Relief of eribulin-associated malaise by l-glutamine in two patients with uterine leiomyosarcoma: a case report.

Eribulin (ERI) treatment for leiomyosarcoma causes unexplained malaise and reduced quality of life (QoL) in about 40% of patients. There have been few reports suggesting the risk factors for occurrence of eribulin-associated malaise or effective treatment, whereas our present report focuses on this issue. We encountered two patients with advanced or recurrent uterine leiomyosarcoma who experienced severe malaise while receiving ERI therapy (ERI 1.4 mg/m2 on days 1 and 8 of each 21-days cycle). We retrospectively reviewed these cases to examine the time of onset and change in the severity of malaise, and the change in QoL before and after ERI therapy. The first patient was a 70-year-old woman with severe malaise 3-6 days after ERI administration on day 1 of treatment. Malaise temporarily improved, but ERI resumption on day 8 caused severe malaise relapse on days 11-13. The second patient was a 58-year-old woman with severe malaise on days 4-5 and 11-12 of treatment. QoL worsened by the development of malaise. A bimodal pattern of malaise development was observed during ERI therapy, corresponding to 3-6 days after the administration of ERI. The pattern of malaise development in the present two patients treated with ERI was similar to that of myalgia in paclitaxel-treated patients. Both patients received l-glutamine/azulene combination for gastritis symptoms starting from cycle 2, relieving malaise, resulting in an improvement in the QoL score. Results from future prospective studies will be used to determine whether or not l-glutamine can alleviate ERI-caused malaise and improve the QoL of patients. © The Japan Society of Clinical Oncology 2020.