A Trial of Glutamine to Prevent Oxaliplatin Neurotoxicity and a Pharmacokinetic Analysis of Oxaliplatin

The investigators hypothesize that glutamine significantly reduces the incidence and severity of peripheral neuropathy in patients receiving oxaliplatin for metastatic colorectal cancer, decreases the need for dose reduction of oxaliplatin, and it does not impair oxaliplatin efficacy or pharmacokinetics.

This is a phase II , open-label, non randomized study of oral glutamine administration to evaluate oxaliplatin pharmacokinetics, and to prevent oxaliplatin neurotoxicity in patients with metastatic colorectal cancer.

Eligibility Criteria:
Study Population: The target population is patients with metastatic colorectal adenocarcinoma who are sufficiently robust to undergo at least 3 cycles of oxaliplatin based chemotherapy (mFOLFOX or XELOX) Sampling Method: Probability Sample.

Inclusion Criteria:

* Patients must hvae metastatic colorectal cancer (stage IV)
* Patients who have been treated with FOLFIRI regimen for metastatic setting may be eligible for this trial
* Patients must be ≥ 18 years
* Patients must have an Eastern Cooperative Oncology Group (EGOC) performance status 0 to 2.
* Patients must have adequate renal function of creatinine \< 1.5mg/dL and a creatinine clearance \> 45mL/min; patients must have adequate hepatic function with a bilirubin \< 1.5mg/dL and AST (normal range 0-14 U/L) and ALT (normal range 0-49 U/L); and patients must have adequate bone marrow function with absolute neutrophil count (ANC) ≥ 1,500/цL and platelets ≥ 100,000/цL and a hemoglobin ≥ 10g/d.
* Patients must be willing and able to comply with the study protocol for the duration of the study.
* Patients must give written informed consent prior to any study-specific screening procedures with the understanding that the patient may withdraw consent at any time without prejudice.
* Women of childbearing potential must have a negative serum pregnancy test performed within 7 days prior to the start of treatment. Women of childbearing potential and men must agree to use adequate contraception prior to study entry and for the duration of study participation.
* The investigator is requested to advise the patient how to achieve an adequate contraception
* Life expectancy longer than 6 months

Exclusion Criteria:

* Patients who have received oxaliplatin previously
* Patients with previous of current diagnosis of peripheral sensory neuropathy
* Patients who have tested positive for HIV
* Patients with other significant medical, psychiatric disorders that, in the opinion of the investigator, will exclude the patient from the study for compliance or safety reasons.
* Patients who cannot swallow
* History of known allergy to oxaliplatin or other platinum compounds, to 5-FU, to LV, glutamine or to any ingredients in the formulations of the containers
* Participation in another clinical trial with any investigational drug within 30 days prior to study screening.
* Pernicious anemia or other megaloblastic anemia with vitamin B12 deficiency
* Patients with concomitant treatment with drugs/ingredients reported to have a potential activity to prevent PSN
* Patients who haven't successfully completed local therapy for previously treated CNS metastases and who haven't been discontinued with corticosteroid for \> 4wks before starting chemotherapy. Patients with asymptomatic brain mets. who have no evidence of midline shift on CT/ MRI may be enrolled without initiation of local therapy for the CNS mets. Repeat scan must be preformed \< 4wks to ensure no progression.