Preventive effects of amino-acid-rich elemental diet Elental® on chemotherapy-induced oral mucositis in patients with colorectal cancer: a prospective pilot study.
OBJECTIVE
The prospective pilot study was designed to evaluate the preventive effects of amino-acid-rich elemental diet (ED), Elental(®), on chemotherapy-induced oral mucositis in patients with colorectal cancer. The factors influencing its efficacy are also investigated.


METHODS
A total of 22 eligible patients with colorectal cancer experiencing grade 1-3 oral mucositis during treatment with fluorouracil-based chemotherapy entered the current study. Their average age was 67 years. There were 10 male and 12 female. The PS was 0 in the majority of patients. Patients received two courses of the same chemotherapy regimen and Elental(®) concurrently after recovery to grade 0 or 1 oral mucositis.


RESULTS
FOLFOX6 + bevacizumab in 8 patients, FOLFIRI + bevacizumab in 8 patients, FOLFIRI + panitumumab in 1 patient, FOLFIRI in 1 patient, XELOX + bevacizumab in 2 patients, and S-1 + cetuximab in 2 patients were used as first-line (16 cases) or as second-line (6 cases) chemotherapy. Dose reduction of 5-fluorouracil (5-FU) or oral fluoropyrimidine was performed in the 2 patients achieving grade 3 oral mucositis and in the 3 patients achieving grade 2 oral mucositis. The maximum grade of oral mucositis decreased in 18 of the 22 patients during the first treatment course with Elental(®) (p = 0.0002) and in 20 of the 22 patients in the second course (p < 0.0001). Multivariate analyses found that the dose reduction in 5-FU or oral fluoropyrimidine, ED intake, and the prior administration of ED were each a significant factor for the preventive efficacy on oral mucositis.


CONCLUSIONS
The amino-acid-rich elemental diet Elental(®) may be useful as a countermeasure for 5-FU-based chemotherapy-induced oral mucositis in patients with colorectal cancer.
Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan. yogata@med.kurume-u.ac.jp.
Yutaka
Y
Ogata
Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan.
Nobuya
N
Ishibashi
Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan.
Keizou
K
Yamaguchi
Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan.
Shinji
S
Uchida
Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan.
Hideki
H
Kamei
Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan.
Goichi
G
Nakayama
Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan.
Hiroaki
H
Hirakawa
Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan.
Masahiko
M
Tanigawa
Department of Surgery, Kurume University School of Medicine, Kurume, 830-0011, Japan.
Yoshito
Y
Akagi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D005260:Female; D005526:Food, Formulated; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D013280:Stomatitis / Q000139:chemically induced / Q000178:diet therapy* / Q000517:prevention & control; D016896:Treatment Outcome
Amino acid; Chemotherapy; Colorectal cancer; Elemental diet (ED); Nourishment academic intervention; Oral mucositis