SAN FRANCISCOPreliminary data from an uncontrolled pilot
study suggest that levocarnitine (L-Carnitine, Carnitor) supplementation can
reduce fatigue in some patients. Francesco Graziano, MD, found that 87% of
patients given levocarnitine 4 g/day po for 7 days reported reduced fatigue.
Dr. Graziano is in the medical oncology department at the Hospital of Urbino,
"Carnitine deficiencies may have a role in the development
of chemotherapy-induced fatigue. The carnitine system is necessary for glucose
and lipid metabolism in cells, and carnitine is essential for mitochondrial
energy production. Chemotherapy causes urinary loss of carnitine, which may
lead to asthenia due to impaired energy metabolism," Dr. Graziano said.
The pilot study of levocarnitine supplementation included 30
patients who complained of asthenia after adjuvant or palliative cancer
chemotherapy. Inclusion criteria included Eastern Cooperative Oncology Group
(ECOG) performance status of 0-1, normal nutritional status, normal renal and
liver function, and adequate bone marrow reserve. Patients with anemia or other
asthenia-associated comorbid conditions were excluded, as were patients
receiving corticosteroids, psychostimulants, or vitamins.
Median hemoglobin was 13 g/dL. Primary disease included gastric
cancer (7), lung cancer (7), breast cancer (5), ovarian cancer (4), sarcoma (4)
and other cancers (3). Twenty-three patients had received palliative
chemotherapy, and seven had received adjuvant chemotherapy with curative
intent. Twenty patients received cisplatin (Platinol)-based regimens, four
received ifosfamide (Ifex)-based regimens, and six received taxanes.
The Functional Assessment of Cancer Therapy-Fatigue (FACT-F)
quality of life questionnaire was used to measure fatigue at baseline and
weekly during treatment.
"After 1 week of levocarnitine, fatigue improved in 26
patients (87%). The median FACT-F score at baseline was 35 (range 20-41). In
the 26 patients who improved, fatigue did not recur, and they maintained the
FACT-F score until the next cycle of chemotherapy," Dr. Graziano reported.
"The difference between pretreatment and posttreatment
FACT-F scores was statistically significant [P < 0.001]," he
continued. His group is now considering further investigation of levocarnitine
in a randomized, placebo-controlled study.