Toxic effects and their management: daily clinical challenges in the treatment of colorectal cancer.

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Nat Rev Clin Oncol. 2009 Apr;6(4):207-18.

Toxic effects and their management: daily clinical challenges in the treatment of colorectal cancer.
 
Eng C.
Department
of Gastrointestinal Medical Oncology, University of Texas MD Anderson
Cancer Center, Houston, TX 77030, USA.

Among
the many chemotherapeutic options for metastatic colorectal cancer,
none has shown clear superiority in efficacy. All pharmacologic agents
in current use have been associated with adverse events. Frequently
reported adverse events associated with the chemotherapeutic agents
oxaliplatin, irinotecan, 5-fluorouracil, and capecitabine include acute
and chronic neuropathy, hypersensitivity reactions, diarrhea,
neutropenia, and hand-foot syndrome. Although biologic agents are
seemingly less toxic, toxic effects can also arise with their use;
antiangiogenic agents result in hypertension, and EGFR inhibitors can
cause severe hypersensitivity, paronychial infections, and more
commonly, dermatologic rash. Furthermore, a correlation has been
reported for the efficacy of anti-EGFR agents and development of rash.
Data indicate that elderly patients with colorectal cancer who have
adequate function and performance status, who may previously have been
dissuaded from pursuing active therapy solely on the basis of age,
should receive the same treatment as younger patients. To enhance the
survival of patients with metastatic colorectal cancer, many therapies
are administered. Recognition of treatment-emergent toxic effects will,
therefore, aid the design and implementation of management strategies
that minimize treatment interruption and/or discontinuation, and
enhance quality of life for patients.