1. ¹Medical Oncology Unit, Hospital of Urbino, Via Bonconte da Montefeltro, 61029 Urbino, Italy
2. ²Medical Oncology Unit, Hospital of Fabriano, Italy
3. ³Division of Medical Oncology, Hospital of Pesaro, Italy
4. ⁴'G. Fornaini' Institute of Biological Chemistry, University of Urbino, Italy
5. ⁵Laboratory of Biostatistics, Centro Nazionale delle Ricerche (CNR), Rome, Italy

Correspondence: Dr F Graziano, E-mail: frada@tin.it

Received 29 November 2001; Revised 22 March 2002; Accepted 12 April 2002.

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 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.