Lactobacillus supplementation for diarrhoea related to chemotherapy of colorectal cancer: a randomised study

Abstract

5-Fluorouracil (5-FU)-based chemotherapy is frequently associated with diarrhoea. We compared two 5-FU-based regimens and the effect of Lactobacillus and fibre supplementation on treatment tolerability. Patients diagnosed with colorectal cancer (n ¼ 150) were randomly allocated to receive monthly 5-FU and leucovorin bolus injections (the Mayo regimen) or a bimonthly 5-FU bolus plus continuous infusion (the simplified de Gramont regimen) for 24 weeks as postoperative adjuvant therapy. On the basis of random allocation, the study participants did or did not receive Lactobacillus rhamnosus GG supplementation (1 -2 Â 10 10 per day) and fibre (11 g guar gum per day) during chemotherapy. Patients who received Lactobacillus had less grade 3 or 4 diarrhoea (22 vs 37%, P ¼ 0.027), reported less abdominal discomfort, needed less hospital care and had fewer chemotherapy dose reductions due to bowel toxicity. No Lactobacillus-related toxicity was detected. Guar gum supplementation had no influence on chemotherapy tolerability. The simplified de Gramont regimen was associated with fewer grade 3 or 4 adverse effects than the Mayo regimen (45 vs 89%), and with less diarrhoea. We conclude that Lactobacillus GG supplementation is well tolerated and may reduce the frequency of severe diarrhoea and abdominal discomfort related to 5-FU-based chemotherapy.

Does Preoperative Radiotherapy with Postoperative Chemotherapy Increase Acute Side-Effects and Postoperative Complications of Total Mesorectal Excision? Report of the Randomized Finnish Rectal Cancer Trial

“…bolus 5-fluorouracil and leucovorin is associated with severe and life-threatening gastrointestinal and haematological toxicity (21,22). Severe neutropenia and sepsis leading to death have been reported and explained by idiosyncrasy i.e.…”

Dietary Supplement Use in Cancer Care: Help or Harm

“…Colorectal cancer patients receiving one of two 5-FU chemotherapy regimens were also randomized to receive either Lactobacillus rhamnosus GG at a dose of 1 to 2 Â 10(10) organisms or 11 g of guar gum per day [143]. Subjects receiving the probiotic had fewer episodes of high-grade diarrhea (22 versus 37%, P ¼ .027) and less abdominal discomfort.…”

“…Lower incidence of new disease, new metastases, or death; increased time to relapse [102,103] Probiotics in biliary cancer patients undergoing surgery; colorectal cancer patients undergoing chemotherapy; patients receiving abdominal and pelvic radiation Lower postoperative infection rates; decreased gastrointestinal toxicity (diarrhea) with less hospital care and less reduction in chemotherapy; decreased incidence of diarrhea [106,[143][144][145][146] Glutamine in variety of cancer patients undergoing chemotherapy and radiation Decreased rates and severity of mucositis, neuropathy, and intestinal toxicity; decreased use of pain medication in stomatitis patients; improved nutrition in stomatitis patients; improved ADL in neuropathy patients [112-119, 137-139, 148-150] Vitamin E topically in children undergoing bone marrow transplant; in adults undergoing chemotherapy or radiation to head and neck area Improved stomatitis [122,124,125] Zinc in head and neck patients during radiation therapy Improved stomatitis [126,127] (continued on next page) Chamomile extract as mouthwash in chemotherapy and radiation Improved stomatits sometimes [129,130] Homeopathic remedy including Arnica montana in chemotherapy Improved stomatitis [132] Proteolytic enzymes in head and neck patients with radiation…”

Significance of Natural Product Interactions in Oncology

“…16 Probiotic supplements were observed to reduce diarrhea caused by 5-fluorouracil. 17 Several other supplements are also under investigation to reduce chemotherapy side effects.…”