Postbiotics Ameliorate Cachexia in Patients With Non-small-cell Lung Cancer

Inclusion criteria

• Age ≥ 18 years, regardless of gender.

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• Patients with histologically or cytologically confirmed non-small-cell lung cancer (NSCLC) classified as stage III-IV according to the 9th TNM edition of IASLC, who are either currently receiving or have completed chemotherapy combined with immunotherapy.

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• Cachexia was diagnosed according to the international consensus criteria: involuntary weight loss >5 % within 6 months preceding screening, or BMI <20 kg/m² combined with >2 % involuntary weight loss within the same period.

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• Eastern Cooperative Oncology Group (ECOG) performance status ≤ 3 and an estimated life expectancy of ≥ 4 months.

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• Prior to the first dose of study treatment, adequate organ function must be documented (no blood products, granulocyte-colony-stimulating factors, or thrombopoietic agents within 14 days before randomisation): 1) Absolute neutrophil count ≥ 1.5 × 10^9/L;2)Platelet count ≥ 100 × 10^9/L; 3) Haemoglobin > 90 g/L; 4) Serum creatinine < 1.5 × upper limit of normal (ULN) or creatinine clearance (Cockcroft-Gault) > 50 mL/min; 5) Total bilirubin < 1.5 × ULN (< 3 × ULN in Gilbert's syndrome) ;6) AST and ALT < 2.5 × ULN (≤ 5 × ULN if hepatic metastases present); 7) INR and aPTT ≤ 1.5 × ULN unless the participant is on therapeutic anticoagulation; 8) Left-ventricular ejection fraction (LVEF) > 50 %

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• Participants must be capable of providing written informed consent and comprehending the potential risks associated with the intervention.

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• Participants must demonstrate high adherence to the study protocol.

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• Gastrointestinal function score of < 5.

Exclusion criteria

• Current presence of reversible causes of reduced food intake (e.g., oral mucositis or mechanical obstruction).

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• Participants who are receiving tube feeding or parenteral nutrition at the time of screening or randomization.

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• Cachexia attributable to other etiologies (e.g., chronic obstructive pulmonary disease, heart failure, or HIV/AIDS).

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• Major surgery within 4 weeks prior to randomization or major surgery planned during the study period.

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• Initiation of systemic corticosteroid therapy within 4 weeks prior to randomization.

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• Use of any appetite- or weight-enhancing agent within 30 days before randomisation, including anamorelin, megestrol acetate, cannabinoids, olanzapine, or mirtazapine.

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• Use of antibiotics or probiotic-containing medications/foods within 2 weeks prior to randomization.

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• Use of glucagon-like peptide-1 (GLP-1) receptor agonists for weight reduction within 30 days prior to randomization.

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• Pregnant or lactating women.

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• Participants who are unable to understand the study objectives or who do not agree to comply with the study requirements.

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• Individuals who lack full legal capacity or whose legal capacity is restricted.

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• Any medical condition that could interfere with the interpretation of study results or increase the participant's risk in the opinion of the investigators.

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• Participation in any other clinical trial.

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• Gastrointestinal function score of ≥ 5.