Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2018

Early signs of impaired gut function in patients with advanced cancer undergoing chemotherapy (#362)

Barbara S van der Meij 1 2 , Nicolaas E Deutz 3 , Steven Olde Damink 4 , Ramon E Rodriguez 5 , Marielle P Engelen 3
  1. Dietetics and Foodservices, Mater Health, Brisbane, QLD, Australia
  2. Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
  3. Center for Translational Research on Aging and Longevity (CTRAL), Texas A&M University, College Station, TX, USA
  4. Department of Surgery, Maastricht University, Maastricht, The Netherlands
  5. Hematology/Oncology, Baylor Scott and White Medical Center, College Station, TX, USA

Aims: Chemotherapy can affect the lining of the gut and the digestion of nutrients and consequently cause muscle wasting and physical impairment. This study investigates gut function, by a battery of tests, in advanced cancer patients undergoing chemotherapy.

Methods: In 16 patients with advanced cancer undergoing chemotherapy (T) and 16 healthy controls (H), we performed gut permeability tests using the inert sugars rhamnose (R), lactulose (L), and 3-O-Methyl-D-glucose (3-OMG) to measure L/R and 3-OMG/R ratios. Mucosal function was assessed by pulse IV administration of L-[5-13C-5,5-2H2]-CIT to calculate citrulline (CIT) concentration and production rate. Protein digestion capacity and splanchnic extraction of phenyalanine (PHE) were measured after combined intake of a high-protein meal with enteral [1-13C]PHE and 15N-spirulina, and primed continuous infusion of [ring-2H5]PHE. Blood/urine samples were obtained for inert sugars and amino concentrations/enrichments by LC-MS/MS, and statistical analysis by unpaired t-tests and Spearman correlation tests.

Results: Both T and H groups included 7 females (43.8%) and mean age was comparable (T: 60.1±16.6y, H: 59.3±16.0y, ns). L/R ratio and 3-OMG/R ratios were not different, but 3-OMG was higher in T (T: 48.4±19.7% vs. H: 35.5±13.5%, p=0.03). Protein digestion capacity tended to be lower in T (0.66±0.08 vs. 0.75±0.15, p=0.07), splanchnic extraction was comparable (T: 0.20±0.1 vs. H: 0.21±0.1, ns). Plasma CIT (T: 20.5±8.4 umol/L vs. H: 29.9±9.6 umol/L, p=0.009) and the production of CIT (T: 16.9±7.7 umol/kg FFM*h vs. H: 11.0±3.4 umol/kg FFM*h, p=0.02) were lower in T.

Conclusions: Patients with cancer undergoing chemotherapy show early signs of a leaky gut and impaired digestion and mucosal function.