Arginine, glutamine, and fish oil supplementation in cancer patients treated with concurrent chemoradiotherapy: A randomized control study

Abstract We evaluated the effectiveness of arginine, glutamine, and fish oil supplementation in patients’ ability to adhere to the planned regimen and associated toxicities in patients who received concurrent chemoradiotherapy (CCRT). Eighty-eight cancer patients were randomized into 2 groups, A; regular diet and B; regular diet plus nutritional supplementation during their CCRT course. Logistic regression was used to assess the association between toxicity and the study groups. Survival analysis was performed using the Kaplan-Meier method, and log-rank tests were used to compare between the 2 groups. Among 88 patients, 45%, 32%, and 23% were head and neck cancer, esophageal cancer, and cervical cancer patients, respectively. Significantly higher grade 3-4 hematologic toxicities were found in group A than in group B (23% vs 5%, P = 0.03). The CCRT completion rate was lower in group A than in group B (75% vs 91%), but the difference was not statistically significant ( P = 0.09). Adjusted for type of cancer and age, group B patients were associated with lower hematologic toxicities of CCRT, P = 0.03. Two-year overall survival was 47% for group A, and 61% for group B, P = 0.22. In conclusion, incidence of severe hematologic toxicities were significantly lower in patients with arginine, glutamine, and fish oil supplementation during CCRT. These findings, therefore, need further studies on the isocaloric design.