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

Br J Cancer. 2007 Oct 22;97(8):1028-34. doi: 10.1038/sj.bjc.6603990. Epub 2007 Sep 25.

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=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 x 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=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.

Publication types

  • Clinical Trial, Phase III
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / drug therapy*
  • Adenocarcinoma / pathology
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Colorectal Neoplasms / drug therapy*
  • Colorectal Neoplasms / pathology
  • Diarrhea / chemically induced
  • Diarrhea / prevention & control*
  • Female
  • Fluorouracil / administration & dosage
  • Fluorouracil / adverse effects
  • Galactans / therapeutic use
  • Humans
  • Lactobacillus rhamnosus*
  • Leucovorin / administration & dosage
  • Leucovorin / adverse effects
  • Male
  • Mannans / therapeutic use
  • Middle Aged
  • Neoplasm Staging
  • Plant Gums / therapeutic use
  • Probiotics / therapeutic use*

Substances

  • Galactans
  • Mannans
  • Plant Gums
  • guar gum
  • Leucovorin
  • Fluorouracil