Chemotherapy-induced diarrhoea (CID) is an adverse event associated with administration of cytotoxic anticancer drugs in dogs. In many cases, chemotherapy reduces the quality of life (QoL) of the patient and can prejudice prognosis. Concurrent treatment with probiotics may support the functions of the intestinal microbiota and reduce the prevalence and severity of CID.
To assess the impact of probiotic treatment on the prevalence and severity of CID, a randomised, double-blinded, placebo-controlled, crossover trial was performed in dogs with cancer scheduled to receive doxorubicin. Dogs received treatment for 14 days, starting on the day of doxorubicin administration, with either a probiotic formulation containing Enterococcus faecium NCIMB 10415 (2 x 109 CFU) or a placebo. A CID assessment form was developed for daily completion by the owner for five days, starting four days after treatment with doxorubicin, and a score was calculated to describe the severity of the event. In addition, a quality of life (QoL) assessment form was developed to assess the QoL of the dog during each treatment period. Faecal samples were collected before administration of doxorubicin and during and after treatment with the probiotic or the placebo. Faecal DNA was extracted and a quantitative polymerase chain reaction was developed to detect and quantify the presence of the specific probiotic strain.
Fifty dogs were recruited, 32 took both the probiotic formulation and the placebo, 11 took either product only, and seven dogs died of their cancer or were removed from the trial, leaving 43 cases for evaluation. Faecal consistency was described as abnormal in 80% of dogs in the probiotic group and 83% in the placebo group. Faecal frequency was increased in 51% of dogs in the probiotic group and 44% in the placebo group. There was no difference in the diarrhoea event scores whilst the dogs took either trial product (p > 0.05). In addition, there was no difference in QoL score between each trial period, but there was a significant correlation between QoL and diarrhoea score; QoL was considered to be worse when the diarrhoea was more severe (p < 0.0001). Also, there was a significant correlation between QoL and tumour type; dogs with lymphoma were described as having a significantly worse QoL compared to dogs with sarcomas or carcinomas (p < 0.05). The probiotic bacteria could be detected in the faeces of most dogs (n = 37) whilst they took the probiotic formulation but only in four dogs, seven days after treatment stopped, independent of the tumour-type, suggesting only transient colonisation of the gastrointestinal tract during the period of probiotic therapy.
Our data clearly indicate that CID reduces QoL. Quality of life as well as prevalence or severity of CID were not improved by treatment with E. faecium NCIMB 10415 for 14 days.
Royal Veterinary College
Linda Matthewman graduated from the Faculty of Veterinary Science, University of Zimbabwe and completed a residency in Internal Medicine (2014) and a PhD entitled ‘Microbiota changes in acute chemotherapy-induced gastrointestinal injury and the efficacy of probiotics’ (2018) at the Royal Veterinary College, University of London.
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