Research progress on irinotecan induced metabolic dysregulation in microbiota- gut-liver axis and Chinese materia medica intervention / 中草药

Irinotecan was a commonly used chemotherapeutic drug for treating colorectal cancer recurrence and deterioration. Despite its good efficacy, gastrointestinal toxicities such as delayed-onset diarrhea, nausea, and vomiting have severely restrained its clinical application. Recent studies have suggested that the gastrointestinal toxicities of irinotecan were closely related to its metabolism in microbiota-gut-liver axis and the associated bile acid and tryptophan metabolic disturbance. Therefore, this review was mainly focused on the relationship between the disturbed metabolism of endogenous and gastrointestinal toxicities of irinotecan. What’s more, in order to provide reference for further study and development of related drugs, the effect of Chinese materia medica in intervention and treatment of irinotecan-induced gastrointestinal toxicity have also been discussed.

A Comparison of Gastrointestinal Toxicities between Intensity-Modulated Radiotherapy and Three-Dimensional Conformal Radiotherapy for Pancreatic Cancer

BACKGROUND/AIMS: Concurrent chemoradiotherapy (CCRT) is considered the treatment option for locally advanced pancreatic cancer, but accompanying gastrointestinal toxicities are the most common complication. With the introduction of three-dimensional conformal radiotherapy (3-D CRT) and intensity-modulated radiotherapy (IMRT), CCRT-related adverse events are expected to diminish. Here, we evaluated the benefits of radiation modalities by comparing gastrointestinal toxicities between 3-D CRT and IMRT. METHODS: Patients who received CCRT between July 2010 and June 2012 in Severance Hospital, Yonsei University College of Medicine, were enrolled prospectively. The patients underwent upper endoscopy before and 1 month after CCRT. RESULTS: A total of 84 patients were enrolled during the study period. The radiotherapy modalities delivered included 3D-CRT (n=40) and IMRT (n=44). The median follow-up period from the start of CCRT was 10.6 months (range, 3.8 to 29.9 months). The symptoms of dyspepsia, nausea/vomiting, and diarrhea did not differ between the groups. Upper endoscopy revealed significantly more gastroduodenal ulcers in the 3-D CRT group (p=0.003). The modality of radiotherapy (3D-CRT; odds ratio [OR], 11.67; p=0.011) and tumor location (body of pancreas; OR, 11.06; p=0.009) were risk factors for gastrointestinal toxicities. CONCLUSIONS: IMRT is associated with significantly fewer gastroduodenal injuries among patients treated with CCRT for pancreatic cancer.