Chemotherapy-induced diarrhea: pathophysiology, frequency and guideline-based management.
Chemotherapy-induced diarrhea: pathophysiology, frequency and guideline-based management.
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DOI：
10.1177/1758834009355164
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发表时间：
2010-01-01
影响因子：
4.9
通讯作者：
Jordan, Karin
中科院分区：
文献类型：
--
作者：
Stein, Alexander;Voigt, Wieland;Jordan, Karin
腹泻是癌症患者的主要缺点之一。可能的病因可能是放疗、化疗药物、身体机能下降、移植物抗宿主病和感染。化疗引起的腹泻（CID）是一个常见的问题，特别是在晚期癌症患者中。据报道，在接受治疗的患者中，CID的发生率高达50-80% (CTC 3-5级≥30%)，特别是5-氟尿嘧啶丸或伊立替康和氟嘧啶的一些联合治疗（IFL， XELIRI）。无论酪氨酸激酶抑制剂和抗体的分子靶向方法如何，腹泻是高达60%的患者常见的副作用，高达10%的患者患有严重腹泻。此外，潜在的病理生理学仍在研究中。尽管有许多临床试验评估CID的治疗或预防措施，但目前的指南中只推荐了三种药物：洛哌丁胺、除臭鸦片酊剂和奥曲肽。正在开发新的战略和更有效的药物，以降低与CID相关的发病率和死亡率。最近的研究集中在抗生素、布地奈德、益生菌或活性炭的预防性使用上，仍然需要确定这些药物在常规临床环境中的作用。虽然化疗后腹泻患者的治疗管理和临床检查相当明确，但CID的预测和预防是一个不断发展的领域。目前的研究重点是建立CID的预测因素，如伊立替康尿嘧啶二磷酸葡萄糖醛酸基转移酶- 1a1多态性或氟嘧啶二氢嘧啶脱氢酶不足。
Diarrhea is one of the main drawbacks for cancer patients. Possible etiologies could be radiotherapy, chemotherapeutic agents, decreased physical performance, graft versus host disease and infections. Chemotherapy-induced diarrhea (CID) is a common problem, especially in patients with advanced cancer. The incidence of CID has been reported to be as high as 50-80% of treated patients (≥30% CTC grade 3-5), especially with 5-fluorouracil bolus or some combination therapies of irinotecan and fluoropyrimidines (IFL, XELIRI). Regardless of the molecular targeted approach of tyrosine kinase inhibitors and antibodies, diarrhea is a common side effect in up to 60% of patients with up to 10% having severe diarrhea. Furthermore, the underlying pathophysiology is still under investigation. Despite the number of clinical trials evaluating therapeutic or prophylactic measures in CID, there are just three drugs recommended in current guidelines: loperamide, deodorized tincture of opium and octreotide. Newer strategies and more effective agents are being developed to reduce the morbidity and mortality associated with CID. Recent research focusing on the prophylactic use of antibiotics, budesonide, probiotics or activated charcoal still have to define the role of these drugs in the routine clinical setting. Whereas therapeutic management and clinical work-up of patients presenting with diarrhea after chemotherapy are rather well defined, prediction and prevention of CID is an evolving field. Current research focuses on establishing predictive factors for CID like uridine diphosphate glucuronosyltransferase-1A1 polymorphisms for irinotecan or dihydropyrimidine-dehydrogenase insufficiency for fluoropyrimidines.