Glutamine in oncological treatment

Glutamine is an amino acid that can be absorbed from the food and it is synthesized and stored, mainly in the muscles. It is the building block of proteins and a major source of cellular fuel. Although abundant in the body, patients with cancer and cachexia or those recovering from catabolic states such as surgery, sepsis, may need to increase intake. In post-surgical or critically ill patients, glutamine may improve nitrogen balance, preserve intestinal integrity, maintain intracellular glutamine levels, and reduce hospital stay, but data on whether it can prevent infections are mixed. Studies suggest glutamine or its derivatives are useful against peripheral neuropathy, mucositis, fluorouracil-induced GI toxicity and FOLFOX-induced diarrhea. Glutamine alone also reduced length of hospital stay in patients with colorectal cancer. But findings from cachexia trials are mixed. Other studies suggest glutamine may reduce treatment-induced mucositis and dysphagia in patients with oropharynx and larynx carcinoma, and delay esophagitis onset in non-small cell lung cancer patients. However, meta-analyses report lack of strong evidence with glutamine for oral mucositis and for radiation dermatitis. In pediatric patients with acute lymphoblastic leukemia, glutamine may have benefits against oral mucositis and chemo-induced peripheral neuropathy. (author)