Nutritional status represents a crucial issue in the management of cancer patients, as between 40% and 60% of them suffer from malnutrition at the time of diagnosis. This condition worsens morbidity, increases treatment-related adverse effects, infections, and hospitalizations, and can lead to death in 10% to 20% of cases, independently of tumor progression. Anticancer treatments often exacerbate malnutrition due to their side effects, such as loss of appetite or taste alterations.
Although international guidelines (ESPEN, ESMO, ASCO) recommend a multimodal nutritional intervention combining nutritional support and physical activity. The effectiveness of these approaches varies among patients. This variability can be explained by several factors, including individual differences in dietary intake response, metabolic status, and digestive tolerance to treatments.
The intestinal and oral microbiota appear to be key cofactors in regulating these various parameters, influencing appetite, host metabolism, and intestinal absorption. Alterations in the microbiota-particularly a decrease in bacterial diversity and an increase in Candida albicans-have been associated with appetite loss and taste perception disorders, especially in patients with digestive cancers. Therefore, the intestinal microbiota constitutes a potential therapeutic and diagnostic target to improve nutritional strategies in oncology.
Interventions targeting the microbiota (such as probiotic supplementation or fecal microbiota transplantation) have already demonstrated an impact on nutritional parameters in preclinical models of malnourished cancer-bearing mice; however, clinical data remain scarce and limited.
The ONCONUTRIBIOTA-cohort study aims to characterize and investigate the oral and intestinal microbiota of patients initiating chemotherapy for digestive cancer, in relation to their nutritional status clinical characteristics and food preferences, in order to identify potential biomarkers or therapeutic targets to optimize their nutritional management.
Patients will be followed during two of their routine care visits: on the day of the first chemotherapy treatment and at the end of the first cycle of chemotherapy. During these visits, stool and saliva samples will be collected, completed by additional assessments including global quality of life and nutritional quality of life questionnaires, olfactory and gustatory tests, and measurements of parameters used to determine the presence of malnutrition, general health status and oncological evaluation.
Adult patient
Borderline or locally advanced pancreatic adenocarcinoma
Metastatic pancreatic adenocarcinoma without symptomatic peritoneal carcinomatosis
metastatic colon/rectal cancer without symptomatic peritoneal carcinomatosis
Pregnant or breastfeeding women
Patients who have received antibiotics within 3 weeks prior to the first chemotherapy treatment (excluding antibiotic prophylaxis administered in the context of surgery or endoscopy).
Individuals receiving psychiatric care that may interfere with their ability to respond to questionnaires (in the investigator's opinion)
Persons deprived of their liberty or subject to legal protection measures (guardianship, curatorship)
Patients treated with chemotherapy in digestive oncology
Cohort
Prospective
Not applicable- observational study
Other interventionDuring two routine care visits - on the day of the first chemotherapy administration and at the end of the first chemotherapy cycle - stool and saliva samples will be collected. These will be complemented by additional assessments, including global and nutritional quality of life questionnaires, olfactory and gustatory tests, and measurements of parameters related to malnutrition, general health status, and oncological evaluation (including blood sampling and specific analyses based on the radiological assessments performed as part of routine care)
Difference in fecal microbiota composition, assessed by beta-diversity (Weighted UniFrac and Bray-Curtis) based on shotgun metagenomic data, between patients with severe, moderate, or no malnutrition evaluated at V1 and V2.
The difference in fecal microbiota composition, measured by beta-diversity (Weighted UniFrac and Bray Curtis) from shotgun metagenomic data, between patients with severe, moderate, and no malnutrition assessed at V1 (before 1st cure of chemotherapy) and V2 (after the first cycle of chemotherapy). Malnutrition is defined according to GLIM recommendations by the combination of the etiological criterion of active neoplasia common to all patients included, associated with a phenotypic criterion (BMI, weight loss, sarcopenia according to a standardized method).
Difference in oral microbiota composition before and after chemotherapy treatment
The difference in oral microbiota composition, measured by beta-diversity (Weighted UniFrac and Bray Curtis) on shotgun metagenomic data, between malnourished and non-malnourished patients (GLIM criteria) assessed at V1 (before 1st cure of chemotherapy) and V2 (after 4 cures of chemotherapy).
Variation in the taxonomic and functional composition of the oral and fecal microbiota
Variation in the taxonomic and functional composition of the oral and fecal microbiota (analysis by beta-diversity and differential taxa and metagenomics) between V1 (before 1st cure of chemotherapy) and V2 (after 4 cures of chemotherapy).
Fecal and oral metabolomic signatures associated with malnutrition status
Fecal and oral metabolomic signatures associated with malnutrition status Identification of fecal and oral metabolomic signatures (by LC-MS or GC-MS) associated with malnutrition status assessed at V1 (before 1st cure of chemotherapy) and V2 (after 4 cures of chemotherapy).
Correlation between taxonomic profiles and markers of nutritional status
Correlation between taxonomic profiles (relative abundance of bacterial taxa) and markers of nutritional status (BMI, weight loss, prealbumin, albumin, CRP) at V1 and V2; calculation of Spearman's coefficient with false positive control (FDR).
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