METABOLIC SUPPORT OF THE GASTROINTESTINAL-TRACT - POTENTIAL GUT PROTECTION DURING INTENSIVE CYTOTOXIC THERAPY

BACKGROUND, Potentially curative options involving cytoablative therap ies are now available for the treatment of almost all human tumors, bu t major toxicities represent the rate-limiting step in achieving a cur e with these therapies. With successful hematoprotective strategies no w in use, it is apparent that the gastrointestinal tract will be the r ate-limiting organ system that prevents further dose escalation in man y cancer patients. METHODS. A review of the English language literatur e was conducted. Paperchase, a computer-based application that reviews the data bases of the National Library of Medicine and the National C ancer Institute, was used to obtain pertinent literature. RESULTS. A v ariety of gut-protective nutrients and growth factors were identified. These substances may be useful in preventing dose-limiting gastrointe stinal symptoms. Animal studies and some patient data suggest that the amino acid glutamine stimulates mucosal growth and promotes gut healt h. When nutrient administration is coupled with growth factors, such a s growth hormone, insulin-like growth factor-1, glucagon-like peptide- 2, and interleukin-ll, a high level of bowel protection should be atta ined. CONCLUSIONS, Therapy is evolving that may be useful in protectin g the intestinal mucosa and preventing dose-limiting gastrointestinal symptoms. (C) 1997 American Cancer Society.