Prevention and treatment of organ toxicity during high-dose chemotherapy: an overview

By using increased doses or dose intensities of cytostatic agents, improvements in clinical outcome may be achieved in some cancer cases. However, high-dose chemotherapy may produce dose-limiting adverse reactions such as myelosuppression, neurotoxicity, cardiotoxicity, gastrointestinal toxicity, nausea and vomiting. The use of bone marrow transplantation, autologous infusion of circulating hematopoietic progenitors and hematopoietic growth factors have been shown to significantly reduce the severity and duration of the pancytopenia associated with cytostatic chemotherapy and chemoradiotherapy. In addition, recent developments in the control of nausea and vomiting with selective 5-HT3 antagonists have improved the tolerability of chemotherapy. The antiemetic efficacy of these agents has been shown to be equivalent to combination therapy with metoclopramide plus dexamethasone in the prevention of cisplatin-induced emesis. Progress in the prevention and treatment of organ toxicity is now required, if treatment with higher doses and dose intensities of cytostatic drug treatments are to be used for the future treatment of human malignancies.