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RecruitingNCT05852990Updated Apr 9, 2026

Glutamine Plus L. Reuteri Prevents TKI Therapy-diarrhea in Patients With NSCLC

A Phase 3 interventional study of Glutamine plus L. reuteri in Non-Small Cell Lung Cancer With EGFR Mutation, sponsored by Instituto Nacional de Cancerologia de Mexico. Recruiting at 1 site in Mexico. Open to participants aged 18 Years to 80 Years. Per ClinicalTrials.gov, last updated 2026-04-09.

Sponsored by Instituto Nacional de Cancerologia de Mexico · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
28
Allocation
Randomized
Ages
18 Years to 80 Years
Sex
All
01

Study summary

This open-label randomized clinical trial aims to evaluate the glutamine plus Lactobacillus reuteri supplementation effect in a standard-of-care diet in EGFR mutant patients with advanced non-small cell lung cancer (NSCLC) under tyrosine kinase inhibitors (TKIs) therapy.

The main question it aims to answer is ¿What is the effect of glutamine plus L. reuteri added to an astringent diet in preventing diarrhea generated by TKI therapy?

Patients will receive an astringent diet supplemented with 10 grams of glutamine and L. reuteri (100 million CFU). Researchers will compare the Glutamine plus L. reuteri diet with a standard astringent diet to see if TKI therapy diarrhea is prevented.

Read the detailed description

Patients in the experimental group will receive two sachets of Glutapak-R every twelve hours for up to six weeks alongside treating physician-chosen EGFR therapy. Patients in the control group will receive a standard-of-care diet.

All patients will receive nutritional counseling every two weeks.

02

Conditions studied

  • Non-Small Cell Lung Cancer With EGFR Mutation

Keywords

  • Non-Small Cell Lung Cancer
  • EGFR mutation
  • Glutamine
  • Lactobacillus reuteri
  • standard-care diet
03

Who can participate

Ages eligible
18 Years to 80 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Both sexes
  • ≥ 18 years old
  • Pathologically confirmed diagnosis of NSCLC
  • Stage IIIB - IV by the American Joint Committee of Cancer Version 8.
  • Candidates to receive EGFR-TKI treatment (1st \& 2nd generation TKI)
  • ECOG score ≤ 2
  • Life expectancy > eight weeks
  • Signed written informed consent

Exclusion criteria

Exclusion Criteria:

  • Patients who cannot attend the first protocol appointment.
  • Treatment with other anti-cancer therapy
  • Participating in other clinical trials in the former four weeks
  • Any other serious condition or uncontrolled active infection, altered mental status or psychiatric disorder that, in the investigator´s opinion, would limit the ability of an individual to meet the requirements of the study or which affects the interpretability of the results.
  • Active hepatitis virus infection (any serotype) or chronic infection with a potential risk of reactivation evaluated through a serological panel.
  • Active HIV infection.
  • Breastfeeding.
04

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Single group
Masking
None (open label)
Enrollment
28 participants (estimated)

Study arms

  • Experimental
    Intervention diet

    Astringent diet supplemented with one sachet containing 10 grams of glutamine plus 100 million Colony Forming Units (CFU) of Lactobacillus reueri every 12 hours, from baseline treatment up to 6 weeks or death.

    Combination Product: Glutamine plus L. reuteri

  • No intervention
    Standard diet

    Astringent diet from baseline treatment up to 6 weeks or death.

Interventions

  • Combination productGlutamine plus L. reuteri

    Glutamine plus Lactobacillus reueri twice daily for up to 6 weeks or death

    Also known as: Glutapak-R

05

What researchers measure

Primary outcomes

  1. Diarrhea toxicity

    The diarrhea grade will be determined from 1 to 5 following the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. As shown below: grade 1: Increase of \< 4 stools per day over baseline; mild increase in ostomy output compared to baseline grade 2: Increase of 4 - 6 stools per day over baseline; moderate increase in ostomy output compared to baseline; limiting instrumental ADL. grade 3: Increase of \>= 7 stools per day over baseline; hospitalization indicated; severe increase in ostomy output compared to baseline; limiting self-care ADL. grade 4: Life-threatening consequences; urgent intervention indicated grade 5: Death

    Time frame: every two weeks, from first dose of TKI therapy up to six weeks.

  2. Functional Assessment of Chronic Illness Therapy

    This assessment will be evaluated with a specific scale for diarrhea (FACIT instrument), which consists of 11 items that assign a value of 0 to 4 for each one. Higher the score, the better quality of life related to diarrhea.

    Time frame: Every two weeks, from first dose of TKI therapy up to six weeks.

Secondary outcomes

  1. Grade of gastrointestinal toxicity

    This outcome will be determined from grades 1 to 5 according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 for gastrointestinal disorders.

    Time frame: Every two weeks, from first dose of TKI therapy up to six weeks.

  2. Measurement of health related quality of life (QoL)

    The QoL of patients with cancer will be determined by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire version 3.0 (EORTC QLQ-C30 v3.0) instrument.

    Time frame: Every two weeks, from first dose of TKI therapy up to six weeks.

  3. Measurement of quality of life (QoL) for lung cancer patients

    The QoL for Lung Cancer patients will be determined by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire version 3.0 (EORTC QLQ-LC13) instrument.

    Time frame: Every two weeks, from first dose of TKI therapy up to six weeks.

06

Study locations

1 of 1 sites recruiting
  • Instituto Nacional de Cancerologia de Mexico
    Mexico City, Mexico City 14080, Mexico
    • Oscar G Arrieta Rodriguez, M.D., M.Sc. · Contact
    Recruiting
07

References and documents

Publications

  • Arrieta O, Nunez-Valencia C, Reynoso-Erazo L, Alvarado S, Flores-Estrada D, Angulo LP, Onate-Ocana LF. Health-related quality of life in patients with lung cancer: validation of the Mexican-Spanish version and association with prognosis of the EORTC QLQ-LC13 questionnaire. Lung Cancer. 2012 Jul;77(1):205-11. doi: 10.1016/j.lungcan.2012.02.005. Epub 2012 Mar 3. PubMed 22387006 ↗
  • Goldstraw P, Ball D, Jett JR, Le Chevalier T, Lim E, Nicholson AG, Shepherd FA. Non-small-cell lung cancer. Lancet. 2011 Nov 12;378(9804):1727-40. doi: 10.1016/S0140-6736(10)62101-0. Epub 2011 May 10. PubMed 21565398 ↗
  • Walters S, Maringe C, Coleman MP, Peake MD, Butler J, Young N, Bergstrom S, Hanna L, Jakobsen E, Kolbeck K, Sundstrom S, Engholm G, Gavin A, Gjerstorff ML, Hatcher J, Johannesen TB, Linklater KM, McGahan CE, Steward J, Tracey E, Turner D, Richards MA, Rachet B; ICBP Module 1 Working Group. Lung cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK: a population-based study, 2004-2007. Thorax. 2013 Jun;68(6):551-64. doi: 10.1136/thoraxjnl-2012-202297. Epub 2013 Feb 11. PubMed 23399908 ↗
  • Secombe KR, Van Sebille YZA, Mayo BJ, Coller JK, Gibson RJ, Bowen JM. Diarrhea Induced by Small Molecule Tyrosine Kinase Inhibitors Compared With Chemotherapy: Potential Role of the Microbiome. Integr Cancer Ther. 2020 Jan-Dec;19:1534735420928493. doi: 10.1177/1534735420928493. PubMed 32493068 ↗
  • Achamrah N, Dechelotte P, Coeffier M. Glutamine and the regulation of intestinal permeability: from bench to bedside. Curr Opin Clin Nutr Metab Care. 2017 Jan;20(1):86-91. doi: 10.1097/MCO.0000000000000339. PubMed 27749689 ↗
  • Sanchez-Lara K, Turcott JG, Juarez E, Guevara P, Nunez-Valencia C, Onate-Ocana LF, Flores D, Arrieta O. Association of nutrition parameters including bioelectrical impedance and systemic inflammatory response with quality of life and prognosis in patients with advanced non-small-cell lung cancer: a prospective study. Nutr Cancer. 2012;64(4):526-34. doi: 10.1080/01635581.2012.668744. Epub 2012 Apr 10. PubMed 22489794 ↗
  • Arrieta O, Michel Ortega RM, Villanueva-Rodriguez G, Serna-Thome MG, Flores-Estrada D, Diaz-Romero C, Rodriguez CM, Martinez L, Sanchez-Lara K. Association of nutritional status and serum albumin levels with development of toxicity in patients with advanced non-small cell lung cancer treated with paclitaxel-cisplatin chemotherapy: a prospective study. BMC Cancer. 2010 Feb 21;10:50. doi: 10.1186/1471-2407-10-50. PubMed 20170547 ↗
08

Registry details

Key details

Study ID
NCT05852990
Lead sponsor
Instituto Nacional de Cancerologia de Mexico
Responsible party
Oscar Gerardo Arrieta Rodríguez (Head of the Thoracic Oncology Unit and Personalized Medicine Laboratory, Instituto Nacional de Cancerologia de Mexico) — Principal investigator
First posted
May 10, 2023
Start date
Mar 1, 2022
Primary completion
Dec 1, 2026 (estimated)
Completion
Dec 12, 2027 (estimated)
Last update
Apr 9, 2026

Study contacts

Oscar G Arrieta Rodriguez, M.D., M.Sc.
Contact
ogar@unam.mx
556280400 ext. 711101
Oscar G Arrieta Rodriguez, M.D., M.Sc.
principal investigator · Instituto Nacional de Cancerología de México

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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