Practical Guide to Immunonutrition and Integrative Therapy in Bladder Cancer
Combining immunonutrition, immunotherapy, gut microbiota regulation, and psychological support to improve recovery and quality of life for bladder cancer patients
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Challenges in Bladder Cancer and Current Treatment Landscape
Bladder cancer ranks as the 10th most common cancer worldwide. Treatment varies depending on disease stage: non–muscle-invasive bladder cancer (NMIBC) is typically managed with BCG intravesical immunotherapy, whereas muscle-invasive bladder cancer (MIBC) often requires radical cystectomy (RC) with lymph node dissection([turn0search9]; [turn0search10]).
However, RC is associated with high complication rates (up to 50–88%), with postoperative infections and rapid muscle wasting being common issues, significantly affecting survival and quality of life ([turn0search0]; [turn0search9]).
What is Immunonutrition (IN)?
Immunonutrition refers to targeted nutritional supplementation with substrates such as L-arginine, glutamine, omega-3 fatty acids, and nucleotides, designed to modulate immunity and inflammation, thereby strengthening host response to stress (e.g., surgery, tumor burden) ([turn0search3]; [turn0search17]).
Evidence shows immunonutrition in cancer surgery patients reduces infection rates, shortens hospital stay, enhances wound healing, and preserves muscle mass ([turn0search3]; [turn0search13]).
Applications of Immunonutrition in Bladder Cancer Surgery
Multicenter Phase III Trial – S1600
At ASCO 2024, the S1600 trial reported the use of specialized perioperative immunonutrition formulas (L-arginine, omega-3, nucleotides) in RC patients. Compared with standard oral nutrition, patients receiving IN showed better symptom control trends and fewer progression/death events, though statistical significance was not achieved ([turn0search1]; [turn0search16]).
Other Studies and Trials
- INCyst Trial: Ongoing multicenter RCT exploring preoperative IN in RC patients. Aims to reduce complications and improve immune and hospitalization outcomes ([turn0search15]; [turn0search23]).
- Short-term pre-op IN studies: Show significant improvement in inflammatory markers and arginine levels in RC patients ([turn0search13]).
- NCI Trial (NCI-2017-02442): Evaluates perioperative IN for immune improvement in resectable bladder cancer ([turn0search16]).
Strategies for Integrative Therapy in Bladder Cancer
| Domain | Specific Strategy |
|---|---|
| Immunotherapy | For non–muscle-invasive bladder cancer, continue BCG therapy; for advanced lesions, use checkpoint inhibitors (e.g., PD-1/PD-L1 inhibitors). |
| Immunonutrition Support | Administer immunonutrition drinks containing L-arginine, Omega-3, and nucleotides 7 days pre-surgery; continue enhanced nutrition post-surgery to reduce infection risk and maintain muscle mass. |
| Microbiome Modulation | Consume a diet rich in fiber and probiotics to optimize gut microbiota and enhance response to immunotherapy (e.g., ICIs effectiveness). |
| Mind-Body Support | Include mindfulness meditation, yoga, and stress management interventions to reduce postoperative anxiety and improve immune function. |
| Multidisciplinary Collaboration | Urologists, nutritionists, immunotherapy specialists, and gut microbiome experts jointly develop an integrated care plan. |
Future Research Directions
- BLOSSOM Study: Investigates the relationship between dietary factors and immunotherapy response in NMIBC ([turn0search2]; [turn0search22]).
- BCANTT 2025: Highlights gut microbiome modulation (e.g., probiotics, fiber diets, fecal microbiota transplantation) as a strategy to optimize checkpoint inhibitor efficacy in bladder cancer ([turn0search20]).
Conclusion
Immunonutrition represents a cross-disciplinary integrative strategy in bladder cancer care. By combining standard therapies + perioperative IN + microbiome modulation + psychosocial support, clinicians can reduce surgical complications, strengthen immune function, and enhance immunotherapy efficacy. With ongoing clinical trials, this holistic, patient-centered model is poised to become a key adjunct in bladder cancer treatment.
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References
- “Nutrition and Bladder Cancer.” University of Kansas Medical Center. ([turn0search0])Hamilton-Reeves, J. M., et al. (2016, 2018). Pilot randomized controlled clinical trial on perioperative immunonutrition. Presented at ASCO 2024 (S1600) ([turn0search1]; [turn0search16])
- Derré, L., et al. (2024). INCyst Trial protocol: preoperative immunonutrition in cystectomy. Trials, 25, 687 ([turn0search15]; [turn0search23])
- Clinical-Genitourinary-Cancer. (2023). Immunonutrition and postoperative infections in bladder cancer. ([turn0search21])
- Liu, Y., et al. (2024). The application of immunonutrition in patients with cancer: current status and future perspectives. Holistic Integrative Oncology, 3, 45 ([turn0search3])
- “Diet, Nutraceuticals & Supplements on Bladder Cancer.” Oncology and Therapy, 2024 (BLOSSOM study) ([turn0search22]; [turn0search2])
- Guercio, B. J., et al. (2025). Nutrition, microbiome, and immunotherapy efficacy. BCANTT 2025 ([turn0search20])
- American Cancer Society. (2025). Immunotherapy for bladder cancer. ([turn0search10]; [turn0search24])
- Riley, Clinical Nutrition guidelines, etc. ([turn0search17])