The therapy of oncological diseases

Medix – July 2015 – No. 117. – www.medix.com.hr

Enterosgel in the supporting therapy of oncological diseases

According to the opinion of some experts, Enterosgel is an effective adjuvant drug in oncology. Based on clinical trials, application of Enterosgel in intensive polychemotherapy of skin diseases reduces nausea and vomiting, reduces hematological intoxication index and improves functional and structural status of erythrocyte membranes. To confirm the efficiency of Enterosgel in prevention of gastrointestinal and other side effects caused by radiotherapy, it is necessary o include a large number of patients, although the preliminary results show that it is possible to use it for supporting therapy to improve quality of life during radiotherapy.

Dr. Višnja Matković, MD, prim.mr.sc. Specialist in radiotherapy and oncology, Institute of gynecological oncology, Clinic of women’s health and gynecology, KBC Zagreb

Incidence of malign diseases is constantly growing both in the world and in Croatia. Advanced radiological diagnostics, discovery of new tumor markers and well-organized screening programs aim at earlier found malignant diseases. Chemotherapy and radiation with surgery form the base of treatment of malignant diseases. Application of any of these treatment modalities provide high efficiency in destruction of tumor growths, however, unfortunately, a series of complications as a consequence of damage of healthy cells, first of all those that divide rapidly, e.g. blood cells (leukocytes, erythrocytes, platelets), hair follicles and cells lining the intestinal walls. Thanks to new cystatins and target therapy, in many patients malignant tumors become chronic, with prolonged survival. Supportive treatment that allows the patients to easier bear the consequences of anti-tumor treatment, form and integral part of therapeutic approach.

Effects of radiotherapy

Radiotherapy is treatment with radiation that destroys cells that divide quickly makes impossible their proliferation. It can be used for complete destruction and treatment of the tumor or to relieve such symptoms as pain and bleeding. It influences both healthy and tumor cells, however healthy cells have better restoration resources that makes possible therapeutic use of radiation.

Radiation is an adjuvant therapy in surgery and acts only at certain fields subdued to irradiation, which depend from tumor localization. Suring head and neck irradiation special attention should be paid to oral hygiene. Prior to beginning of the treatment it is necessary to visit a dentist and extract sore teeth. The most common side effects to be expected are dryness or excessive salivation, burning of the mouth or the surrounding skin, fungous disease of mucous membranes in the mouth cavity, swelling and painful swallowing.

Radiation affects hair growth causing hair loss. it is important that the hair loss begins, only if the hair falls within irradiation are (volume). Hair loss is often irreversible, as it is caused by destruction of hair roots.

Irradiation of breast cancer causes complicated passage of food through the esophagus, there is often burning sense, heartburn and pains behind the sternum. It the breast is irradiated after conservative surgery, swelling of the parts or the whole breast can develop, as well as pain or skin irritation, especially around the nipples. Skin of axillary space and under the breast can bleed, becomes sensitive, wet, vulnerable and burning.

When irradiating abdominal area, special attention should be paid to diet. It is advisable to eat easily digestible foods, without excessive fat and spices, drink a lot of beverages (tea, juices), but mostly between meals. Also agents should be taken that enhance recovery of intestinal mucosa or enhance elimination of toxic metabolites.

Effects of chemotherapy

Chemotherapy, unlike radiotherapy, affects the entire body because it enters through the blood or orally and aims at all cells in the body. It had the greatest effect on cells that divided rapidly. It is this principle that cytostatic treatment uses: destruction of tumor cells that divide rapidly and uncontrollably. However, some normal cells have a tendency to rapid multiplication, such as the blood system and the intestinal epithelium. During chemotherapy most of early complications are related to the two systems. By using drugs that stimulate faster elimination of cytostatics from the digestive system and reducing the level of harmful substances chemotherapy ffects can be reduced.

The role of Enterosgel in oncology

According to some experts, Enterosgel is an efficient means in oncology. Based on the clinical trial application of Enterosgel in the patients who undergo intensive and multi-agent chemotherapy, intensity of nausea and vomiting reduces, with decreasing hematological intoxication indices and improved structural and functional state of erythrocyte membrane. Number of patients with pronounced (<2 x I09/L) leukopenia was reduced from an average of 33 to 18%, while in patients receiving chemotherapy for tumors in the digestive system the difference was 2l.2: 54.6% in the control group.1-6

The findings on the effectiveness of Enterosgel in supporting treatment

Figure 1. Distribution of patients according to diagnosis

The findings on the effectiveness of Enterosgel in supporting treatment in oncology

The findings on the effectiveness of Enterosgel in supporting treatment in oncology

Number of patients

– Group of Enterosgel, cervical cancer

Enterosgel in oncology– Group of Enterosgel, endometrial cancer

Enterosgel in the supporting therapy of oncological diseases – Control group, cervical cancer

Enterosgel in oncological diseases– Control group, endometrial cancer

Figure 2. Change in body weight during treatment (radiotherapy) in the group taking Enterosgel

Change in body weight during treatment (radiotherapy) in the group taking Enterosgel

Change in body weight during treatment (radiotherapy) in the group taking Enterosgel

Change of body weight, kg – Number of patients from 1 to 19

Distribution of patients according to ECOG status
Number of patients in the control group Number of patients in the group taking Enterosgel
ECOG 0 12 16
ECOG 1 6 3
ECOG 2 1 0
ECOG 3 0 0
ECOG 4 0 0
ECOG 5 0 0

ECOG – general status of patients according to the guidelines of ECOG (engl. Eastern Cooperative Oncology Croup)

Figure 3

Enterosgel in Gynecologic Oncology

Change of body weight, kg – Number of patients from 1 to 19 of patients and complications that occur in patients during irradiation of the pelvic area were the stimulus to conduct clinical trials in the Institute of Gynecologic Oncology and KBC Clinic for women’s health in Zagreb, 2014.

The use of Enterosgel was started in July 2014 as a part of clinical trial “Role of Enterosgel in preventing gastrointestinal side effects of percutaneous irradiation”. The study plan included patients with cervical cancer and cancer of the uterine body in which external pelvis irradiation was carried out. During the tests the following parameters were monitored: ECOG, body weight, diarrhea (number), nausea (yes / no), levels of leukocytes, platelets, red blood cells, potassium, and sodium.

Patients were divided into two groups: experimental group that took Enterosgel 3 x 1 tablespoon (45 g daily) and control group that did not take Enterosgel during radiotherapy. All patients were asked to fulfill a questionnaire indicating the aforementioned parameters. The study, conducted from July 1, 2014th to February 1, 2015, included 19 patients of the first group (12 patients with cancer of the uterus and seven with cancer of the uterine body) and 19 patients of the control group (13 with cervical cancer and six with cancer of the uterine body) (Figure 1).

Monitoring the above parameters, differences were observed between the two groups in the  erythrocytes, leukocytes and platelets: all the patients had a slight decrease in the values of these parameters during radiotherapy. In both groups, the observed changes in body weight reduced to 9 kg, while somewhat higher drop in body weight was observed in the control group (Figures 2 and 3).

In the first group four of the 19 patients had 1-5 watery stools a day for 2-8 days (Figure 4) during the second half of the radiation, and in the second group 10 of 19 patients also had 1-5 watery stools daily for 2-15 days (Figure 5) in the second half of radiotherapy (from the third week onwards). The patients who did not take Enterosgel took the supportive therapy (probiotics, loperamide) in therapy of watery stools, while in the first group of patients the stool was regulated thanks to Enterosgel.

Since the majority of patients received, along with radiotherapy, concomitant chemotherapy with cisplatin for cervical cancer, presence of nausea was marked, with the similar results in favor of the first group. In the first group, two of 19 patients had nausea for six days (Figure 6), and in the second group 11 of 19 patients had nausea for 2-25 days (Figure 7). Patients who had nausea took metoclopramide three times daily

According to ECOG (engl. Eastern Cooperative Oncology Croup), general status of the patients did not differ in the study groups: most of the patients had ECOG 0 (Table 1). On analyzing electrolyte levels

Figure 4. Duration of watery stool (days) in patients taking Enterosgel

cervical cancer

cervical cancer

Enterosgel in Oncology– Duration of watery stool, days

Days – Number of patients from 1 to 19

Figure 5. Duration of watery stool (days) in patients of the control group

Enterosgel in Oncology

Enterosgel in Oncology– Duration of watery stool, days

Days – Number of patients from 1 to 19

Figure 6. Duration of nausea (days) in the group taking Enterosgel

Enterosgel in Oncology

Days – Number of patients from 1 to 19

– Nausea, days

Table 7. Duration of nausea (days) in the control group

Days – Number of patients from 1 to 19

Enterosgel in Oncology– Nausea, days

Enterosgel in Oncology

(sodium, potassium) did not also show differences between the groups.

The analysis of the obtained results allows to conclude that Enterosgel during radiotherapy is well tolerated, and the patients who received Enterosgel had fewer gastrointestinal symptoms and did not need supportive therapy (probiotics, loperamide, metoclopramide). To confirm the effectiveness of Enterosgel in the prevention of gastrointestinal and other side effects associated with radiotherapy it is necessary to include a larger number of patients, although preliminary results (treated were only 19 patients of anticipated 50 who have completed the treatment) refer to Enterosgel may be recommended as supportive therapy to improve the quality of life of patients during radiotherapy.

References

Enterosgel in Oncology

Leave a Reply

Your email address will not be published. Required fields are marked *