John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Management of non-dermatologic adverse events of targeted biotherapies Volume 17, special issue 4, Prise en charge de la toxicité de la chimiothérapie anticancéreuse et soins de support en oncologie digestive

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Service d'hépatogastroentérologie et cancérologie digestive, hôpital Robert-Debré, CHU de Reims, avenue du Général-Koenig, 51092 Reims cedex, France

The limits of the antineoplasic chemotherapies reoriented the research to “targeted” biotherapies, aiming the angiogenesis and the cellular proliferation initiated by tyrosine-kinase receptors to growth factors. Although the action of the biotherapies is more targeted than chemotherapies, new adverse staleness, different from the classic iatrogenic effects of chemotherapies, have been described and require a specific management. These effects, even minor, can impact the patient's quality of life, provoke a least observance of the treatment, and even impose deleterious delays or therapeutic stops. A hypomagnesemia and a hypocalcemia must be checked before every administration of anti-EGFR (cetuximab, panitumumab) with parenteral supplementation adapted. An intravenous premedication by antihistaminic H1 and corticosteroids, as well as the close presence of a physician and resuscitation equipment, are recommended during the administration of cetuximab, considering the exceptional risk of serious allergy. The arterial hypertension (AHT) and the proteinuria are effects of the angiogenesis inhibitors class (bevacizumab, sorafenib, sunitinib). The measure of the arterial pressure must be ambulatory. The diagnostic and therapeutic managements of AHT must be done in accordance with national or international guidelines. For the bevacizumab, a delay of four weeks before and after a major surgery must be respected and the wound healing must be verified. The patient must be informed of exceptional risks of serious complications: arterial thromboembolic events, digestive perforation, hemorrhage. The toxicities of imatinib are frequent, but often stern and transient, such as oedema, digestive unrests, arthralgia, myalgia, muscle cramps, and cutaneous rash. An early adapted treatment of these symptoms must be prescribed to improve the compliance with imatinib. Cardiac function follow-up is required with trastuzumab. The multidisciplinary collaboration between the physician prescriber and his/her/its colleagues general and specialists practitioners must be narrow to optimize cares.