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DOI: 10.1055/s-0045-1807866
Use of probiotics in prevention of chemotherapy induced diarrhea in gastrointestinal cancer patients
Background: Chemotherapy-induced diarrhea is a common and distressing side effect experienced by patients undergoing cancer treatment, particularly those with gastrointestinal cancer. It can lead to significant health complications, including dehydration, electrolyte imbalances, and treatment interruptions. Recent studies have shown that the gut microbiota plays an important role in the development and severity of chemotherapy-induced diarrhea. Modulating the gut microbiota through the use of probiotics has emerged as a potential strategy for preventing and managing chemotherapy-induced diarrhea. In this study we aimed to evaluate the efficacy of probiotics in prevention of chemotherapy induced diarrhea among patients with gastrointestinal cancer.
Methods: Between April 2022 and June 2024, 26 patients diagnosed with gastrointestinal cancer who were intended to receive chemotherapy based on fluoropyrimidine, oxaliplatin, and/or irinotecan were randomized in a ratio 1:1 to receive either a placebo or 20 billion colony-forming units (CFU) of a mixture containing five viable strains including 335mg of Lactobacillus acidophilus NCFM®, Lactobacillus paracasei Lpc-37™, Bifidobacterium lactis Bi-04™, Bifidobacterium lactis Bi-07™, and Bifidobacterium bifidum Bb-02™. Patients were instructed to take the product orally once daily for 90 days and to record their bowel habits in a diary using the Bristol stool scale.
Results: The median age of patients was 61 years (range 32-84). Most patients were diagnosed with tumors in the lower gastrointestinal tract, colorectal (n = 16, 61.54%). The most commonly prescribed treatment regimen includes the combination of capecitabine and oxaliplatin (n = 15, 57.69%). The overall incidence of diarrhea did not differ between groups (placebo 58.82% vs. probiotic 41.18%, p = 0,683). Similarly, no statistically significant reduction of grade 2/3 diarrhea was observed in the probiotic group (placebo 55.56% vs. probiotic 44.44%, p = 0,885). The median of diarrhea episodes for the whole period of 90 days in both groups was 9 (p = 0.732).
Conclusion: Probiotics in comparison to placebo did not result in a statistically significant effect, suggesting a lack of benefit from administered probiotic for prevention of chemotherapy induced diarrhea among patients with gastrointestinal cancer. Grant #2021/12587-2, São Paulo Research Foundation (FAPESP). CAAE 51125421.5.0000.5505. UTN U1111-1296-2263.
Corresponding author: Gabriel Caio de Souza (e-mail: caio_sga@hotmail.com).
No conflict of interest has been declared by the author(s).
Publication History
Article published online:
06 May 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)
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Gabriel Caio de Souza, Ana Paula Ribeiro Paiotti, Humberto Bezerra de Araújo Filho, Cleyton Zanardo de Oliveira, Nora Manoukian Forones, Bianca Luise Teixeira. Use of probiotics in prevention of chemotherapy induced diarrhea in gastrointestinal cancer patients. Brazilian Journal of Oncology 2025; 21.
DOI: 10.1055/s-0045-1807866