Aprile Giuseppe, Rihawi Karim, De Carlo Elisa, Sonis Stephen T
Giuseppe Aprile, Karim Rihawi, Elisa De Carlo, Department of Medical Oncology, University and General Hospital of Udine, 33100 Udine, Italy.
World J Gastroenterol. 2015 Nov 7;21(41):11793-803. doi: 10.3748/wjg.v21.i41.11793.
Gastrointestinal toxicities (GIT), including oral mucositis, nausea and vomiting, and diarrhea, are common side effects of chemotherapy and targeted agents in patients with advanced colorectal cancer and pancreatic cancer. Being often underreported, it is still difficult to precisely establish their burden in terms of both patient's quality of life and cancer care costs. Moreover, with the use of more intensive upfront combination regimens, the frequency of these toxicities is rapidly growing with a potential negative effect also on patient's outcome, as a result of dose reductions, delays or even discontinuation of active treatments. Thus, identifying patients at higher risk of developing GIT as well as an optimal management are paramount in order to improve patient's compliance and outcome. After the description of the main treatment-induced GIT, we discuss the current knowledge on the pathophysiology of these side effects and comment the scales commonly used to assess and grade them. We then provide a critical update on GIT incidence based on the results of key randomized trials conducted in patients with metastatic colorectal cancer and advanced pancreatic cancer.
胃肠道毒性（GIT），包括口腔黏膜炎、恶心呕吐和腹泻，是晚期结直肠癌和胰腺癌患者化疗及靶向药物常见的副作用。由于这些副作用常常报告不足，因此在患者生活质量和癌症治疗费用方面，仍难以精确确定其负担。此外，随着更强化的初始联合治疗方案的使用，这些毒性的发生频率迅速增加，由于减少剂量、延迟甚至中断有效治疗，对患者的治疗结果也可能产生负面影响。因此，识别发生胃肠道毒性风险较高的患者以及优化管理对于提高患者的依从性和治疗结果至关重要。在描述了主要的治疗引起的胃肠道毒性之后，我们讨论了关于这些副作用病理生理学的现有知识，并对常用于评估和分级这些毒性的量表进行评论。然后，我们根据在转移性结直肠癌和晚期胰腺癌患者中进行的关键随机试验结果，对胃肠道毒性的发生率进行重要更新。
