new treatment for Taxol induced neuropathy?

[Rich66]

Seems like I heard of one recently. Anyone know it? Mom had 1 round of Taxol late September and still has numbness.

[Lani]

Purpose: Dose-limiting toxicity of many newer chemotherapeutic agents is peripheral neuropathy. Prior attempts to reduce this side effect have been unsuccessful. We report on the possible successful reduction of peripheral neuropathy with glutamine administration after high-dose paclitaxel.

Experimental Design: Patients entered a high-dose chemotherapy protocol in which the first high-dose cycle was paclitaxel at 825 mg/m2 given over 24 h. The first cohort of patients did not receive glutamine, and the second cohort of patients received glutamine at 10 g orally three times a day for 4 days starting 24 h after completion of paclitaxel. Neurological assessment was performed at baseline, and at least 2 weeks after paclitaxel, and consisted of a complete neurological exam and nerve conduction studies.

Results: There were paired pre- and post-paclitaxel evaluations on 33 patients who did not receive glutamine and 12 patients who did. The median interval between pre- and post-exams was 32 days. For patients who received glutamine, there was a statistically significant reduction in the severity of peripheral neuropathy as measured by development of moderate to severe dysesthesias and numbness in the fingers and toes (P < 0.05). The degree and incidence of motor weakness was reduced (56 versus 25%; P = 0.04) as well as deterioration in gait (85 versus 45%; P = 0.016) and interference with activities of daily living (85 versus 27%; P = 0.001). Moderate to severe paresthesias in the fingers and toes were also reduced (55 versus 42% and 64 versus 50%, respectively), although this value was not statistically significant. All of these toxicities were reversible over time.

Conclusions: Glutamine may reduce the severity of peripheral neuropathy associated with high-dose paclitaxel; however, results from randomized, placebo-controlled clinical trials will be needed to fully assess its impact, if any. Trials are currently ongoing to assess its efficacy for standard-dose paclitaxel in breast cancer and other tumors for which peripheral neuropathy is the dose-limiting toxicity.

[Lani]

All: 1

Review: 1
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1: Ann Pharmacother. 2008 Oct;42(10):1481-5. Epub 2008 Aug 12. Links
Oral glutamine for the prevention of chemotherapy-induced peripheral neuropathy.

Amara S.
Pharmacy Department, Saint Barnabas Medical Center, 94 Old Short Hills Rd., Livingston, NJ 07039, USA. samara@sbhcs.com
OBJECTIVE: To evaluate the role of glutamine in the reduction of peripheral neuropathy associated with neurotoxic chemotherapy. DATA SOURCES: Relevant literature was accessed through PubMed (1990-May 2008), using the search terms glutamine, chemotherapy, peripheral neuropathy, neurotoxicity, safety, paclitaxel, platinum compounds, and vinca alkaloids. References in the identified articles were also reviewed for pertinent information. STUDY SELECTION AND DATA EXTRACTION: Studies evaluating the role of oral glutamine for prevention and treatment of chemotherapy-induced peripheral neuropathy (CIPN) were included. Studies regarding the role of glutamine in the reduction of other radiation- and chemotherapy-related toxicities, such as mucositis, cardiotoxicity, diarrhea, and cachexia, were excluded. DATA SYNTHESIS: CIPN is a significant adverse effect associated with neurotoxic chemotherapy, particularly with taxanes, platinum compounds, and vinca alkaloids. There is no standard therapy for the treatment of this dose-limiting reaction. Glutamine is a nonessential amino acid that is thought to have a neuroprotective role, possibly due to the upregulation of nerve growth factor. Two studies revealed that oral glutamine was effective in reducing peripheral neuropathy associated with high-dose paclitaxel, as evidenced by a reduction in numbness, dysesthesias, and motor weakness, as well as a smaller loss of vibratory sensation. Another study found that glutamine effectively reduced peripheral neuropathy in patients with colorectal cancer being treated with oxaliplatin, thereby decreasing the need for an oxaliplatin dose reduction. However, data are limited by small sample sizes in these studies and the lack of placebo-controlled, randomized clinical trials. CONCLUSIONS: Larger, well-designed, placebo-controlled trials assessing both safety and efficacy of oral glutamine are warranted before this agent can be definitively recommended for the prevention of CIPN in patients treated with high-dose paclitaxel or oxaliplatin.
PMID: 18698011

[dlaxague]

Hi Rich,

I don't remember anything new. The L-glutamine idea that Lani posted has been around for a long time - I took it in 2001. And I think that it's meant as preventative - I don't think it's been studied after the neuropathy is already there.

Drugs that work for "nerve pain" can help. Drugs like neurontin and lyrica. Some are bothered by their sedative side effects but usually that improves after the first few days.

I've asked and not really received a good answer, whether these kinds of neuropathic pain drugs actually "fix" the neuropathy or simply mask the symptoms. Maybe I just don't know who to ask. But even if they're just alleviating symptoms, that's something.

Debbie Laxague

[Henny]

I took Neurosol (from Metagenics.com) which my oncology naturopath recommended. I took it during chemo and for about 6 months after.
I don't know if it really worked but the numbness and pain in my feet did lessen tremendously. Maybe my neuropathy would have gotten better all by itself but I wanted to help it along if possible.

[Rich66]

Thanks folks,
I'm surprised one infusion could induce a lasting neuropathy. it's not limiting function but still surprising to me. Makes me wonder what she'll end up with if she needs to revisit taxanes. There's been some discussion of Taxotere down the road if her liver function becomes adequate.

I had a nerve examination of my legs and it consisted of usual tapping with hammers and then a lot of electrical tests. You might be perplexed to know that many of these were in the form of small electric shocks. I am still awaiting for final report. I check out this site but don't know Is it gonna help me or not. May be you can guide me here.

http://www.anodynetherapy.ca/

[Trish]

There was a recent post about a study of a topical analgesic cream for the treatment of peripheral neuropathy. It was called Epi-cept (Amylnitrate and ketamine)
Trish