Nutrición Hospitalaria 04787 / http://dx.doi.org/10.20960/nh.04787
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Elemental diet preventative effects for adverse events during chemotherapy in patients with esophageal cancer - A systematic review and meta-analysis


Hao-Ning Lan, Xu-Ying Huang, Yang Ge, Guang-Yu An, Jian-Nan Yao, Hui-Yun Zhang

Prepublicado: 2024-04-26
Publicado: 2024-06-18

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The effectiveness of an elemental diet (ED) for preventing adverse events (AEs) during chemotherapy for patients with esophageal cancer (EC) remains unclear. The aim of this meta-analysis was to comprehensively assess the efficacy of ED for preventing AE in EC patients during chemotherapy. Medline (via PubMed), Embase, the Cochrane Library, and Web of Science were searched to retrieve prospective and randomized studies published before April 12, 2023. The odds ratio (OR) of each AE was calculated using Review Manger 5.4.1. The risk of bias was assessed, and a random effect model-based meta-analysis was used to analyze the available data. Four prospective and randomized studies involving 237 patients were identified after a systematic search. Regarding gastrointestinal toxicities, the findings indicated a trend toward a decrease in the risk of mucositis (OM) (OR = 0.54, 95 % CI: 0.25-1.14), constipation (OR = 0.87, 95 % CI: 0.49-1.53), and anorexia (OR = 0.99, 95 % CI: 0.32-3.05), as well as an increasing trend in the risk of diarrhea (OR = 1.48, 95 % CI: 0.79-2.79), among patients treated with ED. However, none of these reached statistical significance. For hematological toxicities, the risk of all-grade neutropenia (OR = 0.28, 95 % CI: 0.14-0.57), grade ≥ 2 leucopenia (OR = 0.43, 95 % CI: 0.22-0.84), grade ≥ 2 neutropenia (OR = 0.34, 95 % CI: 0.17-0.67), and grade ≥ 3 neutropenia (OR = 0.28, 95 % CI: 0.12-0.63) was significantly decreased. There is no firm evidence confirming the preventive effect of an ED against OM or diarrhea. However, an ED may potentially be helpful in preventing neutropenia and leucopenia.

Palabras Clave: Elemental diet. Esophageal cancer. Adverse event. Meta-analysis.



Morgan E, Soerjomataram I, Rumgay H, Coleman HG, Thrift AP, Vignat J, et al. The Global Landscape of Esophageal Squamous Cell Carcinoma and Esophageal Adenocarcinoma Incidence and Mortality in 2020 and Projections to 2040: New Estimates From GLOBOCAN 2020. Gastroenterology. 2022.
Network GBoDC;Pageshttps://ghdx.healthdata.org/gbd-2019.
Lagergren P, Johar A, Rosenlund H, Arnberg L, Haglund L, Ness-Jensen E, et al. Severe reflux, sleep disturbances, and health-related quality of life after esophageal cancer surgery. J Cancer Surviv. 2021;15(6):818-24.
DOI: 10.1007/s11764-020-00974-9
He S, Xu J, Liu X, Zhen Y. Advances and challenges in the treatment of esophageal cancer. Acta Pharm Sin B. 2021;11(11):3379-92.
DOI: 10.1016/j.apsb.2021.03.008
Sun JM, Shen L, Shah MA, Enzinger P, Adenis A, Doi T, et al. Pembrolizumab plus chemotherapy versus chemotherapy alone for first-line treatment of advanced oesophageal cancer (KEYNOTE-590): a randomised, placebo-controlled, phase 3 study. Lancet. 2021;398(10302):759-71.
DOI: 10.1016/S0140-6736(21)01234-4
Lu Y, Xu M, Guan L, Yang Y, Chen Y, Yang Y, et al. PD-1 Inhibitor Plus Chemotherapy Versus Chemotherapy as First-line Treatment for Advanced Esophageal Cancer: A Systematic Review and Meta-Analysis. J Immunother. 2022;45(5):243-53.
DOI: 10.1097/CJI.0000000000000420
Li ZC, Sun YT, Lai MY, Zhou YX, Qiu MZ. Efficacy and safety of PD-1 inhibitors combined with chemotherapy as first-line therapy for advanced esophageal cancer: A systematic review and network meta-analysis. Int Immunopharmacol. 2022;109:108790.
DOI: 10.1016/j.intimp.2022.108790
Brown TJ, Gupta A. Management of Cancer Therapy-Associated Oral Mucositis. JCO Oncol Pract. 2020;16(3):103-9.
DOI: 10.1200/JOP.19.00652
Riccardi D, Allen K. Nutritional Management of Patients With Esophageal and Esophagogastric Junction Cancer. Cancer Control. 1999;6(1):64-72.
DOI: 10.1177/107327489900600106
Chen MF, Hsieh CC, Chen PT, Lu MS. Role of Nutritional Status in the Treatment Outcome for Esophageal Squamous Cell Carcinoma. Nutrients. 2021;13(9).
Yang H, Liu H, Chen Y, Zhu C, Fang W, Yu Z, et al. Neoadjuvant Chemoradiotherapy Followed by Surgery Versus Surgery Alone for Locally Advanced Squamous Cell Carcinoma of the Esophagus (NEOCRTEC5010): A Phase III Multicenter, Randomized, Open-Label Clinical Trial. J Clin Oncol. 2018;36(27):2796-803.
DOI: 10.1200/JCO.2018.79.1483
Zhang B, Qi L, Wang X, Xu J, Liu Y, Mu L, et al. Phase II clinical trial using camrelizumab combined with apatinib and chemotherapy as the first-line treatment of advanced esophageal squamous cell carcinoma. Cancer Commun (Lond). 2020;40(12):711-20.
DOI: 10.1002/cac2.12119
Tanaka Y, Takeuchi H, Nakashima Y, Nagano H, Ueno T, Tomizuka K, et al. Effects of an elemental diet to reduce adverse events in patients with esophageal cancer receiving docetaxel/cisplatin/5-fluorouracil: a phase III randomized controlled trial-EPOC 2 (JFMC49-1601-C5). ESMO Open. 2021;6(5):100277.
DOI: 10.1016/j.esmoop.2021.100277
Katada C, Fukazawa S, Sugawara M, Sakamoto Y, Takahashi K, Takahashi A, et al. Randomized study of prevention of gastrointestinal toxicities by nutritional support using an amino acid-rich elemental diet during chemotherapy in patients with esophageal cancer (KDOG 1101). Esophagus. 2021;18(2):296-305.
DOI: 10.1007/s10388-020-00787-w
Ishikawa T, Yasuda T, Doi T, Okayama T, Sakamoto N, Gen Y, et al. The amino acid-rich elemental diet Elental(R) preserves lean body mass during chemo- or chemoradiotherapy for esophageal cancer. Oncol Rep. 2016;36(2):1093-100.
DOI: 10.3892/or.2016.4877
Okada T, Nakajima Y, Nishikage T, Ryotokuji T, Miyawaki Y, Hoshino A, et al. A prospective study of nutritional supplementation for preventing oral mucositis in cancer patients receiving chemotherapy. Asia Pac J Clin Nutr. 2017;26(1):42-8.
Tanaka Y, Shimokawa T, Harada K, Yoshida K. Effectiveness of elemental diets to prevent oral mucositis associated with cancer therapy: A meta-analysis. Clin Nutr ESPEN. 2022;49:172-80.
DOI: 10.1016/j.clnesp.2022.03.005
Tanaka Y, Takahashi T, Yamaguchi K, Osada S, Shimokawa T, Yoshida K. Elemental diet plus glutamine for the prevention of mucositis in esophageal cancer patients receiving chemotherapy: a feasibility study. Support Care Cancer. 2016;24(2):933-41.
DOI: 10.1007/s00520-015-2864-9
Tanaka Y, Ueno T, Yoshida N, Akutsu Y, Takeuchi H, Baba H, et al. The effect of an elemental diet on oral mucositis of esophageal cancer patients treated with DCF chemotherapy: a multi-center prospective feasibility study (EPOC study). Esophagus. 2018;15(4):239-48.
DOI: 10.1007/s10388-018-0620-1
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
Higgins JPT, Cochrane Collaboration. Cochrane handbook for systematic reviews of interventions. Second edition. ed. Hoboken, NJ: Wiley-Blackwell; 2020.
Higgins J, Green S. Cochrane Handbook for Systematic Reviews for Interventions, Version 5.1.0. 2011.
Larry V, Hedges. Advances in statistical methods for meta-analysis. New Directions for Program Evaluation. 1984;1984(24):25-42.
DOI: 10.1002/ev.1376
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539-58.
DOI: 10.1002/sim.1186
Egger M, Juni P, Bartlett C, Holenstein F, Sterne J. How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical study. Health Technol Assess. 2003;7(1):1-76.
DOI: 10.3310/hta7010
Sonis ST. The pathobiology of mucositis. Nat Rev Cancer. 2004;4(4):277-84.
DOI: 10.1038/nrc1318
Harada K, Ferdous T, Kobayashi H, Ueyama Y. Elemental Diet Accelerates the Recovery From Oral Mucositis and Dermatitis Induced by 5-Fluorouracil Through the Induction of Fibroblast Growth Factor 2. Integr Cancer Ther. 2018;17(2):423-30.
DOI: 10.1177/1534735417721014
Harada K, Ferdous T, Mizukami Y, Mishima K. Elemental diet inhibits proinflammatory cytokine production in keratinocytes through the suppression of NFkappaB activation. Oncol Rep. 2018;40(1):361-8.
Harada K, Takenawa T, Ferdous T, Mizukami Y, Mishima K. Elemental diet directly affects chemotherapy-induced dermatitis and raw wound areas. Mol Clin Oncol. 2020;13(2):209-15.
DOI: 10.3892/mco.2020.2050
Argiles JM. Cancer-associated malnutrition. Eur J Oncol Nurs. 2005;9 Suppl 2:S39-50.
Narula N, Dhillon A, Zhang D, Sherlock ME, Tondeur M, Zachos M. Enteral nutritional therapy for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2018;4(4):CD000542.
Navari RM, Aapro M. Antiemetic Prophylaxis for Chemotherapy-Induced Nausea and Vomiting. N Engl J Med. 2016;374(14):1356-67.
DOI: 10.1056/NEJMra1515442
Gould Rothberg BE, Quest TE, Yeung SJ, Pelosof LC, Gerber DE, Seltzer JA, et al. Oncologic emergencies and urgencies: A comprehensive review. CA Cancer J Clin. 2022;72(6):570-93.
DOI: 10.3322/caac.21727
Nomura H, Tsuji D, Demachi K, Mochizuki N, Matsuzawa H, Yano T, et al. ABCB1 and ABCC2 genetic polymorphism as risk factors for neutropenia in esophageal cancer patients treated with docetaxel, cisplatin, and 5-fluorouracil chemotherapy. Cancer Chemother Pharmacol. 2020;86(2):315-24.
DOI: 10.1007/s00280-020-04118-9
Christen D, Brummendorf TH, Panse J. [Leukopenia - A Diagnostic Guideline for the Clinical Routine]. Dtsch Med Wochenschr. 2017;142(23):1744-9.
Abdel-Razeq H, Hashem H. Recent update in the pathogenesis and treatment of chemotherapy and cancer induced anemia. Crit Rev Oncol Hematol. 2020;145:102837.
DOI: 10.1016/j.critrevonc.2019.102837
de Rouw N, Piet B, Derijks HJ, van den Heuvel MM, Ter Heine R. Mechanisms, Management and Prevention of Pemetrexed-Related Toxicity. Drug Saf. 2021;44(12):1271-81.
DOI: 10.1007/s40264-021-01135-2
Holecek M. Histidine in Health and Disease: Metabolism, Physiological Importance, and Use as a Supplement. Nutrients. 2020;12(3).
Yin N, Jin G, Ma Y, Zhao H, Zhang G, Li MO, et al. SZT2 maintains hematopoietic stem cell homeostasis via nutrient-mediated mTORC1 regulation. J Clin Invest. 2022;132(20).
Correia B, Sousa MI, Branco AF, Rodrigues AS, Ramalho-Santos J. Leucine and Arginine Availability Modulate Mouse Embryonic Stem Cell Proliferation and Metabolism. Int J Mol Sci. 2022;23(22).

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