Does a female patient with squamous cell esophageal carcinoma, undergoing surgery and immunotherapy with Nivolumab, have an increased need for omega-3 fatty acids?

From the Guidelines

The female patient with squamous cell esophageal carcinoma undergoing surgery and immunotherapy with Nivolumab does not have a clear increased need for omega-3 fatty acids based on the provided evidence.

Key Points

• The ESPEN practical guideline on clinical nutrition in surgery recommends considering postoperative parenteral nutrition (PN) including omega-3-fatty acids only in patients who cannot be adequately fed enterally and require PN 1.
• Peri- or postoperative administration of specific formulas enriched with omega-3-fatty acids is recommended for malnourished patients undergoing major cancer surgery, but there is no clear evidence for its sole use in the preoperative period 1.
• A meta-analysis of six high-quality studies in patients undergoing gastrointestinal surgery demonstrated significant benefits with regard to postoperative complications with the use of immunonutrition, which includes omega-3-fatty acids 1.
• However, the evidence for the use of omega-3-fatty acids in cancer patients is mixed, with some studies suggesting potential benefits for weight, lean body mass, and survival, while others found no clear evidence of benefit 1.
• The American Cancer Society guide for informed choices recommends eating foods rich in omega-3 fatty acids, such as fish and walnuts, due to their association with a lower risk for cardiovascular diseases and overall mortality rate, but notes that more research is needed to confirm specific benefits for cancer survivors 1.

Clinical Considerations

• The patient's individual nutritional needs and status should be assessed to determine the best course of nutrition support.
• The use of omega-3-fatty acids as part of a comprehensive nutrition plan may be considered, but should be based on the patient's specific needs and medical condition.
• Further research is needed to fully understand the potential benefits and risks of omega-3-fatty acids in cancer patients undergoing surgery and immunotherapy.

From the Research

Omega-3 Fatty Acids and Immunotherapy

• There is no direct evidence in the provided studies to suggest that a female patient with squamous cell esophageal carcinoma, undergoing surgery and immunotherapy with Nivolumab, has an increased need for omega-3 fatty acids.
• The studies primarily focus on the efficacy and safety of Nivolumab in treating esophageal squamous cell carcinoma, with no mention of omega-3 fatty acids 2, 3, 4, 5, 6.

Immunotherapy and Esophageal Squamous Cell Carcinoma

• Nivolumab has been shown to improve overall survival in patients with advanced esophageal squamous cell carcinoma, both as a monotherapy and in combination with other treatments 2, 4.
• The development of immune-related adverse events (irAEs) has been associated with better tumor response and survival in patients with esophageal squamous cell carcinoma treated with Nivolumab 3.
• Neoadjuvant immunotherapy with Nivolumab has shown promise in treating locally advanced esophageal squamous cell carcinoma, with improved perioperative outcomes compared to traditional neoadjuvant therapy 5, 6.

Treatment Outcomes and Prognosis

• The presence of grade 1/2 irAEs has been identified as a predictive marker for improved tumor response and survival in patients with advanced esophageal squamous cell carcinoma treated with Nivolumab 3.
• The expression of PD-L1 has been shown to be a predictor of response to immunotherapy in patients with esophageal squamous cell carcinoma 4, 5.