J Cancer 2020; 11(11):3144-3150. doi:10.7150/jca.37777 This issue

Research Paper

Gastrointestinal toxic effects in patients with cancer receiving platinum-based therapy

Hamzah Abu-Sbeih1, Niharika Mallepally2, Ryan Goldstein3, Ellie Chen2, Tenglong Tang1, Uzoamaka K. Dike3, Mazen Al-Asadi1, Shannon Westin4, Daniel Halperin5, Yinghong Wang1✉

1. Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
2. Department of Internal Medicine, Baylor College of Medicine, 6620 Main St, Houston, TX 77030, USA
3. Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin St, Houston, TX 77030, USA
4. Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
5. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA

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Citation:
Abu-Sbeih H, Mallepally N, Goldstein R, Chen E, Tang T, Dike UK, Al-Asadi M, Westin S, Halperin D, Wang Y. Gastrointestinal toxic effects in patients with cancer receiving platinum-based therapy. J Cancer 2020; 11(11):3144-3150. doi:10.7150/jca.37777. Available from https://www.jcancer.org/v11p3144.htm

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Abstract

Background: Platinum-based therapy (PBT) can be limited by gastrointestinal adverse events, particularly PBT-related colitis and diarrhea (PCD). We studied clinical features, treatments, and outcomes of PCD.

Methods: This was a retrospective study of cancer patients who received PBT and colonoscopic evaluation for PCD symptoms from 2009 to 2018.

Results: Of 36,595 patients who received PBT, 86 (0.2%) met inclusion criteria. Median time from PBT initiation to PCD was 66 days. Regarding PBT type, 47% of the patients received carboplatin, 31% cisplatin, and 22% oxaliplatin. Median duration of PCD symptoms was 20 days. Colonoscopy revealed mucosal ulceration in 34% of the patients and nonulcerative inflammation in 33%. Half of the cohort needed hospitalization for PCD (49%). The majority received treatment for PCD (59%): immunosuppressive therapy in 21%, antibiotics in 27%, antimotility agents in 22%, and intravenous fluids in 51%. Eight patients (9%) were admitted to the intensive care unit for PCD management. Six patients (7%) experienced colonic perforation that required surgical intervention; two of them had gastrointestinal tumors. Physicians restarted PBT in 37 (43%) patients; 8 (22%) of them had PCD recurrence that was managed expectantly. Colonic perforation occurred more frequently with use of oxaliplatin and cisplatin than carboplatin (P=0.05). The median duration of PCD symptoms was longer in patients receiving carboplatin or cisplatin than in those receiving oxaliplatin (P=0.182).

Conclusions: PCD is rare, but in a small subset of patients, it can lead to serious complications. Treatment of PCD is mainly supportive, but immunosuppressive therapy may be required.

Keywords: platinum, carboplatin, cisplatin, gastrointestinal toxicity, colitis