of
chemotherapy through chenges in glutathione metabolism. Ann Surg 1995
Apr;22(4):420-6.
(5) Klimberg VS, et al.: Glutamine, Cancer, and its
Therapy. Am J Surg 1996 nov;172(5):418-24.
(6) Anderson PM, et al.: Oral glutamine reduces the
duration and severity of stomatitis after cytotoxic cancer chemotherapy.
Cancer 1998 Oct 1:83(7):1433-9.
(7) Miller AL: Therapeutic considerations of
L-glutamine: a review of the literature. Altern Med Rev 1999
Aug;4(4):239-48.
(8) Myers CE: Prostate Forum, March 2000;Vol 5, No 34.
(9) Altern Med Rev 1999;4:239-48; and J Surg Res 1990;48:319-23.
(10) Billie J Staley, Ph.D. , et al, Heal with Amino Acids and Nutrients.
