Search in All Title Contents

Madrid, September 12 2019:- 33% of patients receiving immunotherapy have adverse effects involving the digestive system. This is the conclusion reached by a team of oncologists and nutritionists from MD Anderson Cancer Center Madrid led by Dr. Pedro Robledo, head of the Clinical Nutrition and Dietetics Unit, after launching an observational study that, today, involves more than 300 patients.

"From the nutritional point of view, we know what side effects we can expect at the digestive level with the administration of chemotherapy and when they may start, which does not happen with immunotherapy," explains the specialist. Dr. Robledo goes on to say that "immunotherapy has more acute toxicity in the nutritional field, it is more difficult to control and there are no marked times, so we do not know how long it will take for side effects to appear”.

The results of this research show the importance of adding specific recommendations on nutrition for patients undergoing treatment with immunotherapy, since clinical guidelines currently only include general recommendations on chemotherapy and radiotherapy.

“Studying the intestinal flora, the gut microbiota; that is, the microorganisms and bacteria that inhabit our intestines, helps us to see the nutritional status of those affected and therefore to improve their nutritional response”, explains Dr. Robledo.

It is therefore something very relevant for patients because “from our research we can deduce that, unlike those who receive chemotherapy, those undergoing immunotherapy will suffer from malnutrition one way or another because there are no nutritional recommendations to help them avoid it”.

So, it is crucial to define exactly what digestive alterations the subject can experience to “focus nutritional support from the very beginning (before starting treatment), and in the longer term, anticipating possible more acute symptoms”, he says.

Research Development

To reach this conclusion, Dr. Robledo's team decided to collect information from all those patients who started immunotherapy treatment at MD Anderson Madrid, dividing them into two groups: immunotherapy or combined chemotherapy and immunotherapy.

Not only did they obtain data like weight, height and age, but nutritional alterations were also included to determine variations in muscle mass and fat, biological patterns of hormonal function, vitamin deficiency and gut microbiota. In addition, participants were screened nutritionally and a record was kept of their food consumption. This was all done with the aim of "learning what changes occur at the digestive level and how it affects the nutritional status of patients," he clarifies.

From this sample of 300 patients, Dr. Robledo's team selected 41 with lung cancer treated with an anti-PDL1 drug to present, at the 'I International Conference on Diabetes and Cancer' held in Argentina, the first results of a study clinical that has revealed the great nutritional impact of immunotherapy in cancer patients and the differences with chemotherapy or radiotherapy.

"Although 41 patients may seem few, it really is a fairly representative sample if we compare it with the clinical evidence available," says Dr. Robledo, who points out that there are not many studies with patients whose main objective is to measure the nutritional impact of immunotherapy.

Immunotherapy in severe hematologic disease

In the coming months, Dr. Robledo plans to present another clinical study on the nutritional impact of immunotherapy treatment in patients with severe hematologic diseases.

As further evidence of the important relationship between gut microbiota and immunotherapy, a research team from MD Anderson Cancer Center in Houston showed that patients with melanoma and a low level of a group of bacteria (Akkermansia mucinila) had worse responses and suffered greater toxicity associated with their treatment than another group of melanoma patients who presented normal levels. In addition, when the level of these bacteria was normalized, the patients had much better responses to the treatment.