GOALS OF THE WORK Malignancy produces a state of physiologic stress that is characterized by a relative deficiency of glutamine, a condition that is further exacerbated by the effects of cancer treatment. Glutamine deficiency may impact on normal tissue tolerance to antitumor treatment, and may lead to dose reductions and compromised treatment outcome. Providing supplemental glutamine during cancer treatment has the potential to abrogate treatment-related toxicity. We reviewed the available data on the use of glutamine to decrease the incidence and severity of adverse effects due to chemotherapy and/or radiation in cancer patients. METHODS We performed a search of the MEDLINE database during the time period 1980-2003, and reviewed the English language literature of both human and animal studies pertaining to the use of glutamine in subjects with cancer. We also manually searched the bibliographies of published articles for relevant references. MAIN RESULTS The available evidence suggests that glutamine supplementation may decrease the incidence and/or severity of chemotherapy-associated mucositis, irinotecan-associated diarrhea, paclitaxel-induced neuropathy, hepatic veno-occlusive disease in the setting of high dose chemotherapy and stem cell transplantation, and the cardiotoxicity that accompanies anthracycline use. Oral glutamine supplementation may enhance the therapeutic index by protecting normal tissues from, and sensitizing tumor cells to chemotherapy and radiation-related injury. CONCLUSIONS The role of glutamine in the prevention of chemotherapy and radiation-induced toxicity is evolving. Glutamine supplementation is inexpensive and it may reduce the incidence of gastrointestinal, neurologic, and possibly cardiac complications of cancer therapy. Further studies, particularly placebo-controlled phase III trials, are needed to define its role in chemotherapy-induced toxicity.

中文翻译：

---

用谷氨酰胺预防化学疗法和放射毒性。

工作目标恶性肿瘤会产生生理应激状态，其特征是谷氨酰胺相对缺乏，癌症治疗的影响会进一步加剧这种状况。谷氨酰胺缺乏可能影响正常组织对抗肿瘤治疗的耐受性，并可能导致剂量减少和治疗结果受损。在癌症治疗期间提供补充的谷氨酰胺有可能消除与治疗相关的毒性。我们审查了有关使用谷氨酰胺减少癌症患者化疗和/或放疗所致不良反应的发生率和严重性的可用数据。方法我们对1980年至2003年这段时间的MEDLINE数据库进行了搜索，并回顾了人类和动物研究的英语文献，这些文献涉及在癌症患者中使用谷氨酰胺。我们还手动搜索了已发表文章的书目，以获取相关参考。主要结果现有证据表明，在大剂量化疗和干细胞移植的情况下，补充谷氨酰胺可以降低化疗相关的粘膜炎，伊立替康相关的腹泻，紫杉醇引起的神经病变，肝静脉闭塞性疾病的发生率和/或严重程度，以及蒽环类药物使用时的心脏毒性。口服谷氨酰胺补充剂可以通过保护正常组织免于肿瘤细胞并使之对化疗和辐射相关损伤敏感，从而提高治疗指数。结论谷氨酰胺在预防化学疗法和辐射诱导的毒性中的作用正在发展。谷氨酰胺补充剂价格便宜，并且可以减少胃肠道，神经系统疾病的发生，并可能减少癌症治疗的心脏并发症。需要进一步的研究，特别是安慰剂对照的III期临床试验，以确定其在化疗诱导的毒性中的作用。