Metabolic support of the gastrointestinal tract: potential gut protection during intensive cytotoxic therapy

Potentially curative options involving cytoablative therapies are now available for the treatment of almost all human tumors, but major toxicities represent the rate-limiting step in achieving a cure with these therapies. With successful hematoprotective strategies now in use, it is apparent that the gastrointestinal tract will be the rate-limiting organ system that prevents further dose escalation in many cancer patients.

A review of the English language literature was conducted. Paperchase, a computer-based application that reviews the data bases of the National Library of Medicine and the National Cancer Institute, was used to obtain pertinent literature.

A variety of gut-protective nutrients and growth factors were identified. These substances may be useful in preventing dose-limiting gastrointestinal symptoms. Animal studies and some patient data suggest that the amino acid glutamine stimulates mucosal growth and promotes gut health. When nutrient administration is coupled with growth factors, such as growth hormone, insulin-like growth factor-1, glucagon-like peptide-2, and interleukin-11, a high level of bowel protection should be attained.

Therapy is evolving that may be useful in protecting the intestinal mucosa and preventing dose-limiting gastrointestinal symptoms.