The efficacy and safety of probiotics in people with cancer: a systematic review

Redman, Melody; Ward, Evelyn; Phillips, Bob

doi:10.1093/annonc/mdu106

Cited by 165 publications

(116 citation statements)

References 32 publications

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“…Amazingly, the probiotic group obviously reduced the incidence of CTC grade ⩾ 2 diarrhea, (OR = 0.36; 95% CI 0.21-0.59; Po0.0001), also demonstrated in the meta-analysis of Redman et al 22 However, the effect of probiotics was not so significant for reducing incidence of CTC Grade ⩾ 3 diarrhea, as the OR is 0.35 (95% CI 0.13-0.96; P = 0.04), and that, for subgroup analysis, it is also unclear for RID (OR = 0.37, 95% CI 0.09-1.60; P = 0.19) and for CID (OR = 0.40, 95% CI 0.15-1.03; P = 0.06).…”

Section: Efficacysupporting

confidence: 53%

“…As Redman et al 22 reported in a previous systematic review, there was a wide range of AEs for using probiotics in patients with cancer, 'including: bacteraemia/fungaemia, infection, GI symptoms (diarrhoea, constipation, dysphagia, nausea and vomiting), urinary symptoms (only present in patients with transitional cell carcinomas), sicchasia, raised blood pressure and raised intra-cranial pressure'. Because of the heterogeneity of the different treatment regimes and malignancies, the AEs associated with probiotics could not be distinguished.…”

Section: Safetymentioning

confidence: 92%

“…Because of the heterogeneity of the different treatment regimes and malignancies, the AEs associated with probiotics could not be distinguished. Another, what Redman et al 22 studied and assessed was all kinds of tumors, including case reports and non-abdominal or pelvic cancers. The 11 studies assessed in our review included 1612 people (873 consuming probiotics and 739 not consuming probiotics).…”

Section: Safetymentioning

confidence: 99%

“…22,23 However, few systematic reviews and metaanalysis were performed for abdominal and pelvic radiotherapy or CID for the cancers.…”

Section: Introductionmentioning

confidence: 99%

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The efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer: a systematic review and meta-analysis

Wang

et al. 2016

Eur J Clin Nutr

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A systematic review and meta-analysis were designed to evaluate the efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer. We searched the Cochrane Library, PubMed, EMBASE and Web of Science up to November 2015. We also hand searched the citation lists of included studies and previously identified systematic reviews to identify further relevant trials. Odds ratio (OR) was used to compare efficacy, and the pooled OR was estimated using a random effects model; heterogeneity was assessed with Cochran's Q and the Higgins' I-test. Two reviewers assessed trial quality and extracted data independently. Analysis and bias for each included study were performed using Review Manager 5.2. Nine randomized and placebo-controlled studies (N=1265 participants) were included for assessing efficacy, of which seven were about radiotherapy and two about chemotherapy. Probiotic groups were compared with control groups with respect to the the incidence of diarrhea, OR=0.47 (95% confidence interval 0.28-0.76; P=0.002). Eleven studies, including 1612 people (873 consuming probiotics and 739 not consuming probiotics), were used for the analysis of safety of probiotics. Of the 11 studies, seven studies had no adverse events (AEs) caused by probiotics, whereas four studies reported varying degrees of AEs in their treatment. Probiotics may have a beneficial effect in prevention of chemoradiotherapy-induced diarrhea generally, especially for Grade⩾2 diarrhea. Probiotics may rarely cause AEs.

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Section: Efficacysupporting

confidence: 53%

Section: Safetymentioning

confidence: 92%

Section: Safetymentioning

confidence: 99%

“…22,23 However, few systematic reviews and metaanalysis were performed for abdominal and pelvic radiotherapy or CID for the cancers.…”

Section: Introductionmentioning

confidence: 99%

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The efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer: a systematic review and meta-analysis

Wang

et al. 2016

Eur J Clin Nutr

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“…Good evidence in both animal and human studies support that probiotics, prebiotics and synbiotics have a role in the prevention of mucositis during chemotherapy, and that they rarely cause sepsis 86 receptors 99 and, therefore, this finding suggests that the microbiota is a legitimate target for the treatment of patients with metastatic disease. Secondly, it also suggests that there is a role for selective antibiotic use, and that retired compounds can be repurposed for engineering the microbiota.…”

Section: [H2] Dietary Interventionsmentioning

confidence: 99%

Gut microbiota modulation of chemotherapy efficacy and toxicity

Alexander

Wilson

Teare

et al. 2017

Nat Rev Gastroenterol Hepatol

687

560

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Evidence is growing that the gut microbiota modulates the host response to chemotherapeutic drugs, with three main clinical outcomes: facilitation of drug efficacy; abrogation & compromise of anti-cancer effects, and mediation of toxicity. The implication is that gut microbiota are critical to the development of personalized cancer treatment strategies and, therefore, a greater insight into prokaryotic co-metabolism of chemotherapeutic drugs is now required. This thinking is based on evidence from human, animal and in vitro studies and gut bacteria are intimately linked to the pharmacological effects of chemotherapies (5-fluorouracil, cyclophosphamide, irinotecan, oxaliplatin, gemcitabine, methotrexate) and novel targeted immunotherapies such as anti-PD-L1 and anti-CLTA-4. The gut microbiota modulate these agents through key mechanisms, structured as the 'TIMER' mechanistic framework: namely Translocation, Immunomodulation, Metabolism, Enzymatic degradation, andReduced diversity and ecological variation The gut microbiota can now, therefore, be targeted to improve efficacy and reduce the toxicity of current chemotherapy agents. In this Review, we outline the implications of pharmacomicrobiomics in cancer therapeutics and define how the microbiota might be modified in clinical practice to improve efficacy and reduce the toxic burden of these compounds.

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Probiotics for the prevention or treatment of chemotherapy- or radiotherapy-related diarrhoea in people with cancer

Wei

Heus

Wetering

et al. 2018

Cochrane Database of Systematic Reviews

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The efficacy and safety of probiotics in people with cancer: a systematic review

Abstract: Probiotics may be a rare cause of sepsis. Further evidence needs to be collated to determine whether probiotics provide a significant overall benefit for people with cancer.

Cited by 165 publications

References 32 publications

The efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer: a systematic review and meta-analysis

The efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer: a systematic review and meta-analysis

Gut microbiota modulation of chemotherapy efficacy and toxicity

Probiotics for the prevention or treatment of chemotherapy- or radiotherapy-related diarrhoea in people with cancer

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