Nutritional and anti-inflammatory strategies in the treatment of advanced colorectal cancer - a pilot study.


Read JA, Clarke SJ, Volker D.




Asia Pac J Clin Nutr


Background - Patients with advanced cancer become nutritionally compromised and experience considerable wasting, due to the cachectic inflammatory processes apparent in cancer. The impact of nutritional status on the tolerance to anti-neoplastic therapy has been known for some time, however prognostic nutritional assessment tools, prognostic nutritional indicators and nutritional intervention strategies have been neglected in predicting and modifying chemotherapy treatment. Objective - To determine the degree of malnutrition in patients with advanced colorectal cancer, and to determine if nutritional intervention using a source of concentrated Eicosapentanoic acid (EPA) will help maintain or improve the patients' nutritional and "quality of life" parameters, and improve their tolerance to chemotherapy treatment. Design - 15 of 25 patients with advanced colorectal cancer have been recruited. They are instructed to take the EPA (2g) - containing high protein energy supplement for 3 weeks prior to commencing Irinotecan chemotherapy, and then for 6 weeks during 3 cycles of Irinotecan treatment. Nutritional parameters and inflammatory markers are collected at baseline, at the end of week 3 and at the end of week 9. Nutritional parameters include PGSGA, triceps skin fold, bioelectrical Impedance, and quality of life. The inflammatory markers measured include CRP, IL6 and IL1. Outcome - 15 patients have been accrued into the trial. 13 patients have completed to the end of 3 weeks, 8 have fully completed the trial and 2 are currently on trial. 5 patients have withdrawn before completion. After 3 weeks of taking the EPA-supplement, using a Wilcoxon Signed Ranks test, there were no significant changes in nutritional parameters indicating patients are maintaining their nutritional status. There is a significant increase in the inflammatory marker over 3 weeks. Due to small numbers data at 9 weeks cannot be analysed. Of those who have completed only 2 patients experienced gr.3 diarrhoea, and 1 patient experienced gr.3 neutropenia. Conclusion - Animal studies suggest that EPA reduces the toxicity to Irinotecan. The data suggests the EPA in addition to a high energy/protein diet, helps patients to maintain their nutritional status whilst also helping patients tolerate their treatment with fewer side-effects.