title: [Management of side-effects of targeted therapies in renal cancer: gastrointestinal side-effects].
abstract: Several types of gastrointestinal complications can occur during treatment with targeted therapies: diarrhoea, nausea and vomiting, abnormalities in hepatic and pancreatic profiles, etc. Gastrointestinal problems in targeted therapy can have a significant impact on the general status of patients, their weight and their adherence to the treatment. The prevention, screening and rapid treatment of these side-effects are essential elements of patient care and can limit the associated dose reductions and loss of therapeutic benefit. In the case of diarrhoea, treatment must be started at the onset of grade 1 or 2 diarrhoea (four to six stools per day), with loperamide or racecadotril. Treatment with targeted therapy must be stopped if there is diarrhoea of grade 3 or 4 (more than six stools per day). In the case of nausea/vomiting or burning pain in the oesophagus, symptomatic treatment without stopping the targeted therapy is recommended. Biological assessment including transaminases, total and conjugated bilirubin should be prescribed before treatment initiation with targeted therapy. An elevation in alkaline phosphatases without elevation of transaminases suggests primarily the existence of hepatic metastases. In the event of worsening of the hepatic profile, if ALT greater than 5N, treatment must be stopped and specialist advice sought.
authors.affiliation: Clinique Rhône-Durance, urologie, 1750, chemin du Lavarin, BP 844, 84042 Avignon Cedex 2, France. Electronic address: jl.davin@numericable.fr.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Davin
authors.affiliation: CHU Charles-Nicolle, clinique HGE, 1, rue de Germont, 76031 Rouen Cedex, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ducrotté
authors.affiliation: Institut Bergonié, oncologie médicale, 229, cours de l'Argonne, 33076 Bordeaux Cedex France.
authors.forename: Nadine
authors.initials: N
authors.lastname: Houédé
keywords: ALAT; ALT; ASAT; AST; cytolyse hépatique; diarrhoea; diarrhée; hepatic cytolysis; nausea; nausées; vomissements; vomiting