Immunonutrition during neoadjuvant oesophagogastric cancer therapy: no benefit

Immunonutrition is enteral or total parenteral nutrition feeding enriched with various pharmaconutrients (arginine, glutamine, omega-3-fatty acids, nucleotides, and anti-oxidants: copper, selenium, zinc, vitamins B, C, and E) to improve immune responses and modulate inflammatory responses. Prof. Sheraz Markar (Imperial College London, United Kingdom) presented a large, multicentre, blinded clinical trial, which did not demonstrate any major benefit for patients taking immunonutrition during neoadjuvant therapy in patients with oesophageal or gastric cancer [1].

Malnutrition in oesophagogastric cancers is associated with poor outcomes including decreased quality of life (QoL). The aim of this double-blinded, randomised controlled, multicentre clinical trial was to evaluate whether immunonutrition during neoadjuvant treatment prior to surgery would improve patients' QoL, and reduce postoperative morbidity. Adult patients with untreated non-metastatic upper GI tumours were randomised to receive immunonutrition (n=148) or an isocaloric control (n=152) during neoadjuvant therapy. The primary endpoint for the study was QoL, as measured by the EORTC-QLQ-C30. Secondary endpoints included diarrhoea, mucositis, haematologic toxicity, nutritional status, compliance and response to neoadjuvant therapy, postoperative morbidity, and length of hospital stay.

There were no significant differences between the groups at diagnosis vs 30 days postoperatively, either in global health score (HR 1.18; 95% CI 0.843-1.652; P=0.112), time to global health deterioration (P=0.527), physical functioning (P=0.976), role functioning (P=0.777), emotional functioning (P=0.545), cognitive functioning (P=0.207), social functioning (P=0.968), or fatigue score (P=0.920). In addition, no improvements were noted in pain severity, nausea and vomiting, dyspnoea, insomnia, appetite loss, or stool frequency. However, the single 30-day postoperative improvement was the duration of pain and discomfort in patients taking immunonutrition (P=0.007).

Thus, this large, multicentre trial did not demonstrate any major benefit for patients taking immunonutrition during neoadjuvant therapy in patients with oesophageal or gastric cancer, beyond a shortened duration of discomfort.

1. Markar S et al. UEG Week 2019, Abstract OP239.

Posted on 23 October 201921 May 2024