Published online Nov 7, 2015. doi: 10.3748/wjg.v21.i41.11793
Peer-review started: May 20, 2015
First decision: July 13, 2015
Revised: August 6, 2015
Accepted: September 15, 2015
Article in press: September 15, 2015
Published online: November 7, 2015
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.
Core tip: Although extremely frequent, treatment-related gastrointestinal toxicities in patients with advanced colorectal cancer and pancreatic cancer are often underreported. As such, it is difficult to establish to what extent such toxicities affect both patient quality of life and cancer care costs. In our work we describe the main gastrointestinal toxicities as well as their pathophysiology and grading scales. Finally, based on the results of the main randomized clinical trials, we provide a critical update on their incidence with both chemotherapeutic agents and novel targeted drugs.