New Cancer Therapies: Implications for the Perioperative Period
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Purpose of Review
Cancer is on the rise. Standing on verge of exciting discoveries, research is being translated into therapies that are being widely administered to patients. Providing a hope for cure, where none existed before. This new body of knowledge has come from a better understanding of cancer genetics, molecular and sub molecular behavior, and understanding of cancer-generated cellular environments. These have led to development of immunotherapy and its many sub-genres, improvement and introduction of new radiation technologies, and decreasing toxicities of existing chemotherapies.
The purpose of this review is to have a summary look at this huge landscape of cancer therapy. Specially looking at toxicities that an anesthesiologist should be familiar with while providing perioperative care for these patients, complications like tumor lysis syndrome, cytokine release syndromes, Kounis syndrome, myocarditis, encephalopathies, and pituitary failure need to be kept in mind.
One should be knowledgeable about these therapies and approach these patients with a high index of suspicion. Anesthesiologists will need to refine preoperative assessment with appropriate testing and intraoperative and postoperative management in collaboration with oncologists, while involving the expertise of internists, cardiologist, and endocrinologists in helping assess and manage these patients in the perioperative period.
KeywordsAnesthesia assessment in cancer patients Perioperative implications of cancer therapy New cancer therapies, side effects, and management in perioperative period Immunotherapy, mechanism of actions, and side effects Side effects
Compliance with Ethical Standards
Conflict of Interest
TayabAndrabi, Katy E. French, and Muzaffar H. Qazilbash declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 3.•• Aakre BM, Efem RI, Wilson GA, Kor DJ, Eisenach JH. Postoperative acute respiratory distress syndrome in patients with previous exposure to bleomycin. Mayo Clin Proc. 2014;89(2):181–9 Risk of postoperative ARDS in patients exposed to systemicbleomycin appears to be lower than expected. Smoking status may be an important factor that modifies the risk of postoperative ARDS. CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Gudaityte J, Dvylys D, Simeliunaite I. Anaesthetic challenges in cancer patients: current therapies and pain management. Acta Med Austriaca. 2017;24(2):121–7.Google Scholar
- 15.• Rothschild SI, Thommen DS, Moersig W, Muller P, Zippelius A. Cancer immunology - development of novel anti-cancer therapies. Swiss Med Wkly. 2015;145:w14066 Summarises the mechanism of action and subsequent clinical studies of immune checkpoint antibodies in oncology with a particular focus on melanoma and lung cancer.PubMedGoogle Scholar
- 20.•• Bodnar RJ. Anti-angiogenic drugs: involvement in cutaneous side effects and wound-healing complication. Adv Wound Care. 2014;3(10):635–46 Awareness is needed when treating patients on anti-angiogenic drugs so as not to exacerbate potential wound-healing complications when performing surgical procedures. When performing a surgical procedure, the impact ofadverse effects from the use of anti-angiogenic drugs should be considered to ensure the welfare of the patient. CrossRefGoogle Scholar
- 23.•• Ascierto PA, Brugarolas J, Buonaguro L, et al. Perspectives in immunotherapy: meeting report from the Immunotherapy Bridge (29–30 November, 2017, Naples, Italy). J Immunother Cancer. 2018;6:69 Immunotherapy represents the third important wave in the history of the systemic treatment of cancer after chemotherapy and targeted therapy and is now established as a potent and effective treatment option across several cancer types. With over 3000 immuno-oncology trials ongoing, involving hundreds of research institutes across the globe. The potential use of these different immunotherapeutic options in various combinations with one another and with other treatment modalities is an area of particular promise. CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Kounis NG, Zavras GM. Histamine-induced coronary artery spasm: the concept of allergic angina. British J Clin Practice. 1991;45(2):121–8.Google Scholar
- 37.•• Yang L, Yu H, Dong S, Zhong Y, Hu S. Recognizing and managing on toxicities in cancer immunotherapy. Tumor Biol. 2017;39(3):1010428317694542 Treatment toxicity spectrums vary greatly even in same type of cancers. Some side effects are reversible, and can be processed through the standard medicines. However, serious toxicities are lethal, which should be frequently followed-up and identified at an early stage. Google Scholar