Impact of enteral Ecoimmunonutrition on immunological response, nutritional status and tolerance to treatment in gastrointestinal malignancy patients receiving chemotherapy

Abstract

Purpose: Gastrointestinal (GI) malignancies are major contributors to global cancer-related mortality, with many patients experiencing severe nutritional decline and immune suppression due to chemotherapy. Enteral immunonutrition (EIN), which includes immune-modulating nutrients, has shown promise in improving nutrition, reducing chemotherapy-related side effects, and enhancing immune function, but its role in advanced GI cancer patients undergoing chemotherapy is not well-studied. Methods: This randomized, controlled study involved 28 patients with advanced GI malignancies, assigned to either standard nutrition or EIN for 42 days. Key measures included nutritional status, immune markers, quality of life (QoL), and chemotherapy-related toxicities. The study also used a preclinical mouse model to evaluate EIN's impact on tumor growth and intestinal health during chemotherapy. Results: Patients in the EIN group demonstrated significantly improved serum albumin levels on day 28 (P = 0.03) and a higher CD4 + /CD8 + T-cell ratio on day 42 (P < 0.01) compared to controls. EIN supplementation significantly mitigated chemotherapy-induced fatigue and improved QoL scores on days 28 and 42 (P < 0.05). Repeated measures analysis revealed a substantial reduction in pro-inflammatory cytokines (IL-1, IL-6) and an increase in the anti-inflammatory cytokine IL-10 in the EIN group (P < 0.05). Preclinical findings showed that EIN significantly reduced tumor volume (P < 0.05) and preserved the integrity of the intestinal mucosal barrier, evidenced by higher ZO-1 and Occludin expression (P < 0.05). Conclusion: These findings suggest that EIN during chemotherapy enhances nutritional and immune status, reduces inflammation, and improves QoL, warranting further large-scale trials to confirm its benefits in cancer care. Trial Registration: This trial was registered on the Chinese Clinical Trial Register (ChiCTR2400084224) on 13–05-2024.