title: Treatment-related gastrointestinal toxicities and advanced colorectal or pancreatic cancer: A critical update.
abstract: Gastrointestinal toxicities (GIT), including oral mucositis, nausea and vomiting, and diarrhea, are common side effects of chemotherapy and targeted agents in patients with advanced colorectal cancer and pancreatic cancer. Being often underreported, it is still difficult to precisely establish their burden in terms of both patient's quality of life and cancer care costs. Moreover, with the use of more intensive upfront combination regimens, the frequency of these toxicities is rapidly growing with a potential negative effect also on patient's outcome, as a result of dose reductions, delays or even discontinuation of active treatments. Thus, identifying patients at higher risk of developing GIT as well as an optimal management are paramount in order to improve patient's compliance and outcome. After the description of the main treatment-induced GIT, we discuss the current knowledge on the pathophysiology of these side effects and comment the scales commonly used to assess and grade them. We then provide a critical update on GIT incidence based on the results of key randomized trials conducted in patients with metastatic colorectal cancer and advanced pancreatic cancer.
authors.affiliation: Giuseppe Aprile, Karim Rihawi, Elisa De Carlo, Department of Medical Oncology, University and General Hospital of Udine, 33100 Udine, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Aprile
authors.affiliation: Giuseppe Aprile, Karim Rihawi, Elisa De Carlo, Department of Medical Oncology, University and General Hospital of Udine, 33100 Udine, Italy.
authors.forename: Karim
authors.initials: K
authors.lastname: Rihawi
authors.affiliation: Giuseppe Aprile, Karim Rihawi, Elisa De Carlo, Department of Medical Oncology, University and General Hospital of Udine, 33100 Udine, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: De Carlo
authors.affiliation: Giuseppe Aprile, Karim Rihawi, Elisa De Carlo, Department of Medical Oncology, University and General Hospital of Udine, 33100 Udine, Italy.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Sonis
mesh_terms: D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000628:therapy; D006801:Humans; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors
keywords: Colorectal cancer; Diarrhea; Gastrointestinal toxicities; Oral mucositis; Pancreatic cancer