[Prevention of side reactions--present status and problems--special references]

The toxicity of chemotherapy affects adversely the QOL of patients and limits the dose of chemotherapy that can be administered. In the last decade, several agents have been developed that offer possible reduction from the toxicity of a range of anticancer agents. Clinical trials to evaluate these agents are intrinsically more difficult to perform. Standardized assessment and management of chemotherapy-induced toxicities have been required to control these adverse events. Recently, practice guidelines are systematically developed statements to assist the practitioner and patients decision about appropriate management for specific clinical circumstances. Guidelines may be useful in producing better care and decreasing cost. Further clinical research is warranted to address significant questions about the most effective way to assess and treat these adverse events. However, it is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Dr. Rothenberg stated in his recent special article titled "Mortality associated with irinotecan plus bolus fluorouracil/leucovorin: summary findings of an independent panel" (J Clin Oncol 19: 3801-3807, 2001) that "Close clinical monitoring, early recognition of toxicities and toxicity syndromes, aggressive therapeutic interventions, and with holding therapy in the presence of unsolved drug-related toxicities is recommended for patients receiving intensive chemotherapy regimens".