Summary of Immunonutrition in Cancer Care:
This text details the growing role of immunonutrition – the use of nutrients above normal dietary levels to modulate the immune system – in cancer care. Here’s a breakdown of the key points:
1. Established Role in Surgical Settings:
* Strong Evidence Base: Over 100 RCTs and 62 meta-analyses support its effectiveness in oncological surgery.
* ERAS & ESPEN Guidelines: Immunonutrition (specifically arginine, omega-3 fatty acids, and nucleotides) is now recommended for all patients undergoing colorectal surgery and major tumor surgery/GI cancers, not just those malnourished.
* Real-World Implementation: Initiatives like the Clinical Nutrition Network in Lombardy, Italy, aim to increase immunonutrition access to at least 70% of cancer patients.
* Benefits: Reduces hospital stay (2+ days for colorectal, oral, and gastric cancers), leading to significant cost savings. Promising preliminary data exists for bladder cancer.
2. Emerging Role in Systemic Treatment (“The New Frontier”):
* Mechanism: Immunonutrition modulates the tumor microenvironment, reduces inflammation (and cachexia), and boosts immune activation.
* Positive Outcomes: bibliometric analysis suggests reduced mortality and improved quality of life.
* HNSCC Trials: While the IMPATOX trial didn’t show a reduction in mucositis, compliant patients did show improved long-term survival.
* Ongoing Research: New trials are investigating the impact of nutritional counseling alongside immunonutrition, and its potential to enhance immunotherapy efficacy in non-small cell lung cancer. Preliminary trials show positive results in survival and chemotherapy completion rates.
3. Future Directions:
* Combining Therapies: Exploring the synergy between immunotherapy and immunonutrition.
* Gut Microbiome: Investigating the interaction between immunonutrition and the gut microbiome.
In essence,immunonutrition is moving beyond a perioperative intervention to become a potentially integral part of comprehensive cancer care,both during and after systemic treatments. The importance of nutritional counseling alongside immunonutrition is highlighted as a key factor for success.
