Araki Satomi, Araki Takuya, Tanaka Naritaka, Sakai Makoto, Nagamine Ayumu, Nagano Daisuke, Yashima Hideaki, Saeki Hiroshi, Kuwano Hiroyuki, Yamamoto Koujirou
Department of Clinical Pharmacology and Therapeutics, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan.
Department of Pharmacy, Gunma University Hospital, Maebashi, Gunma 371-8511, Japan.
Oncol Lett. 2025 Jul 7;30(3):428. doi: 10.3892/ol.2025.15174. eCollection 2025 Sep.
Reducing the risk of infections associated with myelosuppression, particularly neutropenia, is crucial for ensuring chemotherapy completion and maximizing efficacy. Oral immunonutrition (OIN) containing omega-3 fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), has garnered attention. While OIN can reduce postoperative infections and improve prognosis, its impact on chemotherapy and chemoradiotherapy completion rates in esophageal cancer remains unclear. Therefore, retrospective and prospective (UMIN000056761) studies were conducted to evaluate the effects of OIN in patients undergoing chemotherapy or chemoradiotherapy for esophageal cancer. In the retrospective study, 32 patients were analyzed: 15 in the docetaxel, nedaplatin and 5-fluorouracil (DNF) group (OIN, 6; control, 9) and 17 in the docetaxel, cisplatin and 5-fluorouracil (DCF) with radiotherapy (DCF-RT) group (OIN, 7; control, 10). Although OIN (ProSure) did not significantly affect the completion rates of the DNF regimen (P=0.622), it significantly improved the second-cycle completion rate of the DCF-RT regimen (P=0.030). In addition, although OIN had no significant effect on febrile neutropenia or other adverse events, except for nausea in the DNF group, first-cycle granulocyte colony-stimulating factor (G-CSF) use was significantly lower in the OIN group (P=0.001). In the prospective study, 14 patients were studied. Due to the small sample size, the primary endpoint could not be evaluated; however, OIN significantly increased the plasma-free EPA/arachidonic acid (AA) ratio on days 3 and 7 (both P=0.011), whereas the free DHA/AA ratio remained unchanged. These findings suggested that increasing the EPA/AA ratio via OIN may contribute to immune activation in cancer chemotherapy, leading to reduced G-CSF use and improved treatment completion rates. Although based on a limited number of patients, these results provide pilot evidence supporting the immunonutritional potential of OIN in esophageal cancer treatment. The prospective study (UMIN000056761) was retrospectively registered on January 21, 2025.
降低与骨髓抑制相关的感染风险，尤其是中性粒细胞减少症的风险，对于确保化疗的完成和疗效最大化至关重要。含有ω-3脂肪酸（如二十碳五烯酸（EPA）和二十二碳六烯酸（DHA））的口服免疫营养（OIN）已受到关注。虽然OIN可以降低术后感染并改善预后，但其对食管癌化疗和放化疗完成率的影响仍不清楚。因此，开展了回顾性和前瞻性研究（UMIN000056761）来评估OIN对接受食管癌化疗或放化疗患者的影响。在回顾性研究中，分析了32例患者：多西他赛、奈达铂和5-氟尿嘧啶（DNF）组15例（OIN组6例；对照组9例），多西他赛、顺铂和5-氟尿嘧啶联合放疗（DCF-RT）组17例（OIN组7例；对照组10例）。虽然OIN（ProSure）对DNF方案的完成率没有显著影响（P=0.622），但它显著提高了DCF-RT方案的第二周期完成率（P=0.030）。此外，虽然OIN对发热性中性粒细胞减少症或其他不良事件没有显著影响，但DNF组除外的恶心，OIN组第一周期使用粒细胞集落刺激因子（G-CSF）的情况显著减少（P=0.001）。在前瞻性研究中，研究了14例患者。由于样本量小，无法评估主要终点；然而，OIN在第3天和第7天显著提高了血浆游离EPA/花生四烯酸（AA）比值（均P=0.011），而游离DHA/AA比值保持不变。这些发现表明，通过OIN提高EPA/AA比值可能有助于癌症化疗中的免疫激活，从而减少G-CSF的使用并提高治疗完成率。尽管基于有限数量的患者，但这些结果提供了初步证据，支持OIN在食管癌治疗中的免疫营养潜力。前瞻性研究（UMIN000056761）于2025年1月21日进行了回顾性注册。
