A randomized, double‐blind, placebo‐controlled trial of probiotics to reduce the severity of oral mucositis induced by chemoradiotherapy for patients with nasopharyngeal carcinoma

Abstract

BACKGROUND:The objective of this study was to evaluate the effect of a probiotic combination on the severity of oral mucositis (OM), which is a common, unpreventable complication induced by radiochemotherapy in patients with nasopharyngeal carcinoma who undergo concurrent radiochemotherapy (CCRT). METHODS: Eligible patients (n = 99) with locally advanced nasopharyngeal carcinoma who were undergoing CCRT were randomly assigned (2:1) to receive a probiotic combination or placebo during radiochemotherapy, and the incidence of severe OM (grade 3 or higher) was the primary endpoint. RESULTS: Patients taking the probiotic combination showed a significant reduction in the severity of OM. The incidences of grade 0, 1, 2, and 3 OM in the placebo group and the probiotic combination group were 0% and 12.07%, 0% and 55.17%, 54.29% and 17.24%, and 45.71% and 15.52%, respectively. Furthermore, CCRT greatly lowered the number of immune cells, whereas the probiotic combination markedly lowered the reduction rates of CD4 + T cells (76.59% vs 52.85%; P < .05), CD8 + T cells (62.94% vs 29.76%; P < .05), and CD3 + T cells (69.72% vs 45.49%; P < .05) in an A-CCRT-P (after treatment with radiotherapy plus chemotherapy plus the probiotic combination) group. Highthroughput sequencing results indicated that CCRT had obviously disturbed the intestinal diversity of patients in an A-CCRT (after treatment with radiotherapy plus chemotherapy plus a placebo) group, whereas the probiotic combination distinctly restored the microbial diversity in the A-CCRT-P group toward that of healthy people and a B-CCRT-P (before the treatment of radiotherapy plus chemotherapy plus the probiotic combination) group. CONCLUSIONS: A probiotic combination significantly enhances the immune response of patients and reduces the severity of OM through modification of gut microbiota.

Intestinal microbiota regulates anti‐tumor effect of disulfiram combined with Cu2+ in a mice model

“…18 Chi et al indicated that intestinal microbiota regulated the growth of liver tumors by regulating the amount of natural killer T (NKT) cell in the mice liver through mediating bile acid metabolites, and the use of combined antibiotics reduced the tumor volumes and weight in mice. 19 Moreover our studies indicated that the probiotic combination (Bifico) contained Bifidobacterium longum, Lactobacillus lactis, and Enterococcus faecium could significantly reduce oral mucositis caused by radiotherapy and chemotherapy in patients with nasopharyngeal carcinoma 20 ; and another combination probiotics of L. infantis, L. acidophilus, E. faecalis, and Bacillus cereus significantly reduced the severity of physiological and microbial disorders induced by partial gastrectomy in patients with gastric cancer. 21 In view of the important role of DSF and gut microbiota in cancer development and treatment, we wonder if intestinal microbes also play a role in affecting the efficacy of DSF in the treatment of cancers.…”

Lactobacillus reuteri DSM 17938 and ATCC PTA 5289 ameliorates chemotherapy-induced oral mucositis

“…There is a growing interest in the applicability of probiotics in OM; largely driven by the effectiveness of probiotics in reducing the severity of intestinal mucositis 18,19 . In this study we showed for the first time that L. reuteri DSM 17938 and PTA 5289 significantly reduced 5-FU induced damage to the oral mucosa via the reduction of oxidative stress and inflammation in pre-clinical rodent models.…”

Antibiotics for cancer treatment: A double-edged sword

“…In our previous studies, orally taking of probiotics drugs during radiotherapy, chemotherapy and surgery in patients can significantly reduce their side effects by improving the disorder of intestinal microbiota 94 , 95 . Other works also indicated that dietary supplements (prebiotics) 96 or prebiotics 97 could selectively stimulate the growth and activity of internal probiotics to reduce the disorder of intestinal microbiota.…”