M A Pessi1, N Zilembo2, E R Haspinger2, L Molino2, S Di Cosimo2, M Garassino2, C I Ripamonti3. 1. Supportive Care in Cancer Unit, Department of Hematology and Pediatric Onco-Hematology, Milano, Italy. 2. Medical Oncology 1 Unit. Fondazione IRCCS, Istituto Nazionale Tumori di Milano, Milan, Italy. 3. Supportive Care in Cancer Unit, Department of Hematology and Pediatric Onco-Hematology, Milano, Italy. Electronic address: carla.ripamonti@istitutotumori.mi.it.
Abstract
PURPOSE OF RESEARCH: Revision of the literature on targeted therapy-induced diarrhea (TT-ID). PRINCIPAL RESULTS: TT-ID is frequent; the mechanisms are mainly secretive, followed by ischemic or autoimmune ones. The duration of TT-ID is protracted over time. Its intensity is of grade G1-G3 but may be fatal in patients with diffuse colitis or on ipilimumab. However, no specific guidelines are available on management of different grades of TT-ID. Preventive measures with antibiotics, probiotics or activated charcoal should be further investigated. Loperamide is the first choice drug followed by octreotide. The role of corticosteroids is controversial. CONCLUSION: Early assessment and management of TT-ID is essential to prevent the worsening of this side-effect, patients' hospitalization and dose reduction or oncological treatment discontinuation. Future research is needed to better understand the pathophysiological mechanisms of TT-ID and it should also be investigated whether a specific pharmacological and/or non pharmachological approach is indicated.
PURPOSE OF RESEARCH: Revision of the literature on targeted therapy-induced diarrhea (TT-ID). PRINCIPAL RESULTS:TT-ID is frequent; the mechanisms are mainly secretive, followed by ischemic or autoimmune ones. The duration of TT-ID is protracted over time. Its intensity is of grade G1-G3 but may be fatal in patients with diffuse colitis or on ipilimumab. However, no specific guidelines are available on management of different grades of TT-ID. Preventive measures with antibiotics, probiotics or activated charcoal should be further investigated. Loperamide is the first choice drug followed by octreotide. The role of corticosteroids is controversial. CONCLUSION: Early assessment and management of TT-ID is essential to prevent the worsening of this side-effect, patients' hospitalization and dose reduction or oncological treatment discontinuation. Future research is needed to better understand the pathophysiological mechanisms of TT-ID and it should also be investigated whether a specific pharmacological and/or non pharmachological approach is indicated.
Authors: Anna E Kersh; Spencer Ng; Yun Min Chang; Maiko Sasaki; Susan N Thomas; Haydn T Kissick; Gregory B Lesinski; Ragini R Kudchadkar; Edmund K Waller; Brian P Pollack Journal: J Clin Pharmacol Date: 2017-11-14 Impact factor: 3.126