Journal of Pharmaceutical Care 2016. 4(1-2):9-13.

Adverse Effects of Chemotherapy Regimens Used in Colorectal Cancer Patients in a Referral Cancer Center in North of Iran, 2008-2014
Ebrahim Salehifar, Shayesteh Gheibi, Ghasem Janbabaei, Khali Mousavi

Abstract


Abstract:

Introduction: Gastrointestinal tract cancers are the most common cancers in Iran with a growing incidence in the past two decades, especially in the Northern provinces of the country. Different chemotherapy regimens have been used in the treatment of colorectal cancers (CRC). Considering lack of data, this study aimed to determine the adverse drug reactions (ADRs) of chemotherapy regimens used in treatment of patients with CRC.

Material and methods:This cross-sectional prospective study was carried out in Emam Khomeini Hospital and Tooba Clinic, both affiliated to Mazandaran University of Medical Sciences. ADRsof chemotherapy regimens including nausea, vomiting, fever and neutropenia, diarrhea, oral mucositis, neuropathy and hair loss were documented based on CTCAE Version 4.0 (Common Terminology Criteria for Adverse Events).

Results:Two hundred sixty seven different courses of chemotherapy regimens received by 48 patients were evaluated in terms of adverse events. Three more common chemotherapy regimens wereFOLFOX (Folinic acid, Fluorouracil, Oxaliplatin), FOLFIRI (Folinic acid, Fluorouracil, Irinotecan) and XELOX (Capecitabine, Oxaliplatin).FOLFIRI and FOLFOX regimens were associated with more nausea and vomiting compared to XELOX. The rate of vomiting was marginally different between regimens (P=0.06). Most of nausea and all vomiting were as grade 1 or 2. The diarrhea was more common with FOLFOX (P=0.027). Whereas 14% of patients received FOLFIRI experienced neutropenia, none of patients in XELOX and almost 5% of FOLFOX patients experienced neutropenia. Mucositis happened in 16.1 and 17.8% of patients received FOLFOX and XELOX, respectively. The rate of neuropathy was different among regimens, as XELOX and FOLFOX were associated with more neuropathy compared with FOLFIRI (P=0.019). The rate of hair loss and headache were not different between three regimens.Most of the side effects (e.g., nausea, neuropathy, and headache) were acute. Vomiting and mucositis with XELOX occurred after 24 hours of initiation of chemotherapy.

Conclusion:The results of our study showed that the GI adverse events including nausea, vomiting and severe diarrhea were more common with FOLFIRI regimen. Mucositis and neuropathy were more common with XELOX. Hair loss was more common with FOLFIRI followed by XELOX and FOLFOX. 


 


Keywords


ADR, FOLFOX, XELOX, neuropathy, mucositis

Full Text:

PDF

References


Reference:

Barbounis, V., et al. (2001). "Control of irinotecan-induced diarrhea by octreotide after loperamide failure." Supportive care in cancer 9(4): 258-260.

Benson, A. B., et al. (2004). "Recommended guidelines for the treatment of cancer treatment-induced diarrhea." Journal of Clinical Oncology 22(14): 2918-2926.

Cassidy, J., et al. (2008). "Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer." Journal of Clinical Oncology 26(12): 2006-2012.

Cheeseman, S., et al. (2002). "A ‘modified de Gramont’regimen of fluorouracil, alone and with oxaliplatin, for advanced colorectal cancer." British journal of cancer 87(4): 393-399.

De Vita, F., et al. (2005). "A phase II study of biweekly oxaliplatin plus infusional 5-fluorouracil and folinic acid (FOLFOX-4) as first-line treatment of advanced gastric cancer patients." Br J Cancer 92(9): 1644-1649.

Hasegawa, J., et al. (2014). "Neoadjuvant capecitabine and oxaliplatin (XELOX) combined with bevacizumab for high-risk localized rectal cancer." Cancer Chemother Pharmacol 73(5): 1079-1087.

Hecht, J. R. (1998). "Gastrointestinal toxicity or irinotecan." Oncology (Williston Park, NY) 12(8 Suppl 6): 72-78.

Hochster, H. S., et al. (2008). "Safety and efficacy of oxaliplatin and fluoropyrimidine regimens with or without bevacizumab as first-line treatment of metastatic colorectal cancer: results of the TREE Study." Journal of Clinical Oncology 26(21): 3523-3529.

Hurwitz, H., et al. (2012). "A randomized, phase II trial of standard triweekly compared with dose-dense biweekly capecitabine plus oxaliplatin plus bevacizumab as first-line treatment for metastatic colorectal cancer: XELOX-A-DVS (dense versus standard)." Oncologist 17(7): 937-946.

Janout, V. and H. Kollárová (2001). "Epidemiology of colorectal cancer." Acta-Universitatis Palackianae Olomucensis Facultatis Medicae: 5-10.

Keyhani, H., et al. "Evluation of Preventing Regimens Used for Chemotherapy Induced Nausea and Vomiting."

Maindrault-Goebel, F., et al. (1999). "Oxaliplatin added to the simplified bimonthly leucovorin and 5-fluorouracil regimen as second-line therapy for metastatic colorectal cancer (FOLFOX6)." European Journal of Cancer 35(9): 1338-1342.

Meyerhardt, J. A., et al. (2007). "Phase II study of FOLFOX, bevacizumab and erlotinib as first-line therapy for patients with metastatic colorectal cancer." Ann Oncol 18(7): 1185-1189.

Pahlavan, P. S. and R. Kanthan (2006). "The epidemiology and clinical findings of colorectal cancer in Iran." Women 86: 43.40.

Rothenberg, M. L., et al. (1996). "Phase II trial of irinotecan in patients with progressive or rapidly recurrent colorectal cancer." Journal of Clinical Oncology 14(4): 1128-1135.

Saliba, F., et al. (1998). "Pathophysiology and therapy of irinotecan-induced delayed-onset diarrhea in patients with advanced colorectal cancer: a prospective assessment." Journal of Clinical Oncology 16(8): 2745-2751.

Shadi Kolahdoozan MD, M., et al. (2010). "Five common cancers in Iran." Archives of Iranian medicine 13(2): 143.

Tournigand, C., et al. (2004). "FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study." Journal of Clinical Oncology 22(2): 229-237.

Wadler, S., et al. (1998). "Recommended guidelines for the treatment of chemotherapy-induced diarrhea." Journal of Clinical Oncology 16(9): 3169-3178.


Refbacks

  • There are currently no refbacks.


Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.