L-glutamine Supplementation to Alleviate Symptoms of Taxane-Induced Neuropathy in Patients With Breast Cancer

L-glutamine has previously been shown to help reduce the incidence of numbness and tingling
in patients with breast cancer who are receiving taxane chemotherapies. However, no study to
date looks at the effect of l-glutamine given after this numbness and tingling (called
'perihperhal neuropathy') has already occurred. We hypothesize that administration of this
amino acid in l-glutamine naïve patients will result in a measureable reduction of their
taxane-induced neuropathy.

Inclusion Criteria:

- Biopsy proven adenocarcinoma of the breast

- Received at least one prior taxane-containing chemotherapy regimen which resulted in
persistent taxane-induced peripheral neuropathy

- Anticipated survival of at least 6 months

- Eastern Cooperative Oncology Group (ECOG) performance status (PS) = 0, 1, or 2

- The patient must have screening laboratory: Transaminases<2.5 x upper limit of
normal; total bilirubin <2.0; creatinine <1.5

- Neuropathy onset from taxane administration no more than 18 months from date enrolled
in trial

- Willingness to adhere to supplemental regimen of l-glutamine 10,000mg taken orally
twice daily, with one potential dose escalation to 10,000mg taken orally three times
daily.

- Grade I-III sensory peripheral neuropathy related to prior taxane use as assessed by
their treating oncologist at Eastern Regional Medical Center

- Able to give informed consent for protocol participation

Exclusion Criteria:

- Participants are not able to understand or provide written informed consent.

- The research team deems that the participant may not be able to follow the study
protocol.

- Current diagnosis of bipolar disorder or other manic state

- Prior use of l-glutamine for prevention or empirical treatment of taxane-induced
sensory peripheral neuropathy

- Prior treatment with a platinum chemotherapy

- Concurrent use of physical therapy interventions such as the 'Rebuilder',
chiropractic care, acupuncture, or other modalities specifically targeting peripheral
neuropathy

- Concomitant use of nutraceutical supplements which may mitigate symptoms of
taxane-induced peripheral neuropathy including B-Complex vitamins, alpha-lipoic acid,
vitamin E, acetyl-l-carnitine, intramuscular B12 injections, fish oil, etc… during
study

- Renal insufficiency : serum creatinine of >1.5 mg /dl

- Hepatic insufficiency: transaminases > 2.5 x upper limit of normal due to isolated
reports of possible hepatic encephalopathy

- New prescription or dose adjustment of current medication for the treatment of
peripheral neuropathy such as gabapentin or Lyrica within the past 30 days.

- Pre-existing sensory peripheral neuropathy from other comorbid conditions such as
diabetes or alcoholism

- Current serious infection or other serious medical condition

- Currently active second malignancy other than nonmelanatous skin cancer or carcinoma
in situ of the cervix

- Pregnant or lactating female (pre-menopausal females will undergo pregnancy test
prior to administration of protocol drugs throughout treatment cycles during this
study)

- Acetaminophen use exceeding 2 g per day—includes use of acetaminophen-containing pain
medications such as Percocet.