For ONCODOC please: Glutamine as adjunct in weekly Chemo

[Karel]

For Oncodoc please:

Rachel has been placed in a clinical trial combining docetaxel (Taxotere) with an experimental drug PI-88. The protocol is: week 1, 2 and 3 Taxotere on day 1, PI-88 on days 1, 2, 3 and 4. Week 4 is free.

Rachel had marrow depression with Cisplatin and Gemcitabine which curtailed the treatment (as well as peripheral neuropathy which has not quite cleared up yet). She would like to try Glutamine as a "protective agent", and I noticed in a previous message that you use it for 1 week in a monthly chemo regimen. How would you use it in a weekly schedule? Continuously or for 3-4 days per week?

Thanks in advance, Karel.

[cathy]

Karel,

Just wanted to let you know the doc is out of town until Sunday, he posted that he wasnt sure if he would have internet access...

[john]

Don't know what dose, etc but here is some info

Looks like there are conflicting studies and it probably depends upon the type of chemo

Hopefully oncdoc can clarify this

http://www.clinicaltrials.gov/ct/gui/show/NCT00006994

http://www.ncbi.nlm.nih.gov/entrez/quer ... s=14718801

http://www.ncbi.nlm.nih.gov/entrez/quer ... s=15334869

http://www.ncbi.nlm.nih.gov/entrez/quer ... s=14585260

[-Cheryl-]

Any suggesstions to stop neuropathy in my feet and toes. They feel asleep. almost like pins and needles. I fear it worsening and affecting my walking. What can I do to halt it, and is it permanet? I am on a trial with paclitaxol and carboplatin. I get chemo every 3 weeks, and am doing 20 total.

[karenl]

Hi Cheryl

As Dad mentioned above, Mum has some peripheral neuropathy, worse in her feet than her hands. It comes and goes, and we are hopeful that it will slowly improve. We've done quite a bit of research looking for something that might help, and there is some suggestion that glutamine might help reduce the severity of this side-effect. Will have to wait and see!

Some of the reading we've done suggests that the neuropathy often improves spontaneously after chemo is completed, but that it can take several months for the improvement to occur.

Might be worth doing a Google search on glutamine - would be interested to hear what you think.

Karen

[kimblanchard]

Hi Karel, I usually use glutamine for the pain syndrome that you can get with Taxol or Taxotere and that's not usually as much of a problem when given weekly. There is so little solid evidence with glutamine although I definitely think it helps some people a lot. I would probably use it for 3 days with each treatment, usually start the night before and the dose I usually use is 15 grams twice per day with a product called Glutasolve. You can order it from Novartis, it is much cheaper to get it from them directly via the internet. I'm not as convinced that it helps for neuropathy although I think that it might, there is conflicting data about that.

As far as treating neuropathy when it starts, I've had the most success with Neurontin started at low doses then titrated up until effective. Neuropathy usually (not always) gets better after treatment is done but it can take a LONG time (over a year sometimes).

Cheryl, did I read that right? 20 treatments with full dose carbo/taxol? Wow that is a LOT. Most people would not be able to complete that many treatments because the neuropathy usually gets worse with each treatment. There was a lady who supposedly took 77 cycles of taxol for ovarian cancer though so I guess its possible.

[Karel]

Jan, John and Joe (oncodoc) many thanks for your messages and advice. It is difficult to express the value of this forum (especially to those who have not experienced for comparison the West Australian version of The Cancer Council's "Helpline" ).

Thanks again,

Karel.