Sayles, C., Hickerson, S.C., Bhat, R.R., Hall, J., Garey, K.W., & Trivedi, M.V. (2016). Oral glutamine in preventing treatment-related mucositis in adult patients with cancer: A systematic review. Nutrition in Clinical Practice, 31, 171–179. 

STUDY PURPOSE: To review the evidence for use of oral glutamine to prevent treatment-related mucositis in adult patients with cancer

• DATABASES USED: MEDLINE
• KEYWORDS: glutamine; cancer; mucositis; esophagitis; stomatitis
• INCLUSION CRITERIA: Prospective or retrospective design, evaluating the use of oral glutamine for prevention
• EXCLUSION CRITERIA: Pediatric patients, use of glutamine as treatment for mucositis, combining with other interventions, lack of a control or comparison arm

• FINAL NUMBER STUDIES INCLUDED = 15 studies; only data from 11 studies are discussed.
• TOTAL PATIENTS INCLUDED IN REVIEW = Sample sizes and other study details are not provided.
• SAMPLE RANGE ACROSS STUDIES: 21–326 patients
• KEY SAMPLE CHARACTERISTICS: Patients with varied tumor types and treatments

PHASE OF CARE: Active antitumor treatment

Seven studies reported actual mucositis outcomes. Other studies measured outcomes such as weight change or time to onset but not mucositis grades. Various methods of mucositis grading were used. In seven studies, statistical significance of differences observed was not reported. In 10 of 11 studies, the percent of patients with grade 3 mucositis was lower with oral glutamine. In two studies, grade 4 mucositis incidence was lower with glutamine, and in two studies, it was higher with glutamine. Duration of mucositis and time to development findings were inconsistent. Dosage and timing of glutamine varied across studies.

The results of this systematic review are insufficient to provide strong support for the efficacy of oral glutamine for the prevention of oral mucositis.

The authors stated that the study samples were small. High heterogeneity in terms of tumor types and treatments were involved, and no subgroup analysis was done.

The findings do not show a strong evidence of efficacy of oral glutamine to prevent oral mucositis in patients with cancer undergoing a variety of treatments. Oral glutamine did not, however, demonstrate adverse effects, and some evidence suggests that the severity of mucositis might be lower with glutamine. The effect dose and timing of oral glutamine for various patients and treatment types is unclear.