The Role of Probiotics, Prebiotics, and Synbiotics for Reducing Chemotherapy-Induced Gastrointestinal Toxicity: A Systematic Review and Meta-Analysis

Rachmawati, Ermin ORCID: https://orcid.org/0000-0003-1045-7066, Mutiah, Roihatul ORCID: https://orcid.org/0000-0002-8196-9029, Milliana, Alvi ORCID: https://orcid.org/0000-0003-1010-3591, Taufik, Imam, Maulana, Syafiq ORCID: https://orcid.org/0009-0000-8341-111X, Novindra, Qanita Adzkia and alifah, Fildzah Ghaizani (2025) The Role of Probiotics, Prebiotics, and Synbiotics for Reducing Chemotherapy-Induced Gastrointestinal Toxicity: A Systematic Review and Meta-Analysis. Romanian Journal of Internal Medicine. pp. 1-34. ISSN 15823296, 2501062X

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Abstract

Background: Chemotherapy-induced gastrointestinal toxicity remains a major clinical problem that limits treatment adherence and quality of life in cancer patients. Microbiota modulating interventions such as probiotics, prebiotics, and synbiotics have been proposed as supportive therapies, yet their comparative effectiveness remains unclear.
Objective: This systematic review and meta-analysis evaluated the effectiveness of probiotics, prebiotics, and synbiotics in reducing chemotherapy-induced gastrointestinal toxicity in cancer patients.
Methods: A systematic search of PubMed, Scopus, Cochrane Library, and ClinicalTrials.gov was performed between March and August 2025 to identify randomized controlled trials (RCTs) involving chemotherapy-treated cancer patients with gastrointestinal toxicities. Studies comparing probiotics, prebiotics, or synbiotics with
placebo or standard care were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using standardized criteria. Meta-analysis was conducted using RevMan 5.4.
Results: Twenty-nine RCTs were included, comprising probiotics (n = 17), prebiotics (n = 6), and synbiotics (n = 6). Probiotic supplementation, predominantly containing Lactobacillus and Bifidobacterium species, significantly reduced the incidence of chemotherapy-induced diarrhea (RR = 0.67; 95% CI 0.47–0.95; p = 0.03). Synbiotics demonstrated an even greater protective effect (RR = 0.51; 95% CI 0.29–0.89; p = 0.02). Evidence supporting prebiotics alone was limited and inconsistent.
Conclusion: Probiotics and synbiotics may be effective in reducing chemotherapy-induced gastrointestinal toxicity, with the most consistent evidence for diarrhea.

Item Type:	Journal Article
Keywords:	probiotics; prebiotics; synbiotics; chemotherapy; gastrointestinal toxicity.
Subjects:	11 MEDICAL AND HEALTH SCIENCES > 1112 Oncology and Carcinogenesis > 111204 Cancer Therapy (excl. Chemotherapy and Radiation Therapy) 11 MEDICAL AND HEALTH SCIENCES > 1115 Pharmacology and Pharmaceutical Sciences > 111502 Clinical Pharmacology and Therapeutics 11 MEDICAL AND HEALTH SCIENCES > 1115 Pharmacology and Pharmaceutical Sciences > 111599 Pharmacology and Pharmaceutical Sciences not elsewhere classified
Divisions:	Faculty of Medical and Health Sciences > Department of Medical Education
Depositing User:	dr Ermin rachmawati
Date Deposited:	16 Jul 2026 09:48

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