Gastrointestinal toxic effects in patients with cancer receiving platinum-based therapy

Abstract

Background: Platinum-based therapy (PBT) can be limited by gastrointestinal adverse events, particularly PBT-related colitis and diarrhea (PCD). We studied clinical features, treatments, and outcomes of PCD. Methods: This was a retrospective study of cancer patients who received PBT and colonoscopic evaluation for PCD symptoms from 2009 to 2018. Results: Of 36,595 patients who received PBT, 86 (0.2%) met inclusion criteria. Median time from PBT initiation to PCD was 66 days. Regarding PBT type, 47% of the patients received carboplatin, 31% cisplatin, and 22% oxaliplatin. Median duration of PCD symptoms was 20 days. Colonoscopy revealed mucosal ulceration in 34% of the patients and nonulcerative inflammation in 33%. Half of the cohort needed hospitalization for PCD (49%). The majority received treatment for PCD (59%): immunosuppressive therapy in 21%, antibiotics in 27%, antimotility agents in 22%, and intravenous fluids in 51%. Eight patients (9%) were admitted to the intensive care unit for PCD management. Six patients (7%) experienced colonic perforation that required surgical intervention; two of them had gastrointestinal tumors. Physicians restarted PBT in 37 (43%) patients; 8 (22%) of them had PCD recurrence that was managed expectantly. Colonic perforation occurred more frequently with use of oxaliplatin and cisplatin than carboplatin (P=0.05). The median duration of PCD symptoms was longer in patients receiving carboplatin or cisplatin than in those receiving oxaliplatin (P=0.182). Conclusions: PCD is rare, but in a small subset of patients, it can lead to serious complications. Treatment of PCD is mainly supportive, but immunosuppressive therapy may be required.

Immune checkpoint Inhibitor–Induced diarrhea and Colitis: Incidence and Management. A systematic review and Meta-analysis

“…However, the prevalence of diarrhea after cisplatin or carboplatin has previously been reported to be low [103]. In addition, a retrospective recent study including 36,595 patients receiving platinbased chemotherapy found that only 0.2% developed endoscopic confirmed diarrhea and colitis independent of the drug used [104]. For patients receiving treatment with a taxane, all grade diarrhea has been reported in approximately 40% of patients independent of drug used [103].…”

Severe ileum bleeding following adjuvant capecitabine chemotherapy for locally advanced colon cancer: a case report and review of the literature

“…In a retrospective study of 36,595 patients who received platinum-based therapy, only 37 cases presented blood or mucous in the stools. In these cases, platinum-related colitis and ulcer were found to be the etiology of the hemorrhage [ 13 ].…”

“…Another chemotherapeutic agent in the XELOX regimen is oxaliplatin, which also should be considered as the etiology of the hemorrhage. It has been reported that the symptoms of platinum-induced colitis develop at a median of 66 days after platinum chemotherapy [ 13 ]. In this case, the patient presented to his surgeon with skin rash, fever, and severe bloody diarrhea 2 days after the end of the 2-week capecitabine administration cycle, and the bloody diarrhea persisted until laparotomy.…”

Chemotherapy-induced microbiota exacerbates the toxicity of chemotherapy through the suppression of interleukin-10 from macrophages

“…However, oxaliplatin often causes gastrointestinal, neural, and hematopoietic syndromes, resulting in interruption of treatment or dose reduction. 2–4 Therefore, the amelioration of chemotherapy-induced toxicity is essential for improving cancer treatment.…”