Assessment and management of diarrhea following VEGF receptor TKI treatment in patients with ovarian cancer.

Joyce Liu, Shibani Nicum, Peter Reichardt, Kenneth Croitoru, Beate Illek, Manuela Schmidinger, Catherine Rogers, Christin Whalen, Gordon C Jayson

Journal: Gynecologic oncology 2018;150(1):173-179

PMID: 29627080

Full Text on Elsevier Science View on PubMed

Abstract

Angiogenesis is a proven clinical target for the treatment of advanced epithelial ovarian cancer. Vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) offer patients potential new treatment regimens as they can be given as monotherapy, in combination with poly(ADP-ribose) polymerase (PARP) inhibitors, or with and following cytotoxic chemotherapy. If VEGFR-TKIs are licensed for use in ovarian cancer, patients will require prompt and effective management of adverse events, including diarrhea, to optimize compliance and benefit. As diarrhea is one of the most prevalent toxicities of this class of drug, it is important to consider the potential causes, be they disease related (bowel obstruction), treatment related (VEGFR-TKI-related or infective/neutropenic septic diarrhea when patients are receiving cytotoxic chemotherapy combined with VEGFR inhibitor treatment), or incurred through diet. Here, we provide an overview of the possible mechanisms responsible for VEGFR-TKI-induced diarrhea. We review potential interventions that can help in the management of diarrhea induced by VEGFR-TKIs, when used in combination or as single agents, and we provide a diarrhea treatment algorithm to serve as a clinical reference point for the management of diarrhea in patients with ovarian cancer treated with a VEGFR-TKI in combination with chemotherapy or PARP inhibitors, or as monotherapy.

Address: Dana-Farber Cancer Institute, Boston, MA, USA.; Department of Oncology, University of Oxford, Oxford, UK. Electronic address: [email protected].; Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin, Germany. Electronic address: [email protected].; Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, Canada. Electronic address: [email protected].; Children's Hospital Oakland Research Institute, Oakland, CA, USA. Electronic address: [email protected].; Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria. Electronic address: [email protected].; Christie Hospital and Institute of Cancer Studies, University of Manchester, Manchester, UK. Electronic address: [email protected].; Dana-Farber Cancer Institute, Boston, MA, USA. Electronic address: [email protected].; Christie Hospital and Institute of Cancer Studies, University of Manchester, Manchester, UK. Electronic address: [email protected].

DOI: 10.1016/j.ygyno.2018.03.058

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MeSH Terms: Diarrhea, Female, Humans, Ovarian Neoplasms, Protein Kinase Inhibitors, Receptors, Vascular Endothelial Growth Factor, Retrospective Studies