A randomised double-blind placebo-controlled phase II study of AGI004 for control of chemotherapy-induced diarrhoea

Relationship Between the Gut Microbiome and Systemic Chemotherapy

The intestinal microbiome encodes vast metabolic potential, and multidisciplinary approaches are enabling a mechanistic understanding of how bacterial enzymes impact the metabolism of diverse pharmaceutical compounds, including chemotherapeutics. Microbiota alter the activity of many drugs and chemotherapeutics via direct and indirect mechanisms; some of these alterations result in changes to the drug's bioactivity and bioavailability, causing toxic gastrointestinal side effects. Gastrointestinal toxicity is one of the leading complications of systemic chemotherapy, with symptoms including nausea, vomiting, diarrhea, and constipation. Patients undergo dose reductions or drug holidays to manage these adverse events, which can significantly harm prognosis, and can result in mortality. Selective and precise targeting of the gut microbiota may alleviate these toxicities. Understanding the composition and function of the microbiota may serve as a biomarker for prognosis, and predict treatment efficacy and potential adverse effects, thereby facilitating personalized medicine strategies for cancer patients.

Effect of probiotics on diarrhea secondary to chemotherapy for leukemia

AIM

To evaluate the effect of probiotics on intestinal mucosal barrier function and inflammatory cytokine levels in patients with diarrhea secondary to chemotherapy for acute lymphoblastic leukemia.

METHODS

Ninety patients with chemotherapy-associated diarrhea treated at Taizhou Municipal Hospital from January 2015 to December 2016 were randomly divided into a control group (n = 45) and an observation group (n = 45). Both groups were given montmorillonite powder-based conventional symptomatic treatment, and the observation group was additionally given Bifidobacterium triple viable capsules. Clinical efficacy, intestinal mucosal barrier function, inflammatory cytokine levels, and intestinal flora were compared between the two groups.

RESULTS

In the observation group, 25 (55.56%) cases showed marked improvement and 17 (37.78%) cases showed improvement, with a total effective rate of 93.33%, which was significantly higher than that in the control group (75.56%; P < 0.05). Before treatment, intestinal mucosal barrier function indexes were similar between the two groups (P > 0.05); after treatment, diamine oxidase, D-lactic acid, and endothelin were significantly decreased in both groups, and the decrease was significantly more remarkable in the observation group (P < 0.05). Before treatment, inflammatory cytokines in the two groups were similar (P > 0.05); after treatment, tumor necrosis factor-α, procalcitonin, and interleukin-6 were significantly decreased in both groups, and the decrease was significantly more remarkable in the observation group (P < 0.05). The number of intestinal microbes after treatment was significantly lower than that before treatment in the control group. In the observation group, Bifidobacterium and Lactobacillus were significantly increased after treatment, and the number of intestinal microbes was significantly higher than that of the control group (P < 0.05). Enterobacteriaceae, Enterococcus, and Escherichia coli showed no significant changes between before and after treatment in the observation group (P > 0.05).

CONCLUSION

Auxiliary application of probiotics can significantly improve the therapeutic efficacy for chemotherapy-induced diarrhea in acute lymphoblastic leukemia patients, reduce the levels of inflammatory cytokines, improve intestinal mucosal barrier function, regulate the balance of intestinal flora disturbance, and reconstruct intestinal ecological balance.