Search and Selection of Probiotics That Improve Mucositis Symptoms in Oncologic Patients. A Systematic Review

Abstract

Mucositis is a common and severe adverse effect of radiotherapy and/or chemotherapy treatments applied to oncologic patients. The development of effective therapies and adjuvant treatments to increase their efficacy and reduce adverse effect is a priority in cancer therapy. Probiotics are non-pathogenic live microorganisms that when ingested in adequate amounts can colonize the intestinal tract promoting the restoration of a healthy gut microbiota and contributing to all its functions including the maintenance of the integrity of the mucosa and the modulation of the immune system. In order to check the possible efficacy and safety of these microorganisms to prevent or ameliorate mucositis′ symptoms, we have systematically searched the bibliographic databases MEDLINE (via Pubmed), EMBASE, The Cochrane library, Scopus, Web of science, and Latin American and Caribbean Literature in Health of Sciences (LILACS) using the descriptors “Mucositis”, “Probiotics”, “Neoplasms”, “Humans”, and “Clinical Trials”. After applying our inclusion and exclusion criteria, 15 studies were accepted for review and critical analysis. Our analysis suggests that a combination of Bifidobacterium longum, Lactobacillus acidophilus, Bifidobacterium breve, Bifidobacterium infantis, and Saccharomyces boulardii could be a good combination of probiotics to reduce incident rates of mucositis or ameliorate its symptoms in chemo or radiotherapy treated patients.

A Phase II Randomized Clinical Trial and Mechanistic Studies Using Improved Probiotics to Prevent Oral Mucositis Induced by Concurrent Radiotherapy and Chemotherapy in Nasopharyngeal Carcinoma

“…A recent study also demonstrated that a mix of Bacillus subtilis (2.9 × 10 8 CFU/g), B. bifidum (2.0 × 10 8 CFU/g), E. faecium (2.1 × 10 8 CFU/g), and L. acidophilus (1.0 × 10 8 CFU/g) reduced the histological severity of intestinal mucositis and OM in rats treated with chemotherapy (64). Probiotic-based treatments have proven to be beneficial for chemotherapy-or radiotherapy-induced mucositis, possibly by regulating the microbiome and inhibiting the pro-inflammatory cytokines (65,66). In the same way, B. bifidum G9-1(BBG9-1) eliminates 5-FU-induced mucositis by inhibiting secondary inflammation through a reduction in the abundance of Bacteroidetes and the corresponding increase in the abundance of Firmicutes (67).…”

Acute Radiation Syndrome and the Microbiome: Impact and Review

“…Many probiotic strains were investigated as preventative therapeutics, most of which led to a reduction in diarrhea or bacteremia incidence. Another systematic review considered 15 clinical trials studying varied GI pathologies ( Picó-Monllor and Mingot-Ascencao, 2019 ). They concluded that a combination of probiotics could reduce the incidence of mucositis in chemo- or radiotherapy-treated patients.…”

Effect of <em>Lactobacillus&nbsp;plantarum</em> ACTT 8014 on 5‑fluorouracil induced intestinal mucositis in Wistar rats

“…In animal models attempts to overcome these disturbances were done using probiotics ( 24-29 ), regulators of fecal metabolites ( 30 ), rifaximin ( 31 ) or Chinese medicines with inhibitory effect on cell apoptosis in the intestinal crypt ( 32 ). In humans the treatment of mucositis is based on antibiotics ( 33 ). A recent systematic review concluded that Bifidobacterium longum , Lactobacillus acidophilus , Bifidobacterium breve , Bifidobacterium infantis , and Saccharomyces boulardii could be a good combination of probiotics to prevent mucositis ( 33 ).…”

“…In humans the treatment of mucositis is based on antibiotics ( 33 ). A recent systematic review concluded that Bifidobacterium longum , Lactobacillus acidophilus , Bifidobacterium breve , Bifidobacterium infantis , and Saccharomyces boulardii could be a good combination of probiotics to prevent mucositis ( 33 ).…”