Advances in Colorectal Cancer - Episode 11
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In closing, the panel explores the management of side effects experienced by patients during the treatment colorectal cancer. To address this topic, moderator, John L. Marshall, MD, asks each panelist to provide their unique perspective on the optimal management of a variety of adverse events.
For patients with hand-food syndrome, Johanna Bendell, MD, recommends the application of urea-based creams. Additionally, she advises patients to wear gloves and socks to bed as a means to further alleviate this side effect. In colorectal cancer, hand-foot syndrome is traditionally associated with capecitabine but is now also common with regorafenib.
In the palliative setting, the goal of treatment is to delay tumor progression. As such, Axel Grothey, MD, recommends stopping oxaliplatin after eight cycles, to reduce neuropathy. Additionally, he notes, a non-bolus 5-FU delivery route lessens adverse events. For patients in the palliative setting, Grothey recommends administering modified FOLFOX-7 with 85 mg oxaliplatin for eight cycles. In general, this approach does not cause alopecia and the main side effects include diarrhea and fatigue, Grothey suggests.
In general, steps should be taken to minimize the risk for myelosuppression that accompanies treatment. To accomplish this, Heinz-Josef Lenz, MD, believes dose modifications and administration schedule changes should be performed, rather than utilizing growth factors.
To address asthenia, physicians must first ascertain whether it is a result of treatment or the disease, Claus-Henning Kohne, MD, PhD, suggests. In many cases, a dose reduction can reduce fatigue, rather than completely omitting the treatment.