Probiotics may improve QoL in lung cancer patients

In lung cancer patients undergoing platinum-based doublet chemotherapy, oral compound probiotic supplements may improve their quality of life (QoL) and relieve gastrointestinal (GI) side effects related to their chemo regimen.

Emerging data favour the approach of regulating the gut microbiota to mitigate chemo-related adverse events (AEs). [Crit Rev Microbiol 2023;doi:10.1080/1040841X.2023.2233605] “In particular, the feasibility of probiotic supplementation to ameliorate chemotherapy-related [AEs] has been demonstrated in preclinical and clinical studies,” said the researchers.

However, evidence on the ability of compound probiotics to relieve chemo-related AEs in lung cancer patients undergoing platinum-based doublet chemo is lacking.

Therefore, the team sought to evaluate whether supplementation with oral compound probiotics can reduce chemo-related AEs and deliver QoL improvements in this patient setting. A total of 110 participants (mean age 60 years, 69 percent male) were randomized 1:1 to receive either compound probiotic supplements or placebo. [Thorac Cancer 2024;15:182-191]

After two chemo cycles, those who received probiotics had higher mean scores in the EORTC QLQ C30* dimensions of overall QoL (76.9 vs 58.89; p<0.001) and role function (93.33 vs 85.93; p<0.023) relative to those on placebo.

The higher scores imply that patients on probiotics were able to maintain a relatively good QoL during their chemo sessions, while those on placebo worsened, the researchers said.

There were also markedly lower mean scores (denoting improvement) in the probiotics vs placebo arm in other dimensions such as nausea and vomiting (0 vs 27.04), loss of appetite (6.67 vs 22.22), constipation (0.95 vs 28.15), and diarrhoea (2.86 vs 15.56; p<0.001 for all).

Compared with the placebo arm, the probiotics arm had lower incidences of nausea and vomiting (0 percent vs 71.43 percent), loss of appetite (16.67 percent vs 57.14 percent), constipation (2.38 percent vs 63.27 percent), and diarrhoea (7.14 percent vs 42.86 percent; p<0.001 for all).

There were no grade >3 AEs reported, nor were there any differences in AE rates between the probiotics and placebo arms, except for the incidences of GI reactions such as nausea and vomiting (grade 3; 0 percent vs 4.08 percent), constipation (grade 2; 0 percent vs 10.2 percent), anorexia (grade 2; 2.28 percent vs 12.24 percent), and diarrhoea (grade 3; 0 percent vs 2.04 percent).

Gut microbiota disruption

Chemo drugs can disturb the gut microbiota composition and diversity, and this could lead to adverse effects such as diarrhoea and loss of appetite. [Immunity 2016;45:931-943; Science 2013;342:971-976; Crit Rev Food Sci Nutr 2011;51:239-247]

Given the relationship between gut microbiota composition and short-chain fatty acids (SCFAs) production, the investigators posited that chemo-related GI reactions may be attributed to a drop in SCFA levels due to the gut microbiota imbalance following chemo. [Microorganisms 2022;10:2048]

“Bifidobacterium and Lactobacillus are SCFA-producing microbiota. Supplementation with compound probiotics may reduce chemotherapy-related GI AEs in lung cancer patients by restoring SCFA levels, thus improving QoL,” the researchers said.

Although the study showed that compound probiotic supplements may effectively alleviate GI AEs, the researchers underscored the need for further studies to ascertain whether these supplements can improve other chemo-related AEs and improve the QoL of cancer patients.

“[Our] study is the first step in evaluating compound probiotic supplement intervention in improving QoL and relieving symptoms of patients suffering from the adverse effects of chemo,” they said.

“We have found a positive trend [in] the current study. We plan further clinical trials to provide more robust evidence to confirm the advantages of compound probiotic supplements [in] lung cancer patients undergoing chemotherapy,” they concluded.