摘要
Oxaliplatin and infusional fluorouracil/leucovorin or capecitabine has emerged as important options in the adjuvant and palliative treatment of colorectal cancer. Severe Oxaliplatin induced neurotoxicity may require chemotherapy dose reduction or cessation. The incidence of oxaliplatin-induced neurotoxicity has varied from 12% - 18%. Several attempts have been proposed to prevent or treat oxaliplatin-induced neurotoxicity, but treatment of established chronic Oxaliplatin induced neurotoxicity is limited. Purpose: To assess the efficacy of parenteral Glutamine dipeptide (N2-L-Alanyl-L-Glutamine Dipeptide, 20 g·m/100ml, IV) for preventing of oxaliplatin induced neurotoxicity. Patients and Methods: A pilot study was performed. 120 patients with metastatic colorectal cancer (mCRC) entered into the study. 60 patients randomly assigned to receive IV glutamine dipeptide (20 g·m IV) day 1-2 with FOLFOX-4 to be repeated every 15 days as a first line of treatment of metastatic colorectal cancer and 60 patients assigned to receive only FOLFOX-4 (control group). Neurotoxicity symptoms and signs were evaluated before each cycle. Results: There were significantly fewer neurological symptoms in patients receiving glutamine dipeptide than in those who did not. A decreased percentage of grade 1-2 peripheral neuropathy was observed in the glutamine dipeptide group after two cycles (8.3% versus 20%;P = 0.04) and 4 cycles (13.3% vs 26.7%;P = 0.02). A significantly lower incidence of grade 3-4 neuropathy was noted in the glutamine dipeptide group after four and six cycles (6.7% versus 15%, P = 0.02 and 13.3% versus 33.3%. P = 0.04, respectively). The need for oxaliplatin dose reduction was significantly lower in the glutamine dipeptide (Dipeptiven) group (10% vs 26.7%;P = 0.02) and there were no significant differences between two groups in response to chemotherapy among patient with mCRC (48.3% vs 50%). Conclusion: These data concluded that IV dipeptide glutamine significantly decreases the incidence and severity of oxaliplatin induced neurotoxicity of mCRC without any attendant side effects.
Oxaliplatin and infusional fluorouracil/leucovorin or capecitabine has emerged as important options in the adjuvant and palliative treatment of colorectal cancer. Severe Oxaliplatin induced neurotoxicity may require chemotherapy dose reduction or cessation. The incidence of oxaliplatin-induced neurotoxicity has varied from 12% - 18%. Several attempts have been proposed to prevent or treat oxaliplatin-induced neurotoxicity, but treatment of established chronic Oxaliplatin induced neurotoxicity is limited. Purpose: To assess the efficacy of parenteral Glutamine dipeptide (N2-L-Alanyl-L-Glutamine Dipeptide, 20 g·m/100ml, IV) for preventing of oxaliplatin induced neurotoxicity. Patients and Methods: A pilot study was performed. 120 patients with metastatic colorectal cancer (mCRC) entered into the study. 60 patients randomly assigned to receive IV glutamine dipeptide (20 g·m IV) day 1-2 with FOLFOX-4 to be repeated every 15 days as a first line of treatment of metastatic colorectal cancer and 60 patients assigned to receive only FOLFOX-4 (control group). Neurotoxicity symptoms and signs were evaluated before each cycle. Results: There were significantly fewer neurological symptoms in patients receiving glutamine dipeptide than in those who did not. A decreased percentage of grade 1-2 peripheral neuropathy was observed in the glutamine dipeptide group after two cycles (8.3% versus 20%;P = 0.04) and 4 cycles (13.3% vs 26.7%;P = 0.02). A significantly lower incidence of grade 3-4 neuropathy was noted in the glutamine dipeptide group after four and six cycles (6.7% versus 15%, P = 0.02 and 13.3% versus 33.3%. P = 0.04, respectively). The need for oxaliplatin dose reduction was significantly lower in the glutamine dipeptide (Dipeptiven) group (10% vs 26.7%;P = 0.02) and there were no significant differences between two groups in response to chemotherapy among patient with mCRC (48.3% vs 50%). Conclusion: These data concluded that IV dipeptide glutamine significantly decreases the incidence and severity of oxaliplatin induced neurotoxicity of mCRC without any attendant side effects.
作者
Adel Gabr
Ahmed A. S. Salem
Haisem Ahmed Samy
Shimaa Tmam
Anwar Mohammed Ali
Adel Gabr;Ahmed A. S. Salem;Haisem Ahmed Samy;Shimaa Tmam;Anwar Mohammed Ali(Department of Medical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt;Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt;Diagnostic Radiology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt;Radiation Therapy Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt;Department of Neurophysiology, Faculty of Medicine, Assiut University, Assiut, Egypt)
