Diarrhoea in adult cancer patients: ESMO Clinical Practice Guidelines

Bossi, Paolo; Antonuzzo, Andrea; Cherny, Nathan I.; Rosengarten, Ora; Pernot, Simon; Trippa, Fabio; Schuler, U; Snegovoy, A. V.; Jordan, Karin; Ripamonti, C I

doi:10.1093/annonc/mdy145

Cited by 103 publications

(103 citation statements)

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“…Reasonable initial choices include monotherapy with piperacillin-tazobactam or imipenem-cilastatin or combination therapy with cefepime or ceftazidime along with metrinidazole . [8] Conclusion:-Evidences supports that capecitabine is a useful agent in adjuvant and advanced colorectal cancer treatment. Experiences suggest that its use should be tempered with vigilance for serious gastro-intestinal morbidity.…”

Section: Managementmentioning

confidence: 98%

Capecitabine Induced Necrotizing Enterocolitis.

Pv¹,

ijar²

2019

IJAR

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Capecitabine is an antineoplastic agent belonging to pyrimidine antagonist which is used in the treatment of metastatic colorectal cancer. It is an orally active prodrug of 5-Fluorouracil (5-FU). After absorption it is converted into deoxy-5-fluoridine in the liver and is released into blood. Taken up by cells, it is hydrolyzed to 5-FU by thymidine phosphorylase. 5-FU is metabolized by dihydropyrimidine dehydrogenase(DPD).Since many breast and colorectal cancer cells express large quantity of this enzyme, they generate more 5-FU and suffer higher toxicity than normal cells. A combined regimen of capecitabine and oxaliplatin is frequently used in metastatic colorectal cancer [1] . Capecitabine is registered for treatment of patients following surgery of stage III colon cancer in the adjuvant setting, for treatment of metastatic colorectal cancer, first-line treatment of advanced gastric cancer and for treatment of locally advanced or metastatic breast cancer (European Medicines Agency (EMEA), 2015) [2] . Here we report a case of necrotizing enterocolitis secondary to the use of capecitabine in the treatment of carcinoma stomach stage III and discuss its relevant pathophysiology, clinical presentation and management.Our aim is to create an awareness regarding capecitabine induced necrotizing enterocolitis which is a rare and life threatening adverse event. Case report:A 65years old male was evaluated for abdominal pain, vomiting and loss of appetite. The patient's past medical history shows that he is a known case of COPD and is on inhalers. He is also positive for HbsAG test. Ultrasonography(USG) abdomen done showed suspicious pyloric wall thickening. Oesophago-gastro-duodenoscopy (OGD scopy) done showed growth incisura. Biopsy reports showed poorly differentiated adenocarcinoma stomach. He underwent distal gastrectomy, D2 dissection and esophago jejunostomy. Histopathology reported as tumor size of 8 x 5 x 2 cm, grade III, poorly cohesive carcinoma, margins free and 14/22 lymph nodes positive. He came to hospital for further evaluation and management and was planned for adjuvant chemotherapy with oxaliplatin and capecitabine (capeOX) regimen. The patient successfully tolerated first three cycles of chemotherapy. But post fourth cycle of capecitabine, patient presented with complaints of loose stools and abdominal pain. Diagnosis:Clinical examination showed that the patient's ECOG performance status as 1. The patient was afebrile and vital signs were normal. Post 4 th cycle the patient presented with complaints of giddiness, loose stools and abdominal pain. On clinical examination abdomen was distended and tenderness was positive. USG was done and it showed that the patient got diagnosed with Necrotising enterocolitis. This diagnosis was further confirmed by a CT scan. Blood investigations revealed that the patient have hypokalemia.Corresponding Author:-Athira P V.

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Section: Managementmentioning

confidence: 98%

Capecitabine Induced Necrotizing Enterocolitis.

Pv¹,

ijar²

2019

IJAR

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“…Im unteren Gastrointestinaltrakt stel-lenbeiSymptomenwieDiarrhöundKolitis -neben der Therapie derselben -v. a. die Diagnostik und deren Abgrenzung zu Nebenwirkungen antineoplastischer Therapien und moderner zielgerichteter Therapien (z. B. Tyrosinkinaseinhibitoren und Immuncheckpointinhibitoren) die führenden Probleme dar [20][21][22]. Bei Diarrhöen (≥3 weiche Stühle/24 h) sollte initial die Stuhlbeurteilung hinsichtlich Farbe, Konsistenz und Beimengungen von Blut oder putriden Materials erfolgen.…”

Section: » Bei Schwerer Mukositis Ist Häufig Eine Parenterale Ernähruunclassified

“…Bei Diarrhöen (≥3 weiche Stühle/24 h) sollte initial die Stuhlbeurteilung hinsichtlich Farbe, Konsistenz und Beimengungen von Blut oder putriden Materials erfolgen. Anamnestisch gilt der vorherigen Einnahme von Antibiotika und weiterer Medikationen (Protonenpumpeninhibitoren) besonderes Augenmerk [21,22].…”

Section: » Bei Schwerer Mukositis Ist Häufig Eine Parenterale Ernähruunclassified

“…Als supportive Maßnahme muss eine ausreichende Zufuhr von Flüssigkeit und Elektrolyten erfolgen. Die Entscheidung zur parenteralen Ernährung erfolgt abhängig von weiteren Risikofaktoren (Komorbiditäten, Mangelernährungsrisiko) [21,22].…”

Section: » Bei Schwerer Mukositis Ist Häufig Eine Parenterale Ernähruunclassified

“…Virale Ursachen einer Gastroenteritis werden primär supportiv behandelt, jedoch kann bei schwerer Adenovirusenteritis Cidofovir erwogen werden. Nach Nachweis einer CMV-Enteritis sollte die Behandlung mit Ganciclovir eingeleitet werden [21,22].…”

Section: » Bei Schwerer Mukositis Ist Häufig Eine Parenterale Ernähruunclassified

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