Impact of nutritional status in the era of FOLFOX/FIRI-based chemotherapy

The nutritional status plays a pivotal role during anticancer therapy. This study analyzed whether nutritional status influences the outcomes in the era of FOLFOX/FIRI therapy.

The patients were divided into two groups according to whether the nutritional status was well (serum albumin level ≥ 3.8 g/dL or a ≥ 1.0 g/dL increase as compared with the value before chemotherapy) or not before and 2 and 6 months after the start of chemotherapy. Chemotherapy-related adverse events (AE), treatment effect, and compliance were evaluated according to the nutritional status. The progression-free survival (PFS) and overall survival (OS) were assessed based on the nutritional status at 6 months.

Between 2010 and 2013, data on 108 consecutive patients were analyzed. At 2 months after chemotherapy, the hematotoxicic AE and the value of tumor markers did not differ significantly. The non-hematotoxic AE were less frequent in patients in the well-nourished group (grade 2, 15.9 vs. 38.5%, p < 0.01). Based on the nutritional status at 6 months after chemotherapy, the hematotoxicic AE (grade 3, 9 vs. 19.5%, p = 0.03) and non-hematotoxic AE (grade 2, 31.3 vs. 51.2%, p = 0.04; grade 3, 6.0 vs. 24.4%, p < 0.01) were less frequent, and the median CEA value (5.3 vs. 27.75 mg/L, p < 0.01) was significantly lower in the well-nourished group. The median PFS (364 vs. 233 days, p < 0.01) and 5-year OS (26.5 vs. 11.1%, p = 0.01) are significantly better in the well-nourished group.

The well-nourished at initial 6 months may predict a better treatment response and fewer adverse events in FOLFOX/FIRI chemotherapy.