A study of preoperative methionine-depleting parenteral nutrition plus chemotherapy in gastric cancer patients.

Abstract

AIM:To investigate the interference of methionine-free parenteral nutrition plus 5-Fu (-MetTPN+5-Fu) in gastric cancer cell kinetics and the side effects of the regimen.METHODS:Fifteen patients with advanced gastric cancer were randomly divided intotwo groups, 7 patients were given preoperatively a seven-day course of standard parenteral nutrition in combination with a five-day course of chemotherapy (sTPN+5-Fu), while the other 8 patients were given methionine-deprived parenteral nutrition and 5-Fu (-MetTPN+5-Fu). Cell cycles of gastric cancer and normal mucosa were studied by flow cytometry (FCM). Blood samples were taken to measure the serum protein, methionine (Met) and cysteine (Cys) levels, and liver and kidney functions.RESULTS:As compared with the results obtained before the treatment, the percentage of G(0)/G(1) tumor cells increased and that of S phase decreased in the -MetTPN+5-Fu group, while the contrary was observed in the sTPN+5-Fu group. Except that the ALT, AST and AKP levels were slightly increased in a few cases receiving -MetTPN+5-Fu, all the other biochemical parameters were within normal limits. Serum Cys level decreased slightly after the treatment in both groups. Serum Met level of patients receiving sTPN+5-Fu was somewhat higher after treatment than that before treatment; however, no significant change occurred in the -MetTPN+5-Fu group, nor operative complications in both groups.CONCLUSION:-MetTPN+5-Fu exerted a suppressive effect on cancer cell proliferation, probably through a double mechanism of creating a state of "Met starvation" adverse to the tumor cell cycle, and by allowing 5-Fu to kill specifically cells in S phase. Preoperative shortterm administration of -MetTPN+5-Fu had little undesirable effect on host metabolism.