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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.

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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
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
gi toxicity in targeted therapies
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
diarrhea
Diarrhea
  • Major cause of treatment discontinuation
  • Common DLT
diarrhea1
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
diarrhea management
Diarrhea Management
  • Hydration
  • Electrolyte management
  • BRAT diet
  • Culture
  • Loperamide
  • Octreotide
  • Antibiotics if prolonged or w/neutropenia
  • Low dose aspirin with gefitinib
nausea and vomiting1
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?
management of nausea and vomiting
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
oral mucositis management
Oral Mucositis Management
  • Oral care- Saline rinses, soft tooth brushes
  • Hydration
  • Dietary modifications- Soft diet, bland foods
  • Analgesics- topical and systemic
  • Consider anti-infectives
dyspepsia management
Dyspepsia Management
  • Pharmacologic treatment, watch for drug-drug interactions
  • Dietary changes- avoid spicy or fatty foods, no eating within 2 hours of bedtime
conclusions
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