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Supportive Care in Cancer
Published in: Supportive Care in Cancer 2/2016

Open Access 01-02-2016 | Original Article

Preventive effects of amino-acid-rich elemental diet Elental® on chemotherapy-induced oral mucositis in patients with colorectal cancer: a prospective pilot study

Authors: Yutaka Ogata, Nobuya Ishibashi, Keizou Yamaguchi, Shinji Uchida, Hideki Kamei, Goichi Nakayama, Hiroaki Hirakawa, Masahiko Tanigawa, Yoshito Akagi

Published in: Supportive Care in Cancer | Issue 2/2016

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Abstract

Purpose

The prospective pilot study was designed to evaluate the preventive effects of amino-acid-rich elemental diet (ED), Elental®, on chemotherapy-induced oral mucositis in patients with colorectal cancer. The factors influencing its efficacy are also investigated.

Methods

A total of 22 eligible patients with colorectal cancer experiencing grade 1–3 oral mucositis during treatment with fluorouracil-based chemotherapy entered the current study. Their average age was 67 years. There were 10 male and 12 female. The PS was 0 in the majority of patients. Patients received two courses of the same chemotherapy regimen and Elental® concurrently after recovery to grade 0 or 1 oral mucositis.

Results

FOLFOX6 + bevacizumab in 8 patients, FOLFIRI + bevacizumab in 8 patients, FOLFIRI + panitumumab in 1 patient, FOLFIRI in 1 patient, XELOX + bevacizumab in 2 patients, and S-1 + cetuximab in 2 patients were used as first-line (16 cases) or as second-line (6 cases) chemotherapy. Dose reduction of 5-fluorouracil (5-FU) or oral fluoropyrimidine was performed in the 2 patients achieving grade 3 oral mucositis and in the 3 patients achieving grade 2 oral mucositis. The maximum grade of oral mucositis decreased in 18 of the 22 patients during the first treatment course with Elental® (p = 0.0002) and in 20 of the 22 patients in the second course (p < 0.0001). Multivariate analyses found that the dose reduction in 5-FU or oral fluoropyrimidine, ED intake, and the prior administration of ED were each a significant factor for the preventive efficacy on oral mucositis.

Conclusion

The amino-acid-rich elemental diet Elental® may be useful as a countermeasure for 5-FU-based chemotherapy-induced oral mucositis in patients with colorectal cancer.
Literature
1.
Sonis ST, Elting LS, Keefe D, Peterson DE, Schubert M, Hauer-Jensen M, Bekele BN, Raber-Durlacher J, Donnelly JP, Rubenstein EB, Mucositis Study Section of the Multinational Association for Supportive Care in Cancer; International Society for Oral Oncology (2004) Perspectives on cancer therapy-induced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients. Cancer 100(9 Suppl):1995–2025PubMedCrossRef
2.
Sonis ST (2007) Pathobiology of oral mucositis; novel insights and opportunities. J Support Oncol 5:3–11PubMed
3.
Douillard JY, Cunningham D, Roth AD, Navarro M, James RD, Karasek P, Jandik P, Iveson T, Carmichael J, Alakl M, Gruia G, Awad L, Rougier P (2000) Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomized trial. Lancet 355:1041–1047PubMedCrossRef
4.
de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, Boni C, Cortes-Funes H, Cervantes A, Freyer G, Papamichael D, Le Bail N, Louvet C, Hendler D, de Braud F, Wilson C, Morvan F, Bonetti A (2000) Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18(16):2938–2947PubMed
5.
Cassidy J, Tabernero J, Twelves C, Brunet R, Butts C, Conroy T, Debraud F, Figer A, Grossmann J, Sawada N, Schöffski P, Sobrero A, Van Cutsem E, Díaz-Rubio E (2004) XELOX (capecitabine plus oxaliplatin): active first-line therapy for patients with metastatic colorectal cancer. J Clin Oncol 22:2084–2091PubMedCrossRef
6.
Cory JG, Cory AH (2006) Critical roles of glutamine as nitrogen donors in purine and pyrimidine nucleotide synthesis: asparaginase treatment in childhood acute lymphoblastic leukemia. In vivo 20:587–589PubMed
7.
Chattopadhyay S, Saha A, Azam M, Mukherjee A, Sur PK (2014) Role of oral glutamine in alleviation and prevention of radiation-induced oral mucositis: a prospective randomized study. South Asian J Cancer 3:8–12PubMedPubMedCentralCrossRef
8.
Blijlevens NM, Donnelly JP, Naber AH, Schattenberg AV, DePauw BE (2005) A randomized, double-blinded, placebo-controlled, pilot study of parenteral glutamine for allogeneic stem cell transplant patients. Support Care Cancer 13:790–796PubMedCrossRef
9.
Noé JE (2009) L-glutamine use in the treatment and prevention of mucositis and cachexia: a naturopathic perspective. Integr Cancer Ther 8:409–415PubMedCrossRef
10.
Yamamoto T, Nakahigashi M, Umegae S, Kitagawa T, Matsumoto K (2005) Impact of elemental diet on mucosal inflammation in patients with active Crohn’s disease: cytokine production and endoscopic and histological findings. Inflamm Bowel Dis 11:580–588PubMedCrossRef
11.
Stiff PJ, Erder H, Bensinger WI, Emmanouilides C, Gentile T, Isitt J, Lu ZJ, Spielberger R (2006) Reliability and validity of a patient self-administered daily questionnaire to assess impact of oral mucositis (OM) on pain and daily functioning in patients undergoing autologous hematopoietic stem cell transplantation (HSCT). Bone Marrow Transplant 37:393–401PubMedCrossRef
12.
13.
Sornsuvit C, Komindr S, Chuncharunee S, Wanikiat P, Archararit N, Santanirand P (2008) Pilot study: effects of parenteral glutamine dipeptide supplementation on neutrophil functions and prevention of chemotherapy-induced side-effects in acute myeloid leukemia patients. J Int Med Res 36:1383–1391PubMedCrossRef
14.
Skubitz KM, Anderson PM (1996) Oral glutamine to prevent chemotherapy induced oral mucositis: a pilot study. J Lab Clin Med 127:223–228PubMedCrossRef
15.
Choi K, Lee SS, Oh SJ, Lim SY, Lim SY, Jeon WK, Oh TY, Kim JW (2007) The effect of oral glutamine on 5-fluorouracil/leucovorin-induced mucositis/oral mucositis assessed by intestinal permeability test. Clin Nutr 26:57–62PubMedCrossRef
16.
Keefe DM, Schubert MM, Elting LS, Sonis ST, Epstein JB, Raber-Durlacher JE, Migliorati CA, DB MG, Hutchins RD, Peterson DE, Mucositis Study Section of the Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology (2007) Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer 109:820–831PubMedCrossRef
17.
Barasch A, Peterson DE (2003) Risk factors for ulcerative oral mucositis in cancer patients: unanswered questions. Oral Oncol 39:91–100PubMedCrossRef
18.
Goto A, Yamada Y, Yasui H, Kato K, Hamaguchi T, Muro K, Shimada Y, Shirao K (2006) Phase II study of combination therapy with S-1 and irinotecan in patients with advanced colorectal cancer. Ann Oncol 17:968–973PubMedCrossRef
19.
Vermeulen MA, van de Poll MC, Ligthart-Melis GC, Dejong CH, van den Tol MP, Boelens PG, van Leeuwen PA (2007) Specific amino acids in the critically ill patient—exogenous glutamine/arginine: a common denominator? Crit Care Med 35(9 Suppl):S568–S576PubMedCrossRef
20.
Spielberger R, Stiff P, Bensinger W, Gentile T, Weisdorf D, Kewalramani T, Shea T, Yanovich S, Hansen K, Noga S, McCarty J, LeMaistre CF, Sung EC, Blazar BR, Elhardt D, Chen MG, Emmanouilides C (2004) Palifermin for oral mucositis after intensive therapy for hematologic cancers. N Engl J Med 351:2590–2598PubMedCrossRef
21.
Rosen LS, Abdi E, Davis ID, Gutheil J, Schnell FM, Zalcberg J, Cesano A, Gayko U, Chen MG, Clarke S (2006) Palifermin reduces the incidence of oral mucositis in patients with metastatic colorectal cancer treated with fluorouracil-based chemotherapy. J Clin Oncol 24:5194–5200PubMedCrossRef
22.
Peterson DE, Jones JB, Petit 2nd RG (2007) Randomized, placebo-controlled trial of Saforis for prevention and treatment of oral mucositis in breast cancer patients receiving anthracycline-based chemotherapy. Cancer 109:322–331PubMedCrossRef
23.
Raber-Durlacher JE, von Bültzingslöwen I, Logan RM, Bowen J, Al-Azri AR, Everaus H, Gerber E, Gomez JG, Pettersson BG, Soga Y, Spijkervet FK, Tissing WJ, Epstein JB, Elad S, Lalla RV, Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) (2013) Systematic review of cytokines and growth factors for the management of oral mucositis in cancer patients. Support Care Cancer 21:343–355PubMedCrossRef
Metadata
Title
Preventive effects of amino-acid-rich elemental diet Elental® on chemotherapy-induced oral mucositis in patients with colorectal cancer: a prospective pilot study
Authors
Yutaka Ogata
Nobuya Ishibashi
Keizou Yamaguchi
Shinji Uchida
Hideki Kamei
Goichi Nakayama
Hiroaki Hirakawa
Masahiko Tanigawa
Yoshito Akagi
Publication date
01-02-2016
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 2/2016
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-015-2844-0

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