Review of nutritional status, body composition, and effects of antineoplastic drug disposition

Abstract

The overall survival for children with cancer in high income countries is excellent. However, there are many disparities that may negatively affect survival, which are particularly problematic in low income countries, such as nutritional status at diagnosis and throughout therapy. Nutritional status as well as concomitant foods, supplements, and medications may play a role in overall exposure and response to chemotherapy. Emerging science around the microbiome may also play a role and should be further explored as a contributor to disease progression and therapeutic response. This article highlights some of these issues and proposes additional areas of research relevant to nutritional status and pharmacology that are needed in pediatric oncology.

Management of Nutritional Needs in Pediatric Oncology: A Consensus Statement

“…However, there are no high-quality studies demonstrating their effectiveness in achieving pediatric cancer cures [ 40 ]. One of the most common strategies is the intake of plant-derived bioactive compounds: if on one side there is no evidence of efficacy of these products, on the other hand, they can potentially interfere with the metabolism of drugs, so their use without medical evaluation should be discouraged [ 41 , 42 ]. The use of special diets, such as the ketogenic diet or calorie restriction, is also to be avoided, since they lack proven efficacy and represent a potential harmful strategy that may negatively interfere on both the efficacy of active treatments, especially in patients at risk of malnutrition or sarcopenia, and the long-term outcome of cancer survivors [ 42 , 43 ].…”

Nutritional assessment and dietetic resource for children and young people with cancer in the United Kingdom

“…34 The impact may be mediated by factors such as altered susceptibility to infection, 35 but also by dosing inaccuracy and pharmacokinetic variables. 36,37 There are also data implicating specific cellular mechanisms that may be influenced by nutritional state. 38 Long-term follow-up of survivors has identified the extent to which chronic health conditions may affect adult life.…”

“…Most are studies in leukaemia, 30–33 but data are accruing from children with solid tumours 34 . The impact may be mediated by factors such as altered susceptibility to infection, 35 but also by dosing inaccuracy and pharmacokinetic variables 36,37 . There are also data implicating specific cellular mechanisms that may be influenced by nutritional state 38 …”

The role of nutrition in children with cancer

“…Chemotherapy may cause a loss of adipose tissue and lean tissue, while extracellular fluid volume may increase, modifying the drug distribution. 55 In protein-caloric malnutrition, some oxidative functions of the liver are altered, especially those of cytochrome P450 1A2 and 2E1. 56 Reduced protein intake and protein deficiency decrease renal blood flow, glomerular filtration, and renal tubular secretion.…”

“…Despite many possible methods (dosing by ideal body weight, by adjusted body weight and arbitrary dose capping), it is not easy to find the appropriate dose of chemotherapy in obese patients, but it should be considered case by case, based on the specific patient and drug characteristics (i.e., volume of distribution, lipophilicity, protein binding, renal elimination). 55 Finally, higher body surface area is associated with an increased risk of anthracyclinerelated cardiotoxicity. 61 Specific aspects in children with solid tumours.…”