Drug-induced diarrhea associated with antineoplastic drugs

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Abstract

Diarrhea is the most common adverse reaction of anticancer drugs, as well as radiation therapy of the pelvic organs or abdominal cavity: the incidence of diarrhea of different seveity reaches 80% during chemotherapy and / or radiation therapy; one third of these patients develop severe diarrhea (3rd or 4th degree). Most often, drug-induced diarrhea occurs during chemotherapy, using 5-fluorouracil or irinotecan, taking new anticancer drugs from the classes of checkpoint inhibitors, monoclonal antibodies, tyrosine kinase inhibitors. The most common mechanisms underlying the development of drug-induced diarrhea are damage to the intestinal mucosa, impaired absorption of proteins, carbohydrates, fats, inflammation, a perverse immune response, microflora imbalance, and others.

Algorithms for the management of patients with severe diarrhea include suspension (grade 1-2, 3) or complete cessation (grade 4, grade 3) of the use of an antineoplastic agent – an inducer, prescribing drugs that reduce intestinal motility (loperamide) while excluding the infectious nature of diarrhea, intravenous methylprednisolone (for example, diarrhea caused by monoclinal antibodies in the absence of suspicion of potential bowel perforation). In cases where drug-induced diarrhea lasts more than 48 hours, or a patient reports symptoms of dehydration, or a fever occurs, urgent hospitalization is necessary.

The objective of this review is to analyze scientific literature data on the prevalence, pathophysiological mechanisms and risk factors for the development of diarrhea associated with the intake of anticancer drugs, as well as its prevention and treatment.

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About the authors

Dmitry A. Sychev

Russian Medical Academy of Continuous Professional Education

Email: dimasychev@mail.ru
ORCID iD: 0000-0002-4496-3680
SPIN-code: 4525-7556

MD, Dr. Sci. (Med.), Professor, Correspondence Member of the RAS, Professor of the RAS

Russian Federation, 2/1 Building 1 Barrikadnaya St., Moscow, 125993

Olga D. Ostroumova

Russian Medical Academy of Continuous Professional Education; I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: ostroumova.olga@mail.ru
ORCID iD: 0000-0002-0795-8225
SPIN-code: 3910-6585

MD, Dr. Sci. (Med.), Professor

Russian Federation, 2/1 Building 1 Barrikadnaya St., Moscow, 125993; Moscow

Liliya E. Ziganshina

Russian Medical Academy of Continuous Professional Education

Email: lezign@gmail.com
ORCID iD: 0000-0003-1999-0705
SPIN-code: 6061-7223

MD, Dr. Sci. (Med.), Professor

Russian Federation, 2/1 Building 1 Barrikadnaya St., Moscow, 125993

Anastasiya V. Filippova

Russian Medical Academy of Continuous Professional Education

Author for correspondence.
Email: filippova.96@mail.ru
ORCID iD: 0000-0003-3081-602X

ординатор кафедры терапии и полиморбидной патологии имени академика М.С. Вовси

Russian Federation, 2/1 Building 1 Barrikadnaya St., Moscow, 125993

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