1 / 22

Managing Gastrointestinal Side Effects of Targeted Therapies

Managing Gastrointestinal Side Effects of Targeted Therapies. Amy Goodrich, MSN, NP-AC The Johns Hopkins Kimmel Cancer Center, Baltimore, MD. General Concepts of GI Toxicity in Cancer Patients.

louis
Download Presentation

Managing Gastrointestinal Side Effects of Targeted Therapies

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Managing Gastrointestinal Side Effects of Targeted Therapies Amy Goodrich, MSN, NP-AC The Johns Hopkins Kimmel Cancer Center, Baltimore, MD

  2. General Concepts of GI Toxicity in Cancer Patients • Chronic GI side effects commonly cause significant morbidity and reduced quality of life in cancer patients • GI side effects commonly overlooked due to focus on disease status • GI symptoms can often be alleviated or eliminated

  3. GI Toxicity in Targeted Therapies • Spectrum of GI toxicity and causes often poorly defined • Normal cells of the GI system, including liver, may express molecular targets • Hepatic or GI adverse events may be alternate markers of treatment efficacy of some targeted agents • Extensive Drug-Drug interactions • GI toxicity and management varies from single agent to combination therapy

  4. Diarrhea Grading

  5. Diarrhea • Major cause of treatment discontinuation • Common DLT

  6. Diarrhea • EGFR overexpressed in normal GI mucosa- possibly due to increased chloride secretion leading to secretory diarrhea • Imatinib- dose related • Bortezomib- watery diarrhea with abdominal pain and cramps • Temsiroloimus- Immunosupressive or antimicrobial effect could alter normal bowel flora leading to mucoid feces and colitis • Gefitinib- Inflammatory mediators in response to cell immunity activation

  7. Diarrhea Management • Hydration • Electrolyte management • BRAT diet • Culture • Loperamide • Octreotide • Antibiotics if prolonged or w/neutropenia • Low dose aspirin with gefitinib

  8. Nausea and Vomiting Grading

  9. Nausea and Vomiting

  10. Nausea and Vomiting • Cited as the most concerning symptom of antineoplastic therapy • Significantly impacts quality of life • Affected by: specific agent, dose, schedule and route, patient-related variables • Multifactorial • Most Targeted Therapies have low to minimal emetogenic potential • Is it time for a revised CTCAE to reflect long term therapy vs. traditional chemo cycles?

  11. Management of Nausea and Vomiting • Follow guidelines for prevention and treatment • Hydration • Dietary changes- small frequent meals, bland foods, full liquids, room temperature foods • Nonpharmacologic- acupuncture, guided imagery, music therapy, progressive muscle relaxation, many others

  12. Recommended Antiemesis Prophylaxis

  13. Oral Mucositis Grading

  14. Stomatitis/Mucocitis

  15. Oral Mucositis Management • Oral care- Saline rinses, soft tooth brushes • Hydration • Dietary modifications- Soft diet, bland foods • Analgesics- topical and systemic • Consider anti-infectives

  16. Dyspepsia Grading

  17. Dyspepsia

  18. Dyspepsia Management • Pharmacologic treatment, watch for drug-drug interactions • Dietary changes- avoid spicy or fatty foods, no eating within 2 hours of bedtime

  19. Liver Function Abnormality Grading

  20. Liver Function Abnormalities

  21. GI Emergencies

  22. Conclusions • Targeted therapies carry high incidence of GI toxicity • Usually mild • Patient distress easily overlooked by providers • Chronic dosing of targeted therapies makes side effect control critical

More Related