Potential role of levocarnitine supplementation for the treatment of chemotherapy-induced fatigue in non-anaemic cancer patients

Abstract

Ifosfamide and cisplatin cause urinary loss of carnitine, which is a fundamental molecule for energy production in mammalian cells. We investigated whether restoration of the carnitine pool might improve chemotherapy-induced fatigue in non-anaemic cancer patients. Consecutive patients with low plasma carnitine levels who experienced fatigue during chemotherapy were considered eligible for study entry. Patients were excluded if they had anaemia or other conditions thought to be causing asthenia. Fatigue was assessed by the Functional Assessment of Cancer Therapy-Fatigue quality of life questionnaire. Treatment consisted of oral levocarnitine 4 g daily, for 7 days. Fifty patients were enrolled; chemotherapy was cisplatin-based in 44 patients and ifosfamide-based in six patients. In the whole group, baseline mean Functional Assessment of Cancer Therapy-Fatigue score was 19.7 (±6.4; standard deviation) and the mean plasma carnitine value was 20.9 μ M (±6.8; standard deviation). After 1 week, fatigue ameliorated in 45 patients and the mean Functional Assessment of Cancer Therapy-Fatigue score was 34.9 (±5.4; standard deviation) ( P <.001). All patients achieved normal plasma carnitine levels. Patients maintained the improved Functional Assessment of Cancer Therapy-Fatigue score until the next cycle of chemotherapy. In selected patients, levocarnitine supplementation may be effective in alleviating chemotherapy-induced fatigue. This compound deserves further investigations in a randomised, placebo-controlled study. British Journal of Cancer (2002) 86 , 1854–1857. doi: 10.1038/sj.bjc.6600413 www.bjcancer.com © 2002 Cancer Research UK

Dietary Supplement Use in Cancer Care: Help or Harm

“…After 1 week of supplementation, 13 of 15 subjects increased total and free carnitine along with decreases in fatigue, as measured by Brief Fatigue Inventory scale, and Karnofsky performance status. Similar responses were seen in a group of patients receiving cisplatin or isofosfamide chemotherapy [185]. After 1 week of 4 g of carnitine daily, 45 of 50 subjects with abnormal fatigue significantly improved (P < .001) and they maintained their gains through the next cycle of chemotherapy.…”

“…Decreased dermatitis [162] Chamomile Decreases fatigue [184][185][186][187] Black cohosh extracts in breast cancer patients with menopausal symptoms Decreases vasomotor symptoms in some trials [189,191] Green or black tea in leukoplakia Improved abnormality [194,195] Green tea extract in high-grade intraepithelial neoplasia of the prostate without conventional therapy Decreased progression to frank prostate cancer [196] Pomegranate juice in prostate cancer patients with rising PSA after radiation or surgery…”

Pharmacologic Treatment of Cancer-Related Fatigue

“…We identified three studies (9% of total) of l-carnitine in the treatment of CRF [49][50][51]. These were all open-label prospective designs with 12-50 participants.…”

The Effect of Chemotherapy on Serum Carnitine Levels and Fatigue in Chemotherapy Naive Medical Oncology Patients: A Pilot Study. Carnitine, Chemotherapy and Fatigue

“…Disrupted carnitine metabolism may result in chemotherapy-related fatigue. Previous clinical trials have examined the effects of carnitine supplementation in resolving carnitine deficiencies and its association with fatigue in this population [14,[18][19][20][21][22][23]. The majority of these trials have found carnitine supplementation to significantly improve both carnitine status and measures of fatigue with minimal adverse effects.…”