Probiotics in the prevention of intestinal adverse effects induced by cancer treatments.

What is it about?

The human microbiota comprises a collection of microorganisms that exist in a symbiotic relationship with the host. Recent studies indicate that disturbances in the microbiota may be implicated in a number of chronic diseases, including cancer. Patients receiving cytotoxic and radiation therapy for malignant diseases may go on to exhibit marked changes in the intestinal microbiota. These intestinal microbiota shifts may contribute to the development of mucositis associated diarrhoea and bacteraemia. Prevention of cancer therapy-induced mucositis by probiotics has been investigated in randomised clinical trials with some promising results including a significantly decreased prevalence of diarrhoea and infectious complications.

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Why is it important?

Mucositis is a major side effect of medical treatments in oncology. Other areas of the gastrointestinal as well as the genitourinary tract and other mucosal surfaces can be adversely affected in subjects receiving radiotherapy, and/or chemotherapy. Methotrexate, 5-fluorouracil-, and irinotecan-induced mucositis has been extensively studied. Various pharmaceutical drugs and complementary medicines including activated charcoal (66), glucosamine (67), green tea polyphenols (68), honey (62), linseed oil (69) and traditional Chinese herbal formulations (70) have been investigated for their ability to ameliorate the oral mucositis or intestinal toxicity of chemotherapeutic agents. The potential benefit of probiotics in the prevention or treatment of chemotherapy- or radiation-induced mucositis is emerging in animal (34, 71) and human studies (61, 72). The human microbiota is the collection of microorganisms in the body that exist in a symbiotic relationship with the host. Recent studies indicate that disturbances in the microbiota may be implicated in a number of diseases, including cancer. Patients receiving cytotoxic and radiation therapy exhibit marked changes in intestinal microbiota, which may contribute to the development of mucositis, particularly diarrhoea and bacteraemia. A review of the prevention of cancer therapy-induced mucositis by probiotics has been investigated in randomised clinical trials with some promising results. Three of six trials reported a significantly decreased incidence of diarrhoea. One trial reported a decrease in infectious complications. However the mechanisms of action for these interventions have not been fully elucidated. Investigating the concomitant administration of chemotherapy / radiotherapy regimens with probiotics and the effect of the probiotics on the GIT may provide novel mechanisms of action of probiotic-based interventions. There is a biologically plausible notion that a probiotic formula may rescue the GIT microbiota, decrease adverse gastrointestinal effects (e.g., diarrhoea, gut dysbiosis) and favourably modulate and rescue the gastrointestinal microbiota that has been perturbed through the administration of chemotherapy and or radiotherapy regimens.

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