The Effect of Immunonutrition and Chemotherapy-Induced Neutropenia in Advanced Colorectal Cancer Receiving Palliative Chemotherapy, A Pilot Randomized Controlled Trial

Rungprakai  Injong; Nicha  Somlaw; Thanapoom  Rattananupong; Nattaya  Teeyapun; Virote  Sriuranpong; Suebpong  Tanasanvimol; Napa Parinyanitikul

Authors

Rungprakai Injong Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Nicha Somlaw Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Thanapoom Rattananupong Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Nattaya Teeyapun Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Virote Sriuranpong Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Suebpong Tanasanvimol Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Napa Parinyanitikul Chulalongkorn University and King Chulalongkorn Memorial Hospital

Keywords:

immunonutrition, chemotherapy-induced neutropenia, advanced colorectal cancer

Abstract

Objective: To compare the effect of oral nutritional supplements (ONS) with immunonutrients versus standard ONS on grade II-IV neutropenia in colorectal cancer patients undergoing palliative chemotherapy for advanced diseases.

Methods: We conducted a single-center, double-blind, prospective trial with advanced colorectal cancer patients undergoing palliative chemotherapy. Patients were randomized (1:1) to receive either ONS with immunonutrients (ONS-IM) or standard ONS (ONS-SF), each providing 500 kcal/day for 12 weeks. The primary endpoint was the incidence of grade II-IV neutropenia. Secondary outcomes included body weight,body composition, PG-SGA scores, inflammatory parameters, and treatment toxicities which were assessed at baseline and 12 weeks post-chemotherapy between two groups.

Results: From August 2021 to April 2022, fifty patients (24 ONS-IM, 26 ONS-SF) with colorectal cancer were included, 48% were men, with a mean age of 65.8 years and PG SGA ≥ 9 was 60%. There were no significant differences of baseline between groups. Grade II-IV neutropenia was less frequent in the ONS-IM group (16.7% vs 42.3%, p = 0.067). Better mean difference in PG-SGA score was shown in the ONS-IM group (6.70 vs 4.72, p = 0.05). Higher body fat mass and CD3 percentage in the ONS-IM group were significantly reported.

Conclusions: Supplementation with immunonutrition in colorectal cancer patients receiving palliative chemotherapy potentially trend toward reduction of grade II-IV neutropenia and improved nutritional and immunological parameters.

Trial registration the trial was prospectively registered at TCTR as TCTR20210723001 (July/23/2021).

References

Yu K, Zheng X, Wang G, Liu M, Li Y, Yu P, et al. Immunonutrition vs standard nutrition for cancer patients: a systematic review and metaanalysis (Part 1). JPEN J Parenter Enteral Nutr. 2020;44(5):742–767.

Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11-48.

Prieto I, Montemuio S, Luna J, de Torres MV, Amaya E. The role of immunonutritional support in cancer treatment: current evidence. Clin Nutr. 2017;36(6):1457-64.

Chitapanarux I. Randomized study of nutritional status and treatment toxicities of oral arginine, glutamine, and omega-3 fatty acids during concurrent chemoradiotherapy for patients with head and neck cancer. Funct Foods Health Dis. 2016;6(3):121-32.

Kim JM, Sung MK. The efficacy of oral nutritional intervention in malnourished cancer patients: a systemic review. Clin Nutr Res. 2016;5(4):219-36.

Isenring E, Bauer J, Capra S. The scored patient-generated subjective global assessment (PG-SGA) scored and its association with quality of life in ambulatory patients receiving radiotherapy. Eur J Clin Nutr. 2003;57(2):305-9.

dos Santos AF, Lira LLF, Braga GN, Frota MTB, Correa RdGCF, da Costa Chein MB. Association between early application patient-generated subjective global assessment and survival in cancer patients. Nutr Hosp. 2019;36(1):103-108.

Chitapanarux I, Traisathit P, Chitapanarux T, Jiratrachu R, Chottaweesak P, Chakrabandhu S, et al. Supplementation of arginine, glutamine and fish oil in cancer patients treated with concurrent chemoradiotherapy: a randomized control study. Curr Probl Cancer. 2020;44(1):100482.

Kim SH, Lee SM, Jeung HC, Lee IJ, Park JS, Song M, et al. The effect of nutrition intervention with oral nutritional supplements on pancreatic and bile duct cancer patients undergoing chemotherapy. Nutrients. 2019;11(5):1145.

Talvas J, Garrait G, GoncalvesMendes N, Rouanet J, VergnaudGauduchon J, Kwiatkowski F, et al. Immunonutrition stimulates immune functions and antioxidant defense capacities of leukocytes in patients with head & neck cancer treated with radiochemotherapy and esophageal cancer: a doubleblind randomized clinical trial. Clin Nutr. 2015;34(5):810-7.

Zitarska M, Krawczyk-Lipiec J, Kraj L, Zaucha R, Magorzewicz S. Chemotherapy-related toxicity, nutritional status, and quality of life in precachectic oncologic patients with or without high protein nutritional support: a prospective randomized study. Nutrients. 2017;9(10):1108.

Sunpaweravong S, Puttawibul P, Ruangsin S, Laohawiriyakamol S, Sunpaweravong P, Sangthawan D, et al. Randomized study of the anti-inflammatory and immunomodulatory effects of enteral immunonutrition during concurrent chemoradiotherapy for esophageal cancer. Nutr Cancer. 2014;66(1):1-5.