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Gastrointestinal Cancer: Selection of Clinically Relevant Drug-Induced Toxicities Encountered in Gastrointestinal Cancer Treatment

  • Julie Bogaert
  • Pieter-Jan Cuyle
  • Eric Van Cutsem
Chapter

Abstract

The chemotherapeutic options have increased dramatically in patients with gastrointestinal cancer and have led to an improved outcome. With this, an in-depth understanding of the side effects of chemotherapy is becoming increasingly important in order to minimize the negative impact of the use of these agents. Chemotherapeutic agents have a long list of potential side effects. In this chapter, we focus specifically on some of the more common and/or more relevant and challenging side effects related to frequently used agents in gastrointestinal cancer. The fluoropyrimidines may cause cardiac toxicity, most frequently angina-like chest pain. The knowledge of the catabolism of fluorouracil has led to the possibility of testing for dihydropyrimidine dehydrogenase (DPD) in order to avoid serious fluorouracil-related toxicity in patients with DPD deficiency. Oxaliplatin-induced neurotoxicity is probably the most important clinical problem associated with the administration of oxaliplatin. With the increasing use of oxaliplatin, hypersensitivity reactions are more frequently reported and become challenging in clinical practice. The introduction of the targeted agents in colorectal cancer led also to specific problems: the anti-VEGF-related side effects, of which arterial thrombosis and gastrointestinal perforation, although relatively rare, are very relevant for the patient, and the anti-EGFR-related side effects, including skin rash, hypomagnesemia, and allergic reactions, are common. Understanding the underlying causes, mechanisms, risk factors, and developing treatment guidelines has made these side effects often more acceptable for many patients. However, the side-effect profile always has to be balanced against the activity and benefit of the anticancer agents.

Keywords

Fluorouracil DPD Oxaliplatin Irinotecan VEGF EGFR Bevacizumab Cetuximab Panitumumab 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Julie Bogaert
    • 1
  • Pieter-Jan Cuyle
    • 1
  • Eric Van Cutsem
    • 1
  1. 1.Digestive OncologyUniversity Hospitals GasthuisbergLeuvenBelgium

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