Nutrition intervention using an eicosapentaenoic acid (EPA)-containing supplement in patients with advanced colorectal cancer. Effects on nutritional and inflammatory status: a phase II trial.
OBJECTIVE
The aim of the study was to assess the impact of an eicosapentanoic acid-containing protein and energy dense oral nutritional supplement (EPA-ONS) on nutritional and inflammatory status, quality of life (QOL), plasma phospholipids (PPL) and cytokine profile, tolerance of irinotecan-containing chemotherapy and EPA-ONS in patients with advanced colorectal cancer (CRC) receiving chemotherapy.


METHODS
Patients with advanced CRC having one prior chemotherapy regimen received 480 ml of EPA-ONS daily for 3 weeks before commencing chemotherapy with folinic acid, 5-fluorouracil, irinotecan (FOLFIRI), and continued for 3 cycles of treatment (9 weeks). All assessments including weight, body composition, C-reactive protein (CRP), QOL, dietary intake, PPL and cytokine analyses were performed at baseline, 3 and 9 weeks.


RESULTS
Twenty-three patients were enrolled, 20 completed 3 weeks, and 15 completed 9 weeks. The mean EPA-ONS intake was 1.7 tetrapaks (408 ml) daily. There was a significant increase in mean weight (2.5 kg) at 3 weeks (p=0.03). Lean body mass (LBM) was maintained. Protein and energy intake significantly decreased after the commencement of chemotherapy (protein p=0.003, energy p=0.02). There was a significant increase in energy levels (p=0.03), whilst all other QOL measures were maintained. PPL EPA levels increased significantly over the first 3 weeks. Mean CRP increased by 14.9 mg/L over the first 3 weeks (p=0.004), but decreased to baseline levels by the end of the trial. There was a significant correlation between plasma IL-6 and IL-10 concentrations and survival, and between IL-12 and toxicity.


CONCLUSIONS
Dietary counseling and the provision of EPA-ONS may result in maintenance of nutritional status and QOL, however randomized trials are required to evaluate the impact of EPA on toxicity from chemotherapy.
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Jane A
JA
Sydney Cancer Centre, Royal Prince Alfred Hospital and Concord Hospital, Sydney, Australia.
Beale
Philip J
PJ
Volker
Dianne H
DH
Smith
Narelle
N
Childs
Annabel
A
Clarke
Stephen J
SJ
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001315:Australia; D015415:Biomarkers / Q000097:blood; D001823:Body Composition / Q000187:drug effects; D002166:Camptothecin / Q000009:adverse effects / Q000031:analogs & derivatives; D015179:Colorectal Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism; D016207:Cytokines / Q000097:blood / Q000187:drug effects; D004044:Dietary Proteins / Q000378:metabolism / Q000627:therapeutic use; D019587:Dietary Supplements; D015118:Eicosapentaenoic Acid / Q000378:metabolism / Q000627:therapeutic use*; D002149:Energy Intake / Q000187:drug effects; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects; D006801:Humans; D007249:Inflammation / Q000378:metabolism*; D000077146:Irinotecan; D002955:Leucovorin / Q000009:adverse effects; D008297:Male; D044342:Malnutrition / Q000178:diet therapy* / Q000209:etiology; D008875:Middle Aged; D009752:Nutritional Status; D018529:Nutritional Support; D010743:Phospholipids / Q000097:blood; D011788:Quality of Life; D016896:Treatment Outcome; D014803:Vitamin B Complex / Q000627:therapeutic use
D015415:Biomarkers; D016207:Cytokines; D004044:Dietary Proteins; D010743:Phospholipids; D014803:Vitamin B Complex; D000077146:Irinotecan; D015118:Eicosapentaenoic Acid; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin