Management chemotherapieinduzierter Diarrhöen

 

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Zusammenfassung

Bereits bei den frühen klinischen Studien zur Behandlung metastasierter kolorektaler Karzinome mit 5-Fluorouracil (5-FU)/Folinsäure ebenso wie später mit Irinotecan zeigte sich, dass chemotherapieinduzierte Diarrhöen (CID) als mögliche schwerwiegende Nebenwirkung einer antitumoralen Therapie berücksichtigt werden müssen. Intestinale Funktionsstörungen wie Durchfälle und Obstipation stellen dabei nicht nur eine zusätzliche physische und emotionale Belastung für den Patienten und seine Angehörigen dar, sondern führen auch zu eventuell notwendigen Dosisanpassungen und Therapieunterbrechungen mit verminderter Effektivität der Behandlung. Vor allem bei der Behandlung kolorektaler Tumoren gilt die CID neben Leukopenie, Granulozytopenie und Thrombozytopenie als eine der häufigsten dosislimitierenden und in einigen Fällen auch lebensgefährlichen Nebenwirkungen der Therapie. Das rechtzeitige Erkennen der Situation und Behandeln der Symptome können die hohe Mortalität und Morbidität, die mit CID verbunden ist, verringern. Die Beurteilung des Schweregrades der Nebenwirkungen richtet sich gewöhnlich nach dem „National Cancer Institute Common Toxicity Criteria for Grading the Severity of Diarrhea”. In dieser Übersicht soll auf das heutige Management der CID eingegangen werden, da für Patienten, die auf eine konventionelle pharmakologische Therapie nicht ansprechen, spezifische, ursachenorientierte Therapeutika zur Verfügung stehen.

Abstract

Chemotherapy-induced diarrhea (CID) became first apparent during clinical studies on the combination of 5-FU with leucovorin and, furthermore, with irinotecan in the treatment of metastatic colorectal carcinoma. Bowel dysfunctions, such as diarrhea and constipation, can be a disturbing side effect in chemotherapy that may result not only in significant physical and emotional distress for the patients and care givers, but also in diminished therapeutic efficacy due to dose limitations and treatment interruptions. Besides leucocytopenia, granulocytopenia and thrombocytopenia, CID is considered one of the main dose-limiting toxicities associated with chemotherapy agents, especially in treatment regimens for colorectal cancer and can even be life-threatening. Early recognition and treatment can prevent the morbidity and mortality associated with CID. The most commonly used assessment tool is the National Cancer Institute Common Toxicity Criteria for Grading the Severity of Diarrhea. In this review, we will concentrate on the modern management of CID. Traditional pharmacological management of CID has included mainly non-specific agents. For patients who are refractory to non-specific therapy, there are more sophisticated, specific therapeutic agents available.

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PD Dr. Frank Kullmann

Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität Regensburg

Franz-Josef-Strauß-Allee 11

93042 Regensburg

Email: frank.kullmann@klinik.uni-regensburg.de