Journal of Clinical Oncology, Vol 5, 113-124, Copyright © 1987 by American Society of Clinical Oncology
A randomized study of oral nutritional support versus ad lib nutritional intake during chemotherapy for advanced colorectal and non- small-cell lung cancer
WK Evans, DW Nixon, JM Daly, SS Ellenberg, L Gardner, E Wolfe, FA Shepherd, R Feld, R Gralla and S Fine
One hundred ninety-two patients with previously untreated metastatic cancer
(102 non-small-cell lung cancer [NSCLC]; 90 colorectal cancer) were
randomized to receive either ad lib nutritional intake (control group) or
specific nutritional intervention during a 12-week study period when
chemotherapy was administered. Those patients randomized to nutritional
interventions were counselled to take oral nutrients with caloric intake
equal to 1.7 to 1.95 times their basal energy expenditure, depending on
their pretreatment nutritional status ("standard" group). An augmented
group was counselled to have a caloric intake equivalent to that of the
standard group but with 25% of calories provided as protein and additional
supplements of zinc and magnesium. Counselling increased caloric intake in
both tumor types but reduced weight loss in the short term only for lung
cancer patients. Ninety-three NSCLC patients were evaluable for tumor
response to vindesine and cisplatin. Overall, only 20.4% of the patients
responded, and there were no significant differences in response rates,
median time to progression, or overall duration of survival between the
nutrition intervention groups and the control group. The tumor response
rate to time-sequenced 5-fluorouracil (5-FU) and methotrexate in the 81
evaluable patients with colorectal cancer was only 14.8%, and no
significant differences in tumor response rates were noted between the
three groups. Furthermore, the median time to progression and overall
duration of survival were not different for the control, standard, and
augmented groups. Nutritional interventions using dietary counselling had
no impact on the percent of planned chemotherapy dose administered, the
degree of toxicity experienced by patients, or the frequency of treatment
delays. A multivariate prognostic factor analysis demonstrated that for
lung cancer, the percent of weight loss, serum albumin concentration, and
presence of liver metastases were significant (P less than .05) and
independent prognostic variables for survival duration. For colorectal
cancer, serum albumin, alkaline phosphatase, lactic dehydrogenase (LDH)
levels, and percent targeted caloric intake (TCI) were significant
independent predictors of survival duration.
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