The Gastrointestinal Complications of Oncologic Therapy

Shafi, Mehnaz A.; Bresalier, Robert S.

doi:10.1016/j.gtc.2010.08.004

Cited by 31 publications

(20 citation statements)

References 72 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Phenols can also be formed by gut fermentation, including phenyl-propionic acid (Nordlund et al 2012). A majority of our patients had acute leukemia in complete remission and had been treated with intensive antileukemic chemotherapy prior to the transplantation; this treatment causes mucositis and may cause severe gastrointestinal complications (Shafi and Bresalier 2010), and the production of p-cresols and phenols depends on the intestinal microenvironment, including intestinal flora and pH (Nakabayashi et al 2011). The altered levels of such metabolites may thus reflect disturbances in the gastrointestinal function or the intestinal flora that are associated with a risk of acute GVHD.…”

Section: Resultsmentioning

confidence: 99%

The pretransplant systemic metabolic profile reflects a risk of acute graft versus host disease after allogeneic stem cell transplantation

2015

View full text Add to dashboard Cite

Allogeneic stem cell transplantation is used in the treatment of younger patients with severe hematological diseases, especially hematological malignancies, and acute graft versus host disease (GVHD) is then an important immune-mediated posttransplant complication. Several risk factors for acute GVHD have been identified, including pretransplant factors that possibly influence the posttranspant course through their effects on host immunocompetent cells. Metabolic regulation is important for immunoregulation, and we therefore investigated whether the pretransplant metabolic status of allotransplant recipients was associated with later acute GVHD. In our population-based study we investigated the systemic (serum) metabolic profile for 86 consecutive allotransplant recipients. The samples were collected before start of the pretransplant conditioning therapy. Patients who developed later acute GVHD especially showed altered pretransplant amino acid metabolism, including (1) altered metabolism of immunoregulatory branched chain amino acids (leucine, isoleucine and valine); and (2) altered levels of potentially proinflammatory tyrosine metabolites (p-cresol sulphate, 3-phenylpropionate) formed by the gastrointestinal microbial flora. However, isobutyrylcarnitine and propyonylcarnitine levels were also altered; the carnitines are important for the transport of fatty acids and may also be important for the release of immunoregulatory cytokines in allotransplant recipients. These metabolic alterations were associated with an ongoing pretransplant acute phase reaction or early hematopoietic/immune reconstitution. Thus, allotransplant recipients developing acute GVHD showed altered preconditioning/pretransplant levels of several immunoregulatory metabolites. Our hypothesis is that these metabolites alter or activate recipient immunocompetent cells and thereby enhance or initiate anti-recipient immune reactivity.Electronic supplementary materialThe online version of this article (doi:10.1007/s11306-015-0880-x) contains supplementary material, which is available to authorized users.

show abstract

Section: Resultsmentioning

confidence: 99%

The pretransplant systemic metabolic profile reflects a risk of acute graft versus host disease after allogeneic stem cell transplantation

2015

View full text Add to dashboard Cite

show abstract

“…Moreover, CID has been reported to last as long as 10 years post-treatment (Denlinger and Barsevick, 2009). Persistent and severe chemotherapy-associated Diarrhea is correlated with significant malnutrition and dehydration resulting in concomitant weight loss (cachexia), fatigue, renal failure, hemorrhoids, and perianal skin breakdown (Mitchell, 2006; Shafi and Bresalier, 2010). CID related dehydration is linked to early death rates in roughly 5% of patients undergoing anti-cancer treatment (Rothenberg et al, 2001).…”

Section: Chemotherapy-induced Diarrheamentioning

confidence: 99%

Chemotherapy-Induced Constipation and Diarrhea: Pathophysiology, Current and Emerging Treatments

et al. 2016

View full text Add to dashboard Cite

Gastrointestinal (GI) side-effects of chemotherapy are a debilitating and often overlooked clinical hurdle in cancer management. Chemotherapy-induced constipation (CIC) and Diarrhea (CID) present a constant challenge in the efficient and tolerable treatment of cancer and are amongst the primary contributors to dose reductions, delays and cessation of treatment. Although prevalence of CIC is hard to estimate, it is believed to affect approximately 16% of cancer patients, whilst incidence of CID has been estimated to be as high as 80%. Despite this, the underlying mechanisms of both CID and CIC remain unclear, but are believed to result from a combination of intersecting mechanisms including inflammation, secretory dysfunctions, GI dysmotility and alterations in GI innervation. Current treatments for CIC and CID aim to reduce the severity of symptoms rather than combating the pathophysiological mechanisms of dysfunction, and often result in worsening of already chronic GI symptoms or trigger the onset of a plethora of other side-effects including respiratory depression, uneven heartbeat, seizures, and neurotoxicity. Emerging treatments including those targeting the enteric nervous system present promising avenues to alleviate CID and CIC. Identification of potential targets for novel therapies to alleviate chemotherapy-induced toxicity is essential to improve clinical outcomes and quality of life amongst cancer sufferers.

show abstract

“…Diarrhea occurs because the epithelial cells of the gastrointestinal tract are destroyed by certain antineoplastic agents, such as fluorouracil and irinotecan, which results in poor digestion and absorption of nutrients (Shafi, Bresalier, 2010). In this study, diarrhea was the fourth most commonly reported ADR.…”

Section: Discussionmentioning

confidence: 63%

“…When the patients developed this reaction, loperamide was administered. Loperamide has been recognized as a more effective pharmacological agent for treating diarrhea (Shafi, Bresalier, 2010;Benson et al, 2004), and its use should be adequately monitored.…”

Section: Discussionmentioning

confidence: 99%

Pharmacovigilance in oncology: pattern of spontaneous notifications, incidence of adverse drug reactions and under-reporting

Visacri

Souza

Pimentel

et al. 2014

Braz. J. Pharm. Sci.

View full text Add to dashboard Cite

The high toxicity and narrow therapeutic window of antineoplastic agents makes pharmacovigilance studies essential in oncology. The objectives of the current study were to analyze the pattern of spontaneous notifications of adverse drug reactions (ADRs) in oncology patients and to analyze the incidence of ADRs reported by outpatients on antineoplastic treatment in a tertiary care teaching hospital. To compose the pattern of ADR, the notification forms of reactions in oncology patients in 2010 were reviewed, and the reactions were classified based on the drug involved, mechanism, causality, and severity. To evaluate the incidence of reactions, a questionnaire at the time of chemotherapy was included, and the severity was classified based on the Common Terminology Criteria. The profiles of the 10 responses reported to the Pharmacovigilance Sector were type B, severe, possible, and they were primarily related to platinum compounds and taxanes. When the incidence of reactions was analyzed, it was observed that nausea, alopecia, fatigue, diarrhea, and taste disturbance were the most frequently reported reactions by oncology patients, and the grade 3 and 4 reactions were not reported. Based on this analysis, it is proposed that health professionals should be trained regarding notifications and clinical pharmacists should increasingly be brought on board to reduce under-reporting of ADRs.Uniterms: Pharmacovigilance. Oncovigilance. Drugs/adverse reactions. Adverse drug reactions/underreporting. Adverse drug reactions/Spontaneous notification. Clinical pharmacy.Estudos de farmacovigilância são imprescindíveis em oncologia, pois os antineoplásicos possuem alta toxicidade e estreita janela terapêutica. Os objetivos deste estudo foram analisar o perfil das notificações espontâneas de reações adversas a medicamentos (RAM) em pacientes oncológicos e a incidência de RAM ao tratamento antineoplásico em um hospital terciário e universitário. Para compor o perfil de RAM, revisaram-se os formulários de notificação de reações em pacientes oncológicos do ano de 2010 e classificaram-se as reações conforme o medicamento envolvido, mecanismo, causalidade e gravidade. Para avaliar a incidência de reações, aplicou-se um questionário no momento da quimioterapia e a gravidade foi classificada pelos Critérios Comuns de Toxicidade. Apenas 10 reações foram notificadas ao Setor de Farmacovigilância, cujo perfil encontrado foi tipo B, grave, possível, e foram principalmente relacionadas aos compostos de platina e taxanos. Na análise da incidência das reações, observou-se que náusea, alopecia, fadiga, diarreia e distúrbio do paladar foram as reações mais frequentes relatadas por pacientes oncológicos, e as reações grau 3 e 4 não foram notificadas. De acordo com essas análises, propõe-se que os profissionais da saúde sejam treinados quanto às notificações e que farmacêuticos clínicos sejam cada vez mais inseridos neste contexto para redução da subnotificação de RAM.Unitermos: Farmacovigilância. Oncovigilância. Medicamentos/reações adversas. Anti...

show abstract

The Gastrointestinal Complications of Oncologic Therapy

Cited by 31 publications

References 72 publications

The pretransplant systemic metabolic profile reflects a risk of acute graft versus host disease after allogeneic stem cell transplantation

The pretransplant systemic metabolic profile reflects a risk of acute graft versus host disease after allogeneic stem cell transplantation

Chemotherapy-Induced Constipation and Diarrhea: Pathophysiology, Current and Emerging Treatments

Pharmacovigilance in oncology: pattern of spontaneous notifications, incidence of adverse drug reactions and under-reporting

Contact Info

Product

Resources

About