Oral probiotic supplementation to alleviate diarrhea induced by fluoropyrimidines or irinotecan-based chemotherapy: A systematic review and meta-analysis

IF 3.3 3区医学 Q1 INTEGRATIVE & COMPLEMENTARY MEDICINE

Complementary therapies in medicine Pub Date : 2025-02-22 DOI:10.1016/j.ctim.2025.103151

Tippawan Siritientong , Daylia Thet , Nattawut Leelakanok , Nutthada Areepium

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引用次数: 0

Abstract

Background

Fluoropyrimidines and irinotecan cause diarrhea, which can be particularly severe in some cases. Probiotic supplementation is a potential option for managing chemotherapy-induced diarrhea. This study aims to evaluate the efficacy and safety of probiotics in managing diarrhea induced by fluoropyrimidine or irinotecan-based chemotherapy in cancer patients.

Methods

A literature search was conducted in Cochrane Library, PubMed, ScienceDirect, SciFinder, and Scopus in August 2023. Observational and prospective studies of cancer patients receiving 5-fluorouracil, capecitabine, or irinotecan were included. RevMan (version 5.4.1) was used for statistical analysis. The study protocol was registered in PROSPERO.

Results

Of the 9400 records, 24 and 14 studies were included in the systematic review and meta-analysis, respectively. Most studies provided a combination of probiotic strains to patients from the initiation to the completion of chemotherapy cycles. Probiotic supplementation significantly reduced all grade diarrhea (RR = 0.40; 95 % CI: 0.27, 0.60; P < 0.00001, I²: 0 %), nausea and vomiting (RR = 0.49; 95 % CI [0.37, 0.67]; P < 0.00001, I²: 0 %), bloating (RR = 0.27; 95 % CI [0.11, 0.69]; P = 0.006, I²: 0 %) and anorexia (RR = 0.62: 95 % CI [0.43, 0.90]; P = 0.01, I²: 39 %) compared to controls. Absolute risk reductions (ARR) ranged from 22.7 % to 28.5 %, with the number needed to treat (NNT) value of 3–5. Moreover, probiotics improved intestinal microbial balance and symptom scales of quality of life.

Conclusions

Probiotic supplementation is a promising option to manage chemoradiotherapy-induced diarrhea without serious side effects in cancer patients receiving fluoropyrimidines or irinotecan-based regimens. Given the clinically meaningful ARR and favorable NNT values, probiotics may have a role in clinical practice. However, larger trials are needed to standardize probiotic strain, dosage, duration, and target patient subgroups.

Systematic review registration

PROSPERO database (CRD42023473324)

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来源期刊

Complementary therapies in medicine 医学-全科医学与补充医学

CiteScore

8.60

自引率

2.80%

发文量

101

审稿时长

112 days

期刊介绍： Complementary Therapies in Medicine is an international, peer-reviewed journal that has considerable appeal to anyone who seeks objective and critical information on complementary therapies or who wishes to deepen their understanding of these approaches. It will be of particular interest to healthcare practitioners including family practitioners, complementary therapists, nurses, and physiotherapists; to academics including social scientists and CAM researchers; to healthcare managers; and to patients. Complementary Therapies in Medicine aims to publish valid, relevant and rigorous research and serious discussion articles with the main purpose of improving healthcare.