Probiotics for chemotherapy and radiotherapy diarrhoea
Live bacterial supplements may reduce diarrhoea during pelvic radiotherapy and some chemotherapy, but the trials are small, the strains differ and a Cochrane review rated the evidence low certainty. People with very low white cell counts or central lines should not take them without advice.
Overview
A 2018 Cochrane review of randomised trials found that probiotics may reduce the incidence and severity of diarrhoea caused by chemotherapy or radiotherapy, with low-certainty evidence and marked variation in strains (Lactobacillus, Bifidobacterium, VSL#3), doses and endpoints. Trials in pelvic radiotherapy for cervical, rectal and prostate cancer are the most consistent. Cases of bacteraemia and fungaemia in immunocompromised patients mean probiotics are avoided during profound neutropenia and in patients with central venous catheters unless specifically advised. Separately, antibiotics and probiotics around checkpoint immunotherapy may reduce response by disturbing the microbiome, a distinct question covered in the immunotherapy record.
How it works
Colonising bacteria compete with pathogens, reinforce the mucosal barrier and modulate local inflammation in irradiated or chemotherapy-damaged gut.
- Cochrane signal of benefit for treatment-related diarrhoea
- Cheap and generally safe in immunocompetent patients
- Low-certainty evidence; strains not standardised
- Infection risk in neutropenia and with central lines
- Possible interference with checkpoint immunotherapy
Latest papers
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