A Randomized Phase II Trial of Prophylactic Manuka Honey for the Reduction of Chemoradiation Therapy Induced Esophagitis During the Treatment of Lung Cancer: Results of Trial ****

Publication date: Available online 23 November 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Shannon Fogh, Snehal Deshmukh, Lawrence B. Berk, Amylou C. Dueck, Kevin Roof, Sherif Yacoub, Thomas Gergel, Kevin Stephans, Andreas Rimner, Albert DeNittis, John Pablo, Justin Rineer, Terence M. Williams, Deborah Bruner
PurposeRandomized trials have shown that honey is effective for prevention of radiation-induced mucositis in head and neck cancer patients. Because there is no efficacious preventative for radiation esophagitis in lung cancer patients, this trial compared liquid honey, honey lozenges, and standard supportive care for radiation esophagitis.MethodsPatients were stratified by percentage of esophagus receiving specific radiation dose (V60Gy esophagus < or ≥ 30%), then randomized between supportive care, 10 ml of liquid Manuka honey four times a day or 2 lozenges (10 ml of dehydrated Manuka honey) four times a day during concurrent chemotherapy and radiotherapy. The primary endpoint was patient-reported pain on swallowing utilizing an eleven point (0-10) scale at 4 weeks (Numerical Rating Pain Scale, NRPS). The study was designed to detect 15% relative reduction of change in NRPS score. Secondary endpoints were trend of pain over time, opioid use, clinically-graded and patient-reported adverse events, weight loss, dysphagia, nutritional status and quality of life.Results53 patients were randomized to supportive care, 54 randomized to liquid honey and 56 to lozenge honey. There was no significant difference in the primary endpoint of change in the NRPS at 4 weeks between arms. There were no differences in any of the secondary endpoints except for opioid use at 4 weeks during treatment between the supportive care and liquid honey arms which was found to be significant (p=0.03) with more patients on the supportive care arm taking opioids.ConclusionHoney as prescribed within this protocol was not superior to best supportive care in preventing radiation esophagitis. Further testing of other types of honey and research into the mechanisms of action are needed.

Teaser

As there is currently no efficacious preventative for radiation esophagitis in lung cancer patients, this trial compared liquid honey, honey lozenges, and standard supportive care for radiation esophagitis. Honey prescribed within this protocol was not superior to best supportive care in preventing radiation esophagitis.Further studies are warranted to better understand if the link between honey microbiota, bacteriostatic properties and/or immune response to honey may demonstrate clinical benefit, and whether honey use can reduce opioid use during treatment.Manuka Honey for Esophagitis


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