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Alessandra Fabi

In trincea con nuove tossicità: siamo ben equipaggiati? Tossicità da target therapies e trattamenti integrati: diarrea. Alessandra Fabi. Incidence and sequelae. FU ci: 27% CPT11+FU: 25% CPT11+Oxa: 24% Beva+Oxa+Cap:30% Beva+CPT11: 32% Taxol: 17%. Maroun 2007.

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Alessandra Fabi

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  1. In trincea con nuove tossicità: siamo ben equipaggiati? Tossicità da target therapies e trattamenti integrati: diarrea Alessandra Fabi

  2. Incidence and sequelae • FU ci: 27% • CPT11+FU: 25% • CPT11+Oxa: 24% • Beva+Oxa+Cap:30% • Beva+CPT11: 32% • Taxol: 17% Maroun 2007

  3. Target therapiesCommon AEs (indirect safety comparation):Gastrointestinal 1. Motzer, et al. JCO 2009; 2. Escudier, et al. NEJM 2007 3. Escudier, et al. Lancet 2007; 4. Hudes, et al. NEJM 2007; 5. Motzer et al, Lancet 2008; 6 Sternberg, et al JCO 2010

  4. Diarrhoea: strategies for management *NCI CTCAE v3

  5. Current Oncology 2007

  6. Acute medical management of CID includes loperamide or diphenoxylate as first-line agents. • Sub-cutaneous octreotide is recommended for intractable grade 2 diarrhea and may be considered for grade 1 CID that does not resolve with high-dose loperamide. • Hospitalization is recommended for patients with grades 3 and 4 CID; in-hospital care includes rehydration, antibiotic therapy, and octreotide. MASCC, ASCO, AIOM

  7. ASCO guideline

  8. Target Therapies: management related to the single agent (see lapatinib, everolimus, sunitinib)

  9. Unmet Needs • Current guidelines express the need for diarrhea prophylaxis • Prophylaxis for severe diarrhea (colorectal cancer): octreotide failure (Larcid trial) • For de novo patients with rectal cancer who are undergoing concurrent adjuvant chemotherapy and radiotherapy, no clinical trials have been completed. Octreotide LAR im may be a treatment option in this setting. • More communications with patients (sensibilization of nurses) • Identification of clinical, phenotipic and genetic feature and changes predisposing to toxicity with chemoradiation regimens to identify possible risk factors • - Data base could be auspicable (Nicso)

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