Oral probiotic supplementation to alleviate diarrhea induced by fluoropyrimidines or irinotecan-based chemotherapy: A systematic review and meta-analysis

source extracted confidence: high 2026-04-09
#probiotics #humans #diarrhea #irinotecan #capecitabine

Oral probiotic supplementation to alleviate diarrhea induced by fluoropyrimidines or irinotecan-based chemotherapy: A systematic review and meta-analysis

Siritientong et al., 2025 | Complement Ther Med | Meta Analysis

Citation

Siritientong Tippawan, Thet Daylia, ... Areepium Nutthada. Oral probiotic supplementation to alleviate diarrhea induced by fluoropyrimidines or irinotecan-based chemotherapy: A systematic review and meta-analysis. Complement Ther Med. 2025-May;89:103151. doi:10.1016/j.ctim.2025.103151

Abstract

BACKGROUND: Fluoropyrimidines and irinotecan cause diarrhea, which can be particularly severe in some cases. Probiotic supplementation is a potential option for managing chemotherapy-induced diarrhea. This study aims to evaluate the efficacy and safety of probiotics in managing diarrhea induced by fluoropyrimidine or irinotecan-based chemotherapy in cancer patients. METHODS: A literature search was conducted in Cochrane Library, PubMed, ScienceDirect, SciFinder, and Scopus in August 2023. Observational and prospective studies of cancer patients receiving 5-fluorouracil, capecitabine, or irinotecan were included. RevMan (version 5.4.1) was used for statistical analysis. The study protocol was registered in PROSPERO. RESULTS: Of the 9400 records, 24 and 14 studies were included in the systematic review and meta-analysis, respectively. Most studies provided a combination of probiotic strains to patients from the initiation to the completion of chemotherapy cycles. Probiotic supplementation significantly reduced all grade diarrhea (RR = 0.40; 95 % CI: 0.27, 0.60; P < 0.00001, I2: 0 %), nausea and vomiting (RR = 0.49; 95 % CI [0.37, 0.67]; P < 0.00001, I2: 0 %), bloating (RR = 0.27; 95 % CI [0.11, 0.69]; P = 0.006, I2: 0 %) and anorexia (RR = 0.62: 95 % CI [0.43, 0.90]; P = 0.01, I2: 39 %) compared to controls. Absolute risk reductions (ARR) ranged from 22.7 % to 28.5 %, with the number needed to treat (NNT) value of 3-5. Moreover, probiotics improved intestinal microbial balance and symptom scales of quality of life. CONCLUSIONS: Probiotic supplementation is a promising option to manage chemoradiotherapy-induced diarrhea without serious side effects in cancer patients receiving fluoropyrimidines or irinotecan-based regimens. Given the clinically meaningful ARR and favorable NNT values, probiotics may have a role in clinical practice. However, larger trials are needed to standardize probiotic strain, dosage, duration, and target patient subgroups. SYSTEMATIC REVIEW REGISTRATION: PROSPERO database (CRD42023473324).

Key Findings

Of the 9400 records, 24 and 14 studies were included in the systematic review and meta-analysis, respectively. Most studies provided a combination of probiotic strains to patients from the initiation to the completion of chemotherapy cycles. Probiotic supplementation significantly reduced all grade diarrhea (RR = 0.40; 95 % CI: 0.27, 0.60; P < 0.00001, I2: 0 %), nausea and vomiting (RR = 0.49; 95 % CI [0.37, 0.67]; P < 0.00001, I2: 0 %), bloating (RR = 0.27; 95 % CI [0.11, 0.69]; P = 0.006, I2:

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 14
Age Range See abstract
Condition See abstract

MeSH Terms

  • Probiotics
  • Humans
  • Diarrhea
  • Irinotecan
  • Capecitabine
  • Fluorouracil
  • Pyrimidines
  • Neoplasms
  • Antineoplastic Agents

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Systematic Review, Meta-Analysis
  • Vertical: probiotics

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09