Probiotics supplementation in patients with colorectal cancer: a systematic review of randomized controlled trials

Abstract

Context Colorectal cancer (CRC) is a leading cause of cancer deaths. Recently, much attention has been given to the microbiome and probiotics as preventive and therapeutic approaches to CRC and the mechanisms involved. Objectives To interpret the findings of randomized controlled trials (RCTs) of probiotics relative to patients with CRC and to outline challenges of and future directions for using probiotics in the management and prevention of CRC. Data sources Web of Science, PubMed, ProQuest, Wile, y and Scopus databases were searched systematically from January 17–20, 2020, in accordance with PRISMA guidelines. Study selection Primacy RCTs that reported the effects of administration to patients with CRC of a probiotic vs a placebo were eligible to be included. Data Extraction The studies were screened and selected independently by 2 authors on the basis of prespecified inclusion and exclusion criteria. The data extraction and risk-of-bias assessment were also performed independently by 2 authors. Results A total of 23 RCTs were eligible for inclusion. Probiotics supplementation in patients with CRC improved their quality of life, enhanced gut microbiota diversity, reduced postoperative infection complications, and inhibited pro-inflammatory cytokine production. The use of certain probiotics in patients with CRC also reduced the side effects of chemotherapy, improved the outcomes of surgery, shortened hospital stays, and decreased the risk of death. Bifidobacteria and Lactobacillus were the common probiotics used across all studies. Conclusion Probiotics have beneficial effects in patients with CRC regardless of the stage of cancer. There is an opportunity for probiotics to be used in mainstream health care as a therapy in the fight against CRC, especially in early stages; however, larger clinical trialsof selected or a cocktail of probiotics are needed to confirm the efficacy, dosage, and interactions with chemotherapeutics agents. Systematic Review Registration PROSPERO registration no. CRD42020166865.

Microbiome modulation in the prevention and management of colorectal cancer: a systematic review of clinical interventions

“…Lately, the interest in studying how microbiome modulation can be utilized in the prevention and management of colorectal cancer has increased significantly. Several reviews assessed the impact of gut microbiota and probiotic supplementation in CRC patients [72][73][74]. However, most of these reviews focused on specific evaluations or subgroups of patients, such as being limited to fecal samples or post-op patients.…”

Microbiome & Cancer

“…ESMO, MASCC, and ESPEN guidelines already consider that certain probiotic strains may be used to prevent chemotherapy/radiotherapy treatment-related diarrhoea [5][6][7][8]. In a recent systematic review, the use of probiotics during colorectal cancer treatment was deemed safe; however, the authors did not include any CIT clinical trials [9]. In contrast, other studies have found that probiotics might decrease the response to CIT, and there is a lack of evidence comparing each individual approach/strategy, e.g., probiotics vs. fibre, with regards to improved treatment response [10].…”

Pharmacomicrobiomics: Influence of gut microbiota on drug and xenobiotic metabolism

“…Intake of probiotics which are beneficial microorganisms during chemotherapy has been proven to help to lessen the negative effects of chemotherapeutic agents on the gut microbiota 100 . Although probiotic formulations specific for cancer patients are not yet popular, several studies have shown that administering probiotics either as a mixture or singly to cancer patients is beneficial for the management of microbiota‐mediated drug activity modulation 101,102 …”