1. ¹Department of Oncology, Helsinki University Central Hospital, PO Box 180, 00029 HUS Helsinki, Finland
2. ²Institute of Biomedicine, University of Helsinki, PO Box 63, FI-00014 Finland
3. ³Valio Ltd, R&D, PO Box 30, FI-00039 VALIO, Helsinki, Finland
4. ⁴Department of Internal Medicine, Helsinki University Central Hospital, PO Box 340, FI-00029 Helsinki, Finland
5. ⁵Department of Anaesthesiology, Helsinki University Central Hospital/Jorvi Hospital, Turuntie 150, FI-02740 Espoo, Finland

Correspondence: Dr P Österlund, E-mail: pia.osterlund@hus.fi

Received 30 May 2007; Revised 23 July 2007; Accepted 14 August 2007; Published online 25 September 2007.

Abstract

5-Fluorouracil (5-FU)-based chemotherapy is frequently associated with diarrhoea. We compared two 5-FU-based regimens and the effect of Lactobacillus and fibre supplementation on treatment tolerability. Patients diagnosed with colorectal cancer (n=150) were randomly allocated to receive monthly 5-FU and leucovorin bolus injections (the Mayo regimen) or a bimonthly 5-FU bolus plus continuous infusion (the simplified de Gramont regimen) for 24 weeks as postoperative adjuvant therapy. On the basis of random allocation, the study participants did or did not receive Lactobacillus rhamnosus GG supplementation (1–2 10¹⁰ per day) and fibre (11 g guar gum per day) during chemotherapy. Patients who received Lactobacillus had less grade 3 or 4 diarrhoea (22 vs 37%, P=0.027), reported less abdominal discomfort, needed less hospital care and had fewer chemotherapy dose reductions due to bowel toxicity. No Lactobacillus-related toxicity was detected. Guar gum supplementation had no influence on chemotherapy tolerability. The simplified de Gramont regimen was associated with fewer grade 3 or 4 adverse effects than the Mayo regimen (45 vs 89%), and with less diarrhoea. We conclude that Lactobacillus GG supplementation is well tolerated and may reduce the frequency of severe diarrhoea and abdominal discomfort related to 5-FU-based chemotherapy.