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New Tools Needed to Manage Toxicities in Modern Era of Cancer Therapy

Maurie Markman, MD
Published: Friday, Nov 02, 2018
Maurie Markman, MD

Maurie Markman, MD
Much has been written and discussed over many decades on horrors associated with cytotoxic antineoplastic drug therapy. Of course, there is no official tally of the number of individual stories that have been told about this experience, but it is likely that the majority of adult members of our society can recite the ordeal of a family member or a friend regarding the seriously negative effects of anticancer treatment, ranging from neutropenic fever to bleeding due to low platelet counts, from hair loss to mouth sores, from nausea and vomiting to severe fatigue. These adverse events (AEs) can be distressing, debilitating, and even fatal.

As a result, the search for far less toxic strategies that could lessen the negative impact on quality of life while maintaining therapeutic efficacy has been an appropriate focus of considerable clinical investigation over the past several decades. During this period, various toxicity scales that focused on the acute AEs of antineoplastic cytotoxic therapy were developed and widely employed. These scales have taken into consideration the impact of bone marrow suppression, the development of intense nausea and vomiting, and the influence of therapy on highly susceptible rapidly dividing cells within the gastrointestinal tract that leads to mucositis and stomatitis.

Although chronic influences of treatment, such as congestive heart failure from anthracyclines and secondary acute leukemia from alkylating agents and radiation, were noted in these scales, the major focus of toxicity evaluation was on acute, severe, and potentially life-threatening AEs. This was a reasonable and quite pragmatic approach during this time because treatment of metastatic disease was generally of marginal utility and, therefore, delivered over limited intervals, and prevention of recurrence with adjuvant therapy was also designed only for short-term use.

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