PROBIOTICS MAY LOWER THE RISK OF ORAL MUCOSITIS IN CANCER PATIENTS

Subjects or Study Selection Four electronic databases (PubMed, Embase, Web of Science, and Cochrane Library) as well as ClinicalTrials.gov were search up to May 2019 for randomized controlled trials (RCTs) of cancer patients receiving chemotherapy, radiotherapy, or chemo-radiotherapy potentially causing oral mucositis. A total of 2626 studies were initially identified leading to 5 studies of 435 patients included in the systematic review (SR) and 4 in the meta-analysis (MA). Two independent reviewers extracted the data from included studies which were assessed for risk of bias (RoB) using The Cochrane Collaboration's tool for assessing bias. Key Study Factor The intervention group was treated with probiotic agents, products containing probiotics, or probiotics combined with other drugs. The control group received a placebo, other agents, or no intervention. Main Outcome Measure The primary outcome was the incidence of oral mucositis (OM) according to the Radiation Therapy Oncology Group (RTOG), the European Organization for Research and Treatment of Cancer (EORTC), and the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE). Generally, grade 1-2 OM presents with irritation and patchy mucositis, often with a sero-sanguinous discharge, whereas grade 3-4 OM often presents as fibrinous mucositis, ulceration, hemorrhage, or necrosis leading to severe pain. Main Results Results showed that probiotics significantly reduced the risk of grade 3-4 OM (RR = 0.66, 95%CI = 0.54-0.81) and reduced overall risk by 17% (RR = 0.83, 95%CI 0.72-0.97). There were nonsignificant results provided for cancer therapy completion rate (RR = 1.14, 95%CI = 0.65-2.00) and for patients receiving chemoradiotherapy (RR = 0.52, 95%CI = 0.26-1.04).

Automated summary

The study investigated the impact of cancer patients receiving chemotherapy, radiotherapy, or chemo-radiotherapy on oral mucositis and found that the use of probiotics significantly reduced the risk of moderate to severe oral mucositis, as well as overall risk. However, there were no significant results for cancer therapy completion rate and patients receiving chemoradiotherapy.