Assessment of diarrhea as side effect of oral targeted antineoplastic agents in clinical practice
Vicente Escudero-Vilaplana1,2, Roberto Collado-Borrell3,4, Maria Del Monte-Millán4,5,6
1Pharmacy Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain. vicente.escudero@salud.madrid.org.
Background:
Diarrhea is one of the most frequent class adverse events associated with targeted oral antineoplastic agents (OAAs). Our objective was to analyze the incidence, characteristics, and severity of diarrhea in cancer patients in clinical practice.
Methods:
An observational, longitudinal, and prospective study of cancer outpatients treated with targeted OAAs was carried out in a tertiary hospital. Targed OAAs analyzed were anaplastic lymphoma kinase inhibitors, BCR-ABL inhibitors, cyclin-dependent kinase inhibitors, epidermal growth factor receptor inhibitors, mTOR inhibitors, poly (ADP-ribose) polymerase inhibitors, and vascular endothelial growth factor receptor inhibitors. Patients were given a data collection form to record daily the number, severity (CTCAE version 5.0), and characteristics of stools during the first 30 days of treatment with OAAs. Multivariate analysis was performed to identify risk factors associated with the incidence of diarrhea.
Results:
We analyzed 240 patients, of whom 28.7% experienced diarrhea (25.4% grades 1-2 and 3.3% grades 3-4). Patients treated with EGFR and VEGFR inhibitors had a higher incidence of diarrhea. The multivariate analysis revealed that taking the OAA with food was associated with a lower risk of diarrhea (OR = 0.404 [0.205-0.956], p = 0.038).
Conclusions:
More than a third of patients in treatment with OAAs presented diarrhea (any grade), and 22.1% of stools were semi-liquid/liquid. In multivariate analysis, taking the OAA on an empty stomach was associated with a statistically significant increase in the incidence of diarrhea.
Insights
Diarrhea is a common side effect of oral antineoplastic agents (OAAs). Taking OAAs with food significantly reduces the risk of developing diarrhea in cancer patients.
Area of Science:
- Oncology
- Pharmacology
- Gastroenterology
Background:
- Diarrhea is a frequent adverse event in cancer patients receiving targeted oral antineoplastic agents (OAAs).
- Understanding the incidence, characteristics, and severity of OAA-induced diarrhea is crucial for patient management.
Purpose of the Study:
- To analyze the incidence, characteristics, and severity of diarrhea in cancer patients treated with targeted OAAs in a clinical setting.
- To identify risk factors associated with diarrhea development during OAA therapy.
Main Methods:
- An observational, longitudinal, prospective study was conducted with cancer outpatients receiving targeted OAAs.
- Patients recorded stool characteristics and severity daily for 30 days using CTCAE v5.0.
- Multivariate analysis identified risk factors for diarrhea incidence.
Main Results:
- Diarrhea occurred in 28.7% of 240 patients (25.4% grades 1-2, 3.3% grades 3-4).
- Higher diarrhea incidence was observed with epidermal growth factor receptor (EGFR) and vascular endothelial growth factor receptor (VEGFR) inhibitors.
- Taking OAAs with food was associated with a reduced risk of diarrhea (OR=0.404).
Conclusions:
- Over a third of patients on OAAs experienced diarrhea, with 22.1% reporting semi-liquid/liquid stools.
- Taking OAAs on an empty stomach significantly increased diarrhea incidence.
- Administering OAAs with food is a potential strategy to mitigate diarrhea risk.
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