Supportive Care in Cancer Unit, Department of Hematology and Pediatric Onco-Hematology, Milano, Italy.
Medical Oncology 1 Unit. Fondazione IRCCS, Istituto Nazionale Tumori di Milano, Milan, Italy.
Crit Rev Oncol Hematol. 2014 May;90(2):165-79. doi: 10.1016/j.critrevonc.2013.11.008. Epub 2013 Dec 5.
Revision of the literature on targeted therapy-induced diarrhea (TT-ID).
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.
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.
对靶向治疗相关腹泻（TT-ID）文献进行综述。
TT-ID 较为常见；其机制主要为分泌性，其次为缺血性或自身免疫性。TT-ID 持续时间随时间延长而延长。其严重程度为 G1-G3 级，但在弥漫性结肠炎或伊匹单抗治疗的患者中可能致命。然而，对于不同程度的 TT-ID 管理尚无具体指南。抗生素、益生菌或活性炭的预防措施应进一步研究。洛哌丁胺是首选药物，其次是奥曲肽。皮质类固醇的作用存在争议。
早期评估和管理 TT-ID 对于防止该副作用恶化、患者住院以及减少剂量或停止肿瘤治疗至关重要。需要进一步研究以更好地了解 TT-ID 的病理生理机制，还应研究是否需要特定的药理学和/或非药理学方法。
