The effect of eicosapentaenoic and docosahexaenoic fatty acids on body composition and response to chemotherapy in patients with lung cancer

Patients with lung cancer are at high risk for malnutrition and even mild weight loss has been associated with decreased median survival and poor response to chemotherapy. The purpose of this research was to describe fatty acids status during chemotherapy and determine if supplementation with fish oil attenuates loss of weight, muscle and adipose tissue and improves chemotherapy efficacy in patients with lung cancer. Patients with non-small cell lung cancer who were chemotherapy naive were accrued to 1 of 2 contemporary studies; a descriptive study of fatty acids in patients receiving standard chemotherapy (standard of care, SOC; no intervention) or an open label study of fish oil supplementation during chemotherapy (∼2.5g eicosapentaenoic acid; EPA + docosahexaenoic; DHA per day). Blood was collected at baseline and throughout chemotherapy treatment. Chemotherapy toxicities and response to chemotherapy were determined. Plasma phospholipid fatty acids were isolated and quantified using gas liquid chromatography. Plasma cytokines were quantified using Multi-Array Assay kits. Body composition was assessed using diagnostic computed tomography images when available. The majority of patients were over 60 years old, had advanced disease and heavy body weights. In the SOC group, low amounts of fatty acids were observed in patients with advanced and progressive disease. Depletion of EPA and DHA was prevalent and was associated with low muscle mass, accelerated loss of skeletal muscle and adipose tissue. Supplementation with fish oil provided a benefit over SOC on weight, and skeletal muscle; 69% of patients in the fish oil group maintained or gained weight and muscle compared to 29% of patients in the SOC group. This effect did not appear to be mediated through catabolic cytokines, as overall amounts of plasma cytokines did not change with fish oil supplementation and was not different SOC. Supplementation with fish oil also resulted in a 2-fold improvement in chemotherapy efficacy compared to SOC: 60% of patients in the fish oil group had a reduction in tumour size and there was a trend towards greater 1-year survival. These results demonstrate the potential of fish oil to improve the care and treatment of patients with lung cancer.