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Prophylactic probiotics for cancer therapy-induced diarrhoea

a meta-analysis

Wardill, Hannah R.a,b; Van Sebille, Ysabella Z.A.c; Ciorba, Matthew A.d; Bowen, Joanne M.a

Current Opinion in Supportive and Palliative Care: June 2018 - Volume 12 - Issue 2 - p 187–197
doi: 10.1097/SPC.0000000000000338
GASTROINTESTINAL SYMPTOMS: Edited by Joanne M. Bowen and Nicole Blijlevens

Purpose of review Strong preclinical data support prophylactic probiotics as an effective preventive strategy for diarrhoea secondary to anticancer therapies. To determine the composite evidence that this approach translates to the clinic, we performed a meta-analysis of randomized controlled trials (RCTs) of prophylactic probiotics for the prevention of cancer therapy-induced diarrhoea.

Recent findings A three-step search strategy was used to identify relevant studies (1 June 2000–1 June 2017) investigating probiotic intervention for diarrhoea secondary to any cancer therapy (cytotoxic, targeted and immunotherapies). RCTs across PubMed, Embase, CINAHL and CENTRAL were assessed for eligibility and assessed using RevMan 5.3 (The Cochrane Collaboration). Seven trials with a total of 1091 patients were included in this meta-analysis. Compared with placebo, prophylactic probiotics did not prevent or reduce the overall incidence of diarrhoea or severe CTCAE Grade at least 3 diarrhoea [relative risk (RR) = 0.81, 95% confidence interval (95% CI) = 0.60–1.09, Z = 1.41, P = 0.16; RR = 0.54, 95% CI = 0.25–1.16, Z = 1.58, P = 0.11], nor did it influence the use of rescue medication (RR = 0.93, 95% CI = 0.53–1.65, Z = 0.24, P = 0.81).

Summary Current evidence does not support widespread implementation of probiotics for diarrhoea secondary to cytotoxic therapy and the tyrosine kinase inhibitor, dacomitinib. Research efforts should be diverted to pair specific forms of gastrointestinal toxicity and their unique microbial phenotype to develop the ideal microbial protectant.

aAdelaide Medical School, The University of Adelaide

bCentre for Nutrition and Gastrointestinal Diseases, South Australian Health and Medical Research Institute (SAHMRI)

cDivision of Health Sciences, The University of South Australia, Adelaide, South Australia, Australia

dDivision of Gastroenterology, Washington University School of Medicine, Saint Louis, Missouri, USA

Correspondence to Hannah R. Wardill, Level 7, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia. Tel: +61 8 8128 4842; e-mail:

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