Лекарственно-индуцированная диарея, ассоциированная с применением противоопухолевых препаратов
- Авторы: Сычёв Д.А.1, Остроумова О.Д.1,2, Зиганшина Л.Е.1, Филиппова А.В.1
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Учреждения:
- Российская медицинская академия непрерывного профессионального образования
- Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет)
- Выпуск: Том 13, № 3 (2021)
- Страницы: 5-18
- Раздел: Научный обзор
- Статья получена: 28.10.2021
- Статья одобрена: 05.11.2021
- Статья опубликована: 15.10.2021
- URL: https://journals.eco-vector.com/vszgmu/article/view/84052
- DOI: https://doi.org/10.17816/mechnikov84052
- ID: 84052
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Аннотация
Диарея является наиболее распространенной нежелательной реакцией на прием противоопухолевых препаратов, лучевую терапию органов малого таза или брюшной полости. Частота диареи всех степеней тяжести во время химиотерапии и/или лучевой терапии достигает 80 %, причем у трети пациентов развивается тяжелая диарея (III или IV степени). Чаще всего лекарственно-индуцированная диарея возникает на фоне химиотерапии с использованием 5-фторурацила или иринотекана, а также приема новых противоопухолевых препаратов из классов моноклональных антител и ингибиторов тирозинкиназы. К механизмам, лежащим в основе развития лекарственно-индуцированной диареи, относятся повреждения слизистой оболочки кишечника, нарушение всасывания белков, углеводов и жиров, воспаление, гиперреакивный иммунный ответ, дисбаланс микрофлоры кишечника и др.
Алгоритмы ведения пациентов с тяжелой диареей включают приостановку (при I–III степенях) или полное прекращение (при III–IV степенях) применения противоопухолевого средства — индуктора диареи, а также назначение препаратов, снижающих моторику кишечника, таких как лоперамид (при исключении инфекционной природы диареи) и метилпреднизолон (при диарее, вызванной моноклинальными антителами в отсутствие подозрения в отношении потенциально возможной перфорации кишечника). Если лекарственно-индуцированная диарея длится более 48 ч, пациент сообщает о симптомах обезвоживания или появилась лихорадка, необходима срочная госпитализация.
Цель работы — анализ данных научной литературы о распространенности, патофизиологических механизмах и факторах риска развития диареи, ассоциированной с приемом противоопухолевых лекарственных средств, а также ее профилактике и лечении.
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Об авторах
Дмитрий Алексеевич Сычёв
Российская медицинская академия непрерывного профессионального образования
Email: dimasychev@mail.ru
ORCID iD: 0000-0002-4496-3680
SPIN-код: 4525-7556
д-р мед. наук, профессор, член-кор. РАН, профессор РАН
Россия, 125993, Москва, ул. Баррикадная, д. 2/1, стр. 1Ольга Дмитриевна Остроумова
Российская медицинская академия непрерывного профессионального образования; Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет)
Email: ostroumova.olga@mail.ru
ORCID iD: 0000-0002-0795-8225
SPIN-код: 3910-6585
д-р мед. наук, профессор
Россия, 125993, Москва, ул. Баррикадная, д. 2/1, стр. 1; МоскваЛилия Евгеньевна Зиганшина
Российская медицинская академия непрерывного профессионального образования
Email: lezign@gmail.com
ORCID iD: 0000-0003-1999-0705
SPIN-код: 6061-7223
д-р мед. наук, профессор
Россия, 125993, Москва, ул. Баррикадная, д. 2/1, стр. 1Анастасия Витальевна Филиппова
Российская медицинская академия непрерывного профессионального образования
Автор, ответственный за переписку.
Email: filippova.96@mail.ru
ORCID iD: 0000-0003-3081-602X
ординатор кафедры терапии и полиморбидной патологии имени академика М.С. Вовси
Россия, 125993, Москва, ул. Баррикадная, д. 2/1, стр. 1Список литературы
- Benson A.B. 3rd, Ajani J.A., Catalano R.B. et al. Recommended guidelines for the treatment of cancer treatment-induced diarrhea // J. Clin. Oncol. 2004. Vol. 22, No. 14. P. 2918–2926. doi: 10.1200/JCO.2004.04.132
- Sanguineti G., Endres E.J., Parker B.C. et al. Acute toxicity of whole-pelvis IMRT in 87 patients with localized prostate cancer // Acta. Oncol. 2008. Vol. 47, No. 2. P. 301–310. doi: 10.1080/02841860701558849
- Maroun J.A., Anthony L.B., Blais N. et al. Prevention and management of chemotherapy-induced diarrhea in patients with colorectal cancer: a consensus statement by the Canadian Working Group on Chemotherapy-Induced Diarrhea // Curr. Oncol. 2007. Vol. 14, No. 1. P. 13–20. doi: 10.3747/co.2007.96
- Bossi P., Antonuzzo A., Cherny N.I. et al. Diarrhoea in adult cancer patients: ESMO Clinical Practice Guidelines // Ann. Oncol. 2018. Vol. 29, No. Suppl 4. P. iv126–iv142. doi: 10.1093/annonc/mdy145
- Antonuzzo A., Lucchesi M., Brunetti I.M. et al. Supportive care and not only palliative care in the route of cancer patients // Support Care Cancer. 2013. Vol. 21, No. 3. P. 657–658. doi: 10.1007/s00520-012-1658-6
- Andreyev J., Ross P., Donnellan C. et al. Guidance on the management of diarrhoea during cancer chemotherapy // Lancet Oncol. 2014. Vol. 15, No. 10. P. 447–460. doi: 10.1016/S1470-2045(14)70006-3
- Dunberger G., Lind H., Steineck G. et al. Loose stools lead to fecal incontinence among gynecological cancer survivors // Acta Oncol. 2011. Vol. 50, No. 2. P. 233–242. doi: 10.3109/0284186X.2010.535013
- Dunberger G., Lind H., Steineck G. et al. Self-reported symptoms of faecal incontinence among long-term gynaecological cancer survivors and population-based controls // Eur. J. Cancer. 2010. Vol. 46, No. 3. P. 606–615. doi: 10.1016/j.ejca.2009.10.023
- Richardson G., Dobish R. Chemotherapy induced diarrhea // J. Oncol. Pharm. Pract. 2007. Vol. 13, No. 4. P. 181–198. doi: 10.1177/1078155207077335
- Gibson R.J., Keefe D.M. Cancer chemotherapy-induced diarrhoea and constipation: mechanisms of damage and prevention strategies // Support Care Cancer. 2006. Vol. 14, No. 9. P. 890–900. doi: 10.1007/s00520-006-0040-y
- Andreyev H.J., Davidson S.E., Gillespie C. et al. Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer // Gut. 2012. Vol. 61, No. 2. P. 179–192. doi: 10.1136/gutjnl-2011-300563
- Wei D., Heus P., van de Wetering F.T. et al. Probiotics for the prevention or treatment of chemotherapy- or radiotherapy-related diarrhoea in people with cancer // Cochrane Database Syst. Rev. 2018. Vol. 8, No. 8. P. CD008831. doi: 10.1002/14651858.CD008831.pub3
- Miller L. Guidelines for Management of Systemic Anti-Cancer Therapy (SACT) induced diarrhoea in adult haematology and oncology patients [Электронный ресурс]. Режим доступа: https://www.nhsscotlandnorth.scot/uploads/tinymce/NCA/SACT %20Guidelines/NOS-STG-003_ %20diarrhoea_version %202.pdf. Дата обращения: 12.08.2021.
- Common Terminology Criteria for Adverse Events (CTCAE). Version 5 ed. U.S. [Электронный ресурс] // Department of Health and Human Services. Режим доступа: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/ctcae_v5_quick_reference_5x7.pdf. Дата обращения: 12.08.2021.
- Verhaar S., Vissers P.A., Maas H. et al. Treatment-related differences in health related quality of life and disease specific symptoms among colon cancer survivors: results from the population-based PROFILES registry // Eur. J. Cancer. 2015. Vol. 51, No. 10. P. 1263–1273. doi: 10.1016/j.ejca.2015.04.004
- Parnes H.L., Fung E., Schiffer C.A. Chemotherapy-induced lactose intolerance in adults // Cancer. 1994. Vol. 74, No. 5. P. 1629–1633. doi: 10.1002/1097-0142(19940901)74:5<1629::aid-cncr2820740523>3.0.co;2-l
- Osterlund P., Ruotsalainen T., Peuhkuri K. et al. Lactose intolerance associated with adjuvant 5-fluorouracil-based chemotherapy for colorectal cancer // Clin. Gastroenterol. Hepatol. 2004. Vol. 2, No. 8. P. 696–703. doi: 10.1016/s1542-3565(04)00293-9
- Pearson A.D., Craft A.W., Pledger J.V. et al. Small bowel function in acute lymphoblastic leukaemia // Arch. Dis. Child. 1984. Vol. 59, No. 5. P. 460–465. doi: 10.1136/adc.59.5.460
- Pettoello-Mantovani M., Guandalini S., diMartino L. et al. Prospective study of lactose absorption during cancer chemotherapy: feasibility of a yogurt-supplemented diet in lactose malabsorbers // J. Pediatr. Gastroenterol. Nutr. 1995. Vol. 20, No. 2. P. 189–195. doi: 10.1097/00005176-199502000-00009
- Bustillo I., Larson H., Saif M.W. Small intestine bacterial overgrowth: an underdiagnosed cause of diarrhea in patients with pancreatic cancer // JOP. 2009. Vol. 10, No. 5. P. 576–578.
- Stringer A.M., Gibson R.J., Logan R.M. et al. Gastrointestinal microflora and mucins may play a critical role in the development of 5-Fluorouracil-induced gastrointestinal mucositis // Exp. Biol. Med. (Maywood). 2009. Vol. 234, No. 4. P. 430–441. doi: 10.3181/0810-RM-301
- Grace E., Shaw C., Whelan K., Andreyev H.J. Review article: small intestinal bacterial overgrowth--prevalence, clinical features, current and developing diagnostic tests, and treatment // Aliment Pharmacol. Ther. 2013. Vol. 38, No. 7. P. 674–688. doi: 10.1111/apt.12456
- Grigg A.P., Angus P.W., Hoyt R., Szer J. The incidence, pathogenesis and natural history of steatorrhea after bone marrow transplantation // Bone Marrow Transplant. 2003. Vol. 31, No. 8. P. 701–703. doi: 10.1038/sj.bmt.1703911
- Meta-Analysis Group In Cancer, Lévy E., Piedbois P., Buyse M. et al. Toxicity of fluorouracil in patients with advanced colorectal cancer: effect of administration schedule and prognostic factors // J. Clin. Oncol. 1998. Vol. 16, No. 11. P. 3537–3541. doi: 10.1200/JCO.1998.16.11.3537
- Claassen Y.H., van der Valk M.J., Breugom A.J. et al. Survival differences with immediate versus delayed chemotherapy for asymptomatic incurable metastatic colorectal cancer // Cochrane Database Syst. Rev. 2018. Vol. 11, No. 11. P. CD012326. doi: 10.1002/14651858.CD012326.pub2
- Van Cutsem E., Findlay M., Osterwalder B. et al. Capecitabine, an oral fluoropyrimidine carbamate with substantial activity in advanced colorectal cancer: results of a randomized phase II study // J. Clin. Oncol. 2000. Vol. 18, No. 6. P. 1337–1345. doi: 10.1200/JCO.2000.18.6.1337
- Yumuk P.F., Aydin S.Z., Dane F. et al. The absence of early diarrhea with atropine premedication during irinotecan therapy in metastatic colorectal patients // Int. J. Colorectal. Dis. 2004. Vol. 19, No. 6. P. 609–610. doi: 10.1007/s00384-004-0613-5
- Tomita Y., Moldovan M., Chang Lee R. et al. Salvage systemic therapy for advanced gastric and oesophago-gastric junction adenocarcinoma // Cochrane Database Syst. Rev. 2020. Vol. 11, No. 11. P. CD012078. doi: 10.1002/14651858.cd012078.pub2
- Ramesh M., Ahlawat P., Srinivas N.R. Irinotecan and its active metabolite, SN-38: review of bioanalytical methods and recent update from clinical pharmacology perspectives // Biomed. Chromatogr. 2010. Vol. 24, No. 1. P. 104–123. doi: 10.1002/bmc.1345
- Wulaningsih W., Wardhana A., Watkins J. et al. Irinotecan chemotherapy combined with fluoropyrimidines versus irinotecan alone for overall survival and progression-free survival in patients with advanced and/or metastatic colorectal cancer // Cochrane Database Syst. Rev. 2016. Vol. 2. P. CD008593. doi: 10.1002/14651858.CD008593.pub3
- Clarke S.J., Yip S., Brown C. et al. Single-agent irinotecan or FOLFIRI as second-line chemotherapy for advanced colorectal cancer; results of a randomised phase II study (DaVINCI) and meta-analysis [corrected] // Eur. J. Cancer. 2011. Vol. 47, No. 12. P. 1826–1836. doi: 10.1016/j.ejca.2011.04.024
- Stein A., Voigt W., Jordan K. Chemotherapy-induced diarrhea: pathophysiology, frequency and guideline-based management // Ther. Adv. Med. Oncol. 2010. Vol. 2, No. 1. P. 51–63. doi: 10.1177/1758834009355164
- Chen E., Abu-Sbeih H., Thirumurthi S. et al. Clinical characteristics of colitis induced by taxane-based chemotherapy // Ann. Gastroenterol. 2020. Vol. 33, No. 1. P. 59–67. doi: 10.20524/aog.2019.0431
- Cherny N.I. Evaluation and management of treatment-related diarrhea in patients with advanced cancer: a review // J. Pain Symptom Manage. 2008. Vol. 36, No. 4. P. 413–423. doi: 10.1016/j.jpainsymman.2007.10.007
- Shaikh D.H., Baiomi A., Mehershahi S. et al. Paclitaxel-induced bowel perforation: a rare cause of acute abdomen // Case Rep. Gastroenterol. 2020. Vol. 14, No. 3. P. 687–694. doi: 10.1159/000510131
- Aapro M., Tjulandin S., Bhar P., Gradishar W. Weekly nab-paclitaxel is safe and effective in ≥65 years old patients with metastatic breast cancer: a post-hoc analysis // Breast. 2011. Vol. 20, No. 5. P. 468–474. doi: 10.1016/j.breast.2011.07.005
- Dranitsaris G., Yu B., King J. et al. Nab-paclitaxel, docetaxel, or solvent-based paclitaxel in metastatic breast cancer: a cost-utility analysis from a Chinese health care perspective // Clinicoecon. Outcomes Res. 2015. Vol. 7. P. 249–256. DOI: 10.2147 / CEOR.S82194
- De Bono J.S., Oudard S., Ozguroglu M. et al. Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: a randomised open-label trial // Lancet. 2010. Vol. 376, No. 9747. P. 1147–1154. doi: 10.1016/S0140-6736(10)61389-X
- Nieuweboer A.J., de Graan A.M., Hamberg P. et al. Effects of budesonide on cabazitaxel pharmacokinetics and cabazitaxel-induced diarrhea: a randomized, open-label multicenter phase II study // Clin. Cancer Res. 2017. Vol. 23, No. 7. P. 1679–1683. doi: 10.1158/1078-0432.CCR-16-2110
- Venkatesh P., Kasi A. Anthracyclines [Internet] // StatPearls. Treasure Island (FL). StatPearls Publishing, 2021.
- McQuade R.M., Stojanovska V., Abalo R. et al. Chemotherapy-induced constipation and diarrhea: pathophysiology, current and emerging treatments // Front. Pharmacol. 2016. Vol. 7. P. 414. doi: 10.3389/fphar.2016.00414
- Pessi M.A., Zilembo N., Haspinger E.R. et al. Targeted therapy-induced diarrhea: A review of the literature // Crit. Rev. Oncol. Hematol. 2014. Vol. 90, No. 2. P. 165–179. doi: 10.1016/j.critrevonc.2013.11.008
- Secombe K.R., Van Sebille Y.Z.A., Mayo B.J. et al. Diarrhea induced by small molecule tyrosine kinase inhibitors compared with chemotherapy: potential role of the microbiome // Integr. Cancer Ther. 2020. Vol. 19. P. 1534735420928493. doi: 10.1177/1534735420928493
- Yang J.C., Reguart N., Barinoff J. et al. Diarrhea associated with afatinib: an oral ErbB family blocker // Expert. Rev. Anticancer Ther. 2013. Vol. 13, No. 6. P. 729–736. doi: 10.1586/era.13.31
- Peterson M.E. Management of adverse events in patients with hormone receptor-positive breast cancer treated with everolimus: observations from a phase III clinical trial // Support Care Cancer. 2013. Vol. 21, No. 8. P. 2341–2349. doi: 10.1007/s00520-013-1826-3
- Chan D.L.H., Segelov E., Wong R.S. et al. Epidermal growth factor receptor (EGFR) inhibitors for metastatic colorectal cancer // Cochrane Database Syst. Rev. 2017. Vol. 6, No. 6. P. CD007047. doi: 10.1002/14651858.CD007047.pub2
- Sim E.H., Yang I.A., Wood-Baker R. et al. Gefitinib for advanced non-small cell lung cancer // Cochrane Database Syst. Rev. 2018. Vol. 1, No. 1. P. CD006847. doi: 10.1002/14651858.CD006847.pub2
- Greenhalgh J., Boland A., Bates V. et al. First-line treatment of advanced epidermal growth factor receptor (EGFR) mutation positive non-squamous non-small cell lung cancer // Cochrane Database Syst. Rev. 2021. Vol. 3, No. 3. P. CD010383. doi: 10.1002/14651858.CD010383.pub3
- Yang J.C., Hirsh V., Schuler M. et al. Symptom control and quality of life in LUX-Lung 3: a phase III study of afatinib or cisplatin/pemetrexed in patients with advanced lung adenocarcinoma with EGFR mutations // J. Clin. Oncol. 2013. Vol. 31, No. 27. P. 3342–3350. doi: 10.1200/JCO.2012.46.1764
- Wu Y.L., Zhou C., Hu C.P. et al. Afatinib versus cisplatin plus gemcitabine for first-line treatment of Asian patients with advanced non-small-cell lung cancer harbouring EGFR mutations (LUX-Lung 6): an open-label, randomised phase 3 trial // Lancet Oncol. 2014. Vol. 15, No. 2. P. 213–222. doi: 10.1016/S1470-2045(13)70604-1
- Giaccone G., Herbst R.S., Manegold C. et al. Gefitinib in combination with gemcitabine and cisplatin in advanced non-small-cell lung cancer: a phase III trial--INTACT 1 // J. Clin. Oncol. 2004. Vol. 22, No. 5. P. 777–784. doi: 10.1200/JCO.2004.08.001
- Herbst R.S., Giaccone G., Schiller J.H. et al. Gefitinib in combination with paclitaxel and carboplatin in advanced non-small-cell lung cancer: a phase III trial--INTACT 2 // J. Clin. Oncol. 2004. Vol. 22, No. 5. P. 785–794. doi: 10.1200/JCO.2004.07.215
- Wu Y.L., Saijo N., Thongprasert S. et al. Efficacy according to blind independent central review: Post-hoc analyses from the phase III, randomized, multicenter, IPASS study of first-line gefitinib versus carboplatin/paclitaxel in Asian patients with EGFR mutation-positive advanced NSCLC // Lung Cancer. 2017. Vol. 104. P. 119–125. doi: 10.1016/j.lungcan.2016.11.022
- Wu Y.L., Fukuoka M., Mok T.S. et al. Tumor response and health-related quality of life in clinically selected patients from Asia with advanced non-small-cell lung cancer treated with first-line gefitinib: post hoc analyses from the IPASS study // Lung Cancer. 2013. Vol. 81, No. 2. P. 280–287. doi: 10.1016/j.lungcan.2013.03.004
- Thongprasert S., Duffield E., Saijo N. et al. Health-related quality-of-life in a randomized phase III first-line study of gefitinib versus carboplatin/paclitaxel in clinically selected patients from Asia with advanced NSCLC (IPASS) // J. Thorac. Oncol. 2011. Vol. 6, No. 11. P. 1872–1880. doi: 10.1097/JTO.0b013e31822adaf7
- Shi Y.K., Wang L., Han B.H. et al. First-line icotinib versus cisplatin/pemetrexed plus pemetrexed maintenance therapy for patients with advanced EGFR mutation-positive lung adenocarcinoma (CONVINCE): a phase 3, open-label, randomized study // Ann. Oncol. 2017. Vol. 28, No. 10. P. 2443–2450. doi: 10.1093/annonc/mdx359
- Chen Y.M., Tsai C.M., Fan W.C. et al. Phase II randomized trial of erlotinib or vinorelbine in chemonaive, advanced, non-small cell lung cancer patients aged 70 years or older // J. Thorac. Oncol. 2012. Vol. 7, No. 2. P. 412–418. doi: 10.1097/JTO.0b013e31823a39e8
- Rosell R., Carcereny E., Gervais R. et al. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial // Lancet Oncol. 2012. Vol. 13, No. 3. P. 239–246. doi: 10.1016/S1470-2045(11)70393-X
- Heigener D.F., Deppermann K.M., Pawel J.V. et al. Open, randomized, multi-center phase II study comparing efficacy and tolerability of Erlotinib vs. Carboplatin/Vinorelbin in elderly patients (>70 years of age) with untreated non-small cell lung cancer // Lung Cancer. 2014. Vol. 84, No. 1. P. 62–66. doi: 10.1016/j.lungcan.2014.01.024
- Lee S.M., Khan I., Upadhyay S. et al. First-line erlotinib in patients with advanced non-small-cell lung cancer unsuitable for chemotherapy (TOPICAL): a double-blind, placebo-controlled, phase 3 trial // Lancet Oncol. 2012. Vol. 13, No. 11. P. 1161–1170. doi: 10.1016/S1470-2045(12)70412-6
- Lee A., Arasaratnam M., Chan D.L.H. et al. Anti-epidermal growth factor receptor therapy for glioblastoma in adults // Cochrane Database Syst. Rev. 2020. Vol. 5, No. 5. P. CD013238. doi: 10.1002/14651858.CD013238.pub2
- Jiao J., Li C., Yu G. et al. Efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) in the management of malignant ascites // World J. Surg. Oncol. 2020. Vol. 18, No. 1. P. 180. doi: 10.1186/s12957-020-01956-y
- Baratelli C., Zichi C., Di Maio M. et al. A systematic review of the safety profile of the different combinations of fluoropyrimidines and oxaliplatin in the treatment of colorectal cancer patients // Crit. Rev. Oncol. Hematol. 2018. Vol. 122. P. 21–29. doi: 10.1016/j.critrevonc.2017.12.010
- Haanen J.B.A.G., Carbonnel F., Robert C. et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up // Ann. Oncol. 2017. Vol. 28, No. suppl_4. P. iv119–iv142. doi: 10.1093/annonc/mdx225
- Лоранская И.Д. Диарея при заболеваниях органов пищеварения [Электронный ресурс] // Журнал лечащий врач. 2007. Режим доступа: https://www.lvrach.ru/2007/06/4535302. Дата обращения: 13.08.2021.
- Goldkuhle M., Dimaki M., Gartlehner G. et al. Nivolumab for adults with Hodgkin’s lymphoma (a rapid review using the software RobotReviewer) // Cochrane Database Syst. Rev. 2018. Vol. 7, No. 7. P. CD012556. doi: 10.1002/14651858.CD012556.pub2
- Armand P., Engert A., Younes A. et al. Nivolumab for relapsed/refractory classic hodgkin lymphoma after failure of autologous hematopoietic cell transplantation: extended follow-up of the multicohort single-arm phase II checkmate 205 trial // J. Clin. Oncol. 2018. Vol. 36, No. 14. P. 1428–1439. doi: 10.1200/JCO.2017.76.0793
- Slangen R.M., van den Eertwegh A.J., van Bodegraven A.A., de Boer N.Kh. Diarrhoea in a patient with metastatic melanoma: Ipilimumab ileocolitis treated with infliximab // World J. Gastrointest. Pharmacol. Ther. 2013. Vol. 4, No. 3. P. 80–82. doi: 10.4292/wjgpt.v4.i3.80
- De Felice K.M., Gupta A., Rakshit S. et al. Ipilimumab-induced colitis in patients with metastatic melanoma // Melanoma Res. 2015. Vol. 25, No. 4. P. 321–327. doi: 10.1097/CMR.0000000000000165
- Mocellin S., Goodwin A., Pasquali S. Risk-reducing medications for primary breast cancer: a network meta-analysis // Cochrane Database Syst. Rev. 2019. Vol. 4, No. 4. P. CD012191. doi: 10.1002/14651858.CD012191.pub2
- Lee H.Y., Lee Y.H., Kim M.J., Kim H.K. Secondary prophylaxis of docetaxel induced diarrhea with loperamide: case report // J. Korean Med. Sci. 2013. Vol. 28, No. 10. P. 1549–1551. doi: 10.3346/jkms.2013.28.10.1549
- Lawrie T.A., Green J.T., Beresford M. et al. Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers // Cochrane Database Syst. Rev. 2018. Vol. 1, No. 1. P. CD012529. doi: 10.1002/14651858.CD012529.pub2
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