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Article

The usefulness of immunonutrition in chemotherapy and chemoradiotherapy for esophageal cancer

  • Authors:
    • Satomi Araki
    • Takuya Araki
    • Naritaka Tanaka
    • Makoto Sakai
    • Ayumu Nagamine
    • Daisuke Nagano
    • Hideaki Yashima
    • Hiroshi Saeki
    • Hiroyuki Kuwano
    • Koujirou Yamamoto
  • View Affiliations / Copyright

    Affiliations: Department of Clinical Pharmacology and Therapeutics, Gunma University Graduate School of Medicine, Maebashi, Gunma 371‑8511, Japan, Division of Gastroenterological Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma 371‑8511, Japan, Department of Pharmacy, Gunma University Hospital, Maebashi, Gunma 371‑8511, Japan, Regional Comprehensive Support Center, Okagaki Hospital, Onga, Fukuoka 811‑4204, Japan
  • Article Number: 428
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    Published online on: July 7, 2025
       https://doi.org/10.3892/ol.2025.15174
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Abstract

Reducing the risk of infections associated with myelosuppression, particularly neutropenia, is crucial for ensuring chemotherapy completion and maximizing efficacy. Oral immunonutrition (OIN) containing omega‑3 fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), has garnered attention. While OIN can reduce postoperative infections and improve prognosis, its impact on chemotherapy and chemoradiotherapy completion rates in esophageal cancer remains unclear. Therefore, retrospective and prospective (UMIN000056761) studies were conducted to evaluate the effects of OIN in patients undergoing chemotherapy or chemoradiotherapy for esophageal cancer. In the retrospective study, 32 patients were analyzed: 15 in the docetaxel, nedaplatin and 5‑fluorouracil (DNF) group (OIN, 6; control, 9) and 17 in the docetaxel, cisplatin and 5‑fluorouracil (DCF) with radiotherapy (DCF‑RT) group (OIN, 7; control, 10). Although OIN (ProSure®) did not significantly affect the completion rates of the DNF regimen (P=0.622), it significantly improved the second‑cycle completion rate of the DCF‑RT regimen (P=0.030). In addition, although OIN had no significant effect on febrile neutropenia or other adverse events, except for nausea in the DNF group, first‑cycle granulocyte colony‑stimulating factor (G‑CSF) use was significantly lower in the OIN group (P=0.001). In the prospective study, 14 patients were studied. Due to the small sample size, the primary endpoint could not be evaluated; however, OIN significantly increased the plasma‑free EPA/arachidonic acid (AA) ratio on days 3 and 7 (both P=0.011), whereas the free DHA/AA ratio remained unchanged. These findings suggested that increasing the EPA/AA ratio via OIN may contribute to immune activation in cancer chemotherapy, leading to reduced G‑CSF use and improved treatment completion rates. Although based on a limited number of patients, these results provide pilot evidence supporting the immunonutritional potential of OIN in esophageal cancer treatment. The prospective study (UMIN000056761) was retrospectively registered on January 21, 2025.
View Figures

Figure 1

Changes in TTR. (A) Observed TTR
values in the DCF-RT group. (B) Percentage changes in TTR in the
DCF-RT group. (C) Observed TTR values in the DNF group. (D)
Percentage changes in TTR in the DNF group. Closed circles and
solid lines indicate the OIN group (n=6); open circles and dashed
lines indicate the control group (n=9). In the DCF-RT group,
although 7 OIN and 10 control patients were originally enrolled,
one patient in each group lacked continuous TTR data and was
excluded from the figure. Note: Some baseline (day 0) data were
unavailable, resulting in missing connecting lines from day 0. TTR,
total transferrin receptor; DCF-RT,
docetaxel/cisplatin/5-fluorouracil with radiotherapy; DNF,
docetaxel/nedaplatin/5-fluorouracil; OIN, oral immunonutrition.

Figure 2

Trends in EPA/AA and DHA/AA ratios.
(A) Free EPA/Free AA. (B) Free DHA/Free AA. (C) Total EPA/Total AA.
(D) Total DHA/Total AA. Closed circles, OIN group; open circles,
control group; error bars, standard deviation. *q<0.05;
**q<0.01; ***q<0.005 vs. control group. EPA, eicosapentaenoic
acid; DHA, docosahexaenoic acid; AA, arachidonic acid; OIN, oral
immunonutrition.
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Copy and paste a formatted citation
Spandidos Publications style
Araki S, Araki T, Tanaka N, Sakai M, Nagamine A, Nagano D, Yashima H, Saeki H, Kuwano H, Yamamoto K, Yamamoto K, et al: The usefulness of immunonutrition in chemotherapy and chemoradiotherapy for esophageal cancer. Oncol Lett 30: 428, 2025.
APA
Araki, S., Araki, T., Tanaka, N., Sakai, M., Nagamine, A., Nagano, D. ... Yamamoto, K. (2025). The usefulness of immunonutrition in chemotherapy and chemoradiotherapy for esophageal cancer. Oncology Letters, 30, 428. https://doi.org/10.3892/ol.2025.15174
MLA
Araki, S., Araki, T., Tanaka, N., Sakai, M., Nagamine, A., Nagano, D., Yashima, H., Saeki, H., Kuwano, H., Yamamoto, K."The usefulness of immunonutrition in chemotherapy and chemoradiotherapy for esophageal cancer". Oncology Letters 30.3 (2025): 428.
Chicago
Araki, S., Araki, T., Tanaka, N., Sakai, M., Nagamine, A., Nagano, D., Yashima, H., Saeki, H., Kuwano, H., Yamamoto, K."The usefulness of immunonutrition in chemotherapy and chemoradiotherapy for esophageal cancer". Oncology Letters 30, no. 3 (2025): 428. https://doi.org/10.3892/ol.2025.15174
Copy and paste a formatted citation
x
Spandidos Publications style
Araki S, Araki T, Tanaka N, Sakai M, Nagamine A, Nagano D, Yashima H, Saeki H, Kuwano H, Yamamoto K, Yamamoto K, et al: The usefulness of immunonutrition in chemotherapy and chemoradiotherapy for esophageal cancer. Oncol Lett 30: 428, 2025.
APA
Araki, S., Araki, T., Tanaka, N., Sakai, M., Nagamine, A., Nagano, D. ... Yamamoto, K. (2025). The usefulness of immunonutrition in chemotherapy and chemoradiotherapy for esophageal cancer. Oncology Letters, 30, 428. https://doi.org/10.3892/ol.2025.15174
MLA
Araki, S., Araki, T., Tanaka, N., Sakai, M., Nagamine, A., Nagano, D., Yashima, H., Saeki, H., Kuwano, H., Yamamoto, K."The usefulness of immunonutrition in chemotherapy and chemoradiotherapy for esophageal cancer". Oncology Letters 30.3 (2025): 428.
Chicago
Araki, S., Araki, T., Tanaka, N., Sakai, M., Nagamine, A., Nagano, D., Yashima, H., Saeki, H., Kuwano, H., Yamamoto, K."The usefulness of immunonutrition in chemotherapy and chemoradiotherapy for esophageal cancer". Oncology Letters 30, no. 3 (2025): 428. https://doi.org/10.3892/ol.2025.15174
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