Abstract
Cancer is the second leading cause of death in the western world. In the era of precision medicine, a significant number of cancer patients can be cured with several anti-cancer therapeutic regimens. However, therapy failure may be caused by treatment side effects, such as diarrhea, especially occurring in patients with gastrointestinal or pelvic malignancies. In particular, diarrhea is one of the most frequent gastrointestinal toxicity during cancer treatment and it can result from nearly bot chemo- and radio-therapeutic strategies currently used. Diarrhea has a serious impact on patients’ quality of life and treatment dosing and schedule modification due to its severity can negatively influence treatment outcomes. In this context, probiotics may play an interesting role in several human diseases with an inflammatory bowel involvement and, among these, Lactobacillus rhamnosus GG (LGG) is one of the most characterized and utilized. In particular, LGG is able to reverse intestinal dysbiosis and moderate diarrhea. Moreover, preclinical studies have documented its effects in reducing chronic inflammation associated with cancer development. This review summarizes the preclinical results of LGG on cancer cells proliferation and tumor invasion as well as the potential role of LGG use in cancer patients for the prevention and management of diarrhea associated with cancer treatment. Overall, these encouraging data support further investigation on the use of LGG in stratified patients undergoing specific therapeutic protocols, including chemotherapy and pelvic radiotherapy, in order to reduce the development of severe diarrhea and thus improve the adherence to the therapy and patients’ quality of life.
Highlights
Cancer remains the second leading cause of death in the western world (Siegel et al, 2017)
Among the gastrointestinal adverse events (AEs) diarrhea is a frequent and potentially fatal toxicity associated with anti-cancer treatment. (Gibson and Stringer, 2009) diarrhea of any grade occurs in 30–87% of patients receiving chemotherapy and in 20–49% of patients receiving pelvic radiotherapy
The most important effect of Lactobacillus rhamnosus GG (LGG), observed in cancers patients is linked to the reduction of acute or chronic diarrhea associated with chemotherapy and radiotherapy in cancer patients (Wang et al, 2016)
Summary
Cancer remains the second leading cause of death in the western world (Siegel et al, 2017). In melanoma patients specific gut microbiota patterns have been recently linked to improved response rate to ipilimumab (CTLA-4 inhibitor) and to an increased occurrence of ipilimumab-induced colitis (Chaput et al, 2017) Taken together these findings support the hypothesis that preventive probiotics treatments may modulate cancer immunotherapy efficacy as well as the impact of specific toxicities and can be associated with the improvement of response rate in cancer patients. Through the comparison of the genome sequence of LGG and other Lactobacillus spp., Kankainen et al (2009) identified LGG-specific islands containing genes coding for three secreted LPXTG-like pilins (spaCBA) and a pilin-dedicated sortase notoriously involved in the mechanisms of adhesion to the intestinal mucosa (Kankainen et al, 2009) It matches the selection criteria for probiotics, including high adhesion in vitro, survival trough GIT (gastric acid, bile) and tendency to form colonies with a good persistence in the gut (Gorbach, 1996).
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