Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2015; 21(41): 11793-11803
Published online Nov 7, 2015. doi: 10.3748/wjg.v21.i41.11793
Treatment-related gastrointestinal toxicities and advanced colorectal or pancreatic cancer: A critical update
Giuseppe Aprile, Karim Rihawi, Elisa De Carlo, Stephen T Sonis
Giuseppe Aprile, Karim Rihawi, Elisa De Carlo, Department of Medical Oncology, University and General Hospital of Udine, 33100 Udine, Italy
Stephen T Sonis, Divisions of Oral Medicine, Brigham and Women’s Hospital, Boston, MA 02115, United States
Stephen T Sonis, the Dana-Farber Cancer Institute, Biomodels, LLC, Watertown, MA 02115, United States
Author contributions: Aprile G, Rihawi K, De Carlo E and Sonis ST equally contributed to this work.
Conflict-of-interest statement: The authors have no conflict-of-interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Stephen T Sonis, DMD, DMSc, Divisions of Oral Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, United States.
Telephone: +1-617-5256864 Fax: +1-617-5256899
Received: May 18, 2015
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.

Keywords: Gastrointestinal toxicities, Oral mucositis, Diarrhea, Colorectal cancer, 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.