Taxol neuropathy--advice?
 

I've had 5 infusions of Taxol and Herceptin (following dose-dense AC) and I am really starting to get some neuropathy in my fingers. They don't hurt. They are just numb and it is getting difficult to do some tasks with them.
I'm wondering if others are going through this and if they are finding anything that helps. I took glutamine for the first couple of infusions and the numbness went away after 3 days. But both my oncologists said to stop it because it can make tumors grow. I do take B12 and a B Complex. Are there other things that your docs recommend? I really want to complete the course of Taxol and Herceptin but I also don't want permanent neuropathy.
Thanks in advance for all of your input.
Hugs,
Deb

One thing that I found that has helped Neuropathy is Aloe Vera juice, it really helped me when I had a small stroke. There was a supplement that my oncologist recommended - I will try to find the name when I get home from work. It was kind of pricey - but I breezed through Taxol until the last few weeks.

Taxol and Neuropathy
 

I think the peripheral neuropathy is one of (or the) most common side effects to Taxol. I finished Taxol/Herceptin together at the end of February. Side effects included neuopathy (fingers, hands, toes, feet) also accompanied by hypersensitivity to the skin in those areas, soreness and pain around fingernails. I used lots of bandaids and some neosporin(depending on the sensitivity) both on my hands and my feet (depending on the area worst affected).

I couldn't walk more than a half block because of the pain in my feet. I couldn't feel with my fingers...i.e. problems with buttoning, typing, turning pages when reading, opening cans/bottles.

My husband helped by "opening" everything I had trouble with. This was important I think to reduce injury caused by applying too much pressure on areas that were numb.

My doctor took me off the Taxol for 4 out of the 12 weeks. My understanding is that the Taxol is important so I didn't want to wimp out. Basically he understood the side effects without me saying much.

The only noticeable after-effects I am aware of is slight numbness sometimes in my fingers. But that may go away too after time.

Apparently most people probably don't have all these side effects...so you will probably be more fortunate. The good news is that most of the side effects disappear.

I need to type a lot at work. I had problems typing all through the time I was taking Taxol. But not now.

All this to say that the neuropathy is common, something you will want your doctor to be aware of. But nothing to be particularly scared of (I think) unless it becomes extreme.

Also if you are only beginning to notice after several infusions, that may be a good sign as well.

Melanie

My oncologist was the one who suggested I take Glutamine for the duration of my chemo. I did have neuropathy in my left side. It was one reason that she discontinued the T/C component of my chemo after 4 doses. I continue on Herceptin. The neuropathy remains but to a lesser degree. Comes and goes.

To me it is just flat out weird for your onc to follow the belief that oral glutamine supplementation causes tumor growth.

Print this entire article out and take it to him and see what he thinks.

http://theoncologist.alphamedpress.o.../full/12/3/312


Excerpts:

"...Glutamine is a gluconeogenic nonessential amino acid that isstored primarily in skeletal muscle and liver [14], and is oftendepleted in stress states, such as malignancy [16]. It servesas the primary carrier of nitrogen and is the main energy sourcefor rapidly proliferating cells. Rapid proliferation of a tumormay deplete glutamine stores and subsequently lead to cancer-relatedcachexia [17]. Studies have indicated that glutamine supplementationis well tolerated and potentially effective in preventing sideeffects for patients receiving high-dose chemotherapy and bonemarrow transplantation [25]. Supplementation with glutaminecan also protect against doxorubicin-induced cardiac toxicity[26] and prevents atrophy of the intestinal mucosa in patientsreceiving total parenteral nutrition [27]. Preliminary animalstudies suggest that glutamine may prevent neurotoxicity causedby vincristine, cisplatin, as well as paclitaxel [28, 29]. Clinically,paclitaxel-induced myalgias and arthralgias have been successfullyreduced by glutamine in breast cancer patients [30]. Glutaminesupplements may also reduce the severity of peripheral neuropathyin metastatic breast cancer patients receiving high-dose paclitaxeland hematopoietic stem cell transplantation [18]. Interestingly,a byproduct of glutamine metabolism has been identified thatprotects advanced CRC patients from oxaliplatin-induced neuropathy[13].

In the current study, supplementation with glutamine significantlyreduced the incidence and severity of peripheral neuropathyas well as the need for dose reduction of oxaliplatin in thesepatients (Tables 1 and 3). These properties may increase thetherapeutic index of oxaliplatin. The potential role of glutamineas a neuroprotectant may be better understood in the contextof the current hypothesis explaining chemotherapy-induced neuropathy.A study of circulating nerve growth factor (NGF) levels in cancerpatients treated with neurotoxic chemotherapeutic agents foundthat peripheral neuropathy worsened as serum levels of NGF declined[31]. Moreover, the administration of NGF prevents paclitaxel-inducedneuropathy in mice [32]. Because glutamine is known to upregulateNGF mRNA in an animal model [33], glutamine supplements mayprevent chemotherapy-induced neuropathy via upregulating theNGF level. On the other hand, it has also been hypothesizedthat high systemic levels of glutamine may downregulate theconversion of glutamine to an excitatory neuropeptide, glutamate,which may also account for the reduced symptoms observed inpatients receiving glutamine [34]...."
<sup>

</sup>"...A major concern is that glutamine supplements might protecttumor cells from the cytotoxic effects of chemotherapy. However,in the current study, no between-group difference was foundin the response to chemotherapy (52.4% versus 47.8%; p = .90)or survival (p = .79; log-rank test). Although in vitro evidenceof the dependence of tumor growth on glutamine has deterredits application in cancer patients [36], several studies havefailed to show that supplemental glutamine stimulates tumorgrowth [37, 38]. In fact, accumulating in vivo evidence suggeststhat glutamine may actually decrease tumor growth, possiblyby upregulating the immune system [37, 39]. The net outcomemay improve the therapeutic index of oxaliplatin. The overalllymphocyte response (i.e., entry into the cell cycle and proliferation)has been directly correlated with glutamine concentration ofthe culture medium [40]. In a breast cancer xenograft model,the supplemental glutamine group had higher natural killer cellactivity and nearly one half the tumor volume, compared withthe placebo group [41]..."

Brenda, thanks for posting that article.

I had numb fingers and toes while on T/C/H, and am beginning to experience that on T-DM1 (which I think is similar to Vincristine so it was interesting to see that listed as a neuropathy culprit).

My oncologist also recommended Glutamine, along with B-12, B-complex, B6, Folic Acid, CoQ10, Alpha lipoic acid, Acetyl L carnitine, and some others I can't remember - there was a whole list of things (which I am kicking myself for throwing away!). I took all of them. For me, the neuropathy stopped in its tracks, and although it took quite a while to get back to "normal", it did not worsen after I started the supplement regime.

I'll be following this thread in hopes of more info because I could use it myself now~!

My Oncologist recommend Glutasolve - he told me to take it twice a day for 4 days with each treatment. He not only recommended it - but gave me samples - here is link:

http://www.amazon.com/gp/product/B000IFD3PG

I suspect it is similar to what you were taking.

Thanks to everyone for the input. I already have the article one of you posted and I am taking it to the onc. tomorrow. I don't just have 1 onc. telling me not to take it, I have 2!! One is at Cleveland Clinic FL, the other at Mayo Clinic in Rochester. I think they are hung up on a few in vitro studies done in the early 90s that appear to have shown tumor growth. That seems to have been disproved by lots of small studies since so I am challenging them on this. Will keep you posted.

Deb

You go girl! You have your ammo. now.