Advertisement

Notfälle unter medikamentöser Tumortherapie

  • Annabel Alig
  • Michael von Bergwelt
  • Clemens Gießen-JungEmail author
Leitthema
  • 65 Downloads

Zusammenfassung

Onkologische Notfälle sind in der Ätiologie und Symptomatik vielfältig und treten häufig mit der Einleitung einer Chemotherapie auf, können sich aber auch während oder mit zeitlicher Verzögerung manifestieren. Die Kenntnis onkologischer Notfälle unter medikamentöser Tumortherapie ist daher nicht nur für die behandelnden Fachdisziplinen wichtig, sondern auch für mit- oder weiterbetreuende Kollegen. Jeder dieser Krankheitszustände erfordert eine sorgfältige Beurteilung der Symptome, klinische, laborchemische und apparative diagnostische Schritte sowie akute Interventionen und unterstützende Pflegemaßnahmen. Im Folgenden werden sechs häufige, akut verlaufende und/oder schwerwiegende Nebenwirkungen vorgestellt und auf das spezifische Management eingegangen.

Schlüsselwörter

Onkologischer Notfall Chemotherapie Paravasat Tumorlysesyndrom Immunassoziierte Nebenwirkungen 

Emergencies under drug anti-cancer treatment

Abstract

Oncological emergencies are manifold in the etiology and symptoms and often occur with the initiation of chemotherapy but can also present during treatment or after a delay in time. Knowledge of oncological emergencies under drug treatment for cancer is crucial not only for hematologists and medical oncologists but also for other personnel involved in primary care and multidisciplinary treatment concepts. Each of these illness situations necessitates careful evaluation of the symptoms, clinical, laboratory and further diagnostic steps as well as acute interventions and supportive care measures. In this article six frequent, acutely occurring and/or severe side effects are presented and the specific management is discussed.

Keywords

Oncological emergency Chemotherapy Extravasation Tumor lysis syndrome Immune-associated side effects 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

A. Alig, M. von Bergwelt und C. Gießen-Jung geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Literatur

  1. 1.
    Alter P, Herzum M, Soufi M et al (2006) Cardiotoxicity of 5‑fluorouracil. Cardiovasc Hematol Agents Med Chem 4:1–5CrossRefGoogle Scholar
  2. 2.
    Arriola E, Wheater M, Karydis I et al (2015) Infliximab for IPILIMUMAB-related colitis-letter. Clin Cancer Res 21:5642–5643CrossRefGoogle Scholar
  3. 3.
    Berman D, Parker SM, Siegel J et al (2010) Blockade of cytotoxic T‑lymphocyte antigen‑4 by ipilimumab results in dysregulation of gastrointestinal immunity in patients with advanced melanoma. Cancer Immun 10:11PubMedPubMedCentralGoogle Scholar
  4. 4.
    Biffi R, Pozzi S, Agazzi A et al (2004) Use of totally implantable central venous access ports for high-dose chemotherapy and peripheral blood stem cell transplantation: results of a monocentre series of 376 patients. Ann Oncol 15:296–300CrossRefGoogle Scholar
  5. 5.
    Cairo MS, Bishop M (2004) Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol 127:3–11CrossRefGoogle Scholar
  6. 6.
    Cardinale D, Colombo A, Lamantia G et al (2010) Anthracycline-induced cardiomyopathy: clinical relevance and response to pharmacologic therapy. J Am Coll Cardiol 55:213–220CrossRefGoogle Scholar
  7. 7.
    Cassagnol M, Mcbride A (2009) Management of chemotherapy extravasations. US Pharm 34(9):3–11Google Scholar
  8. 8.
    Champiat S, Lambotte O, Barreau E et al (2016) Management of immune checkpoint blockade dysimmune toxicities: a collaborative position paper. Ann Oncol 27:559–574CrossRefGoogle Scholar
  9. 9.
    Coiffier B, Altman A, Pui CH et al (2008) Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol 26:2767–2778CrossRefGoogle Scholar
  10. 10.
    Cortes J, Moore JO, Maziarz RT et al (2010) Control of plasma uric acid in adults at risk for tumor Lysis syndrome: efficacy and safety of rasburicase alone and rasburicase followed by allopurinol compared with allopurinol alone—results of a multicenter phase III study. J Clin Oncol 28:4207–4213CrossRefGoogle Scholar
  11. 11.
    De Forni M, Malet-Martino MC, Jaillais P et al (1992) Cardiotoxicity of high-dose continuous infusion fluorouracil: a prospective clinical study. J Clin Oncol 10:1795–1801CrossRefGoogle Scholar
  12. 12.
    Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF) Supportive Therapie bei onkologischen PatientInnen – Langversion 1.1, 2017, AWMF Registernummer: 032/054OL. http://leitlinienprogramm-onkologie.de/Supportive-Therapie.95.0.html. Zugegriffen: 12. Sept. 2019Google Scholar
  13. 13.
    Friedman CF, Proverbs-Singh TA, Postow MA (2016) Treatment of the immune-related adverse effects of immune checkpoint inhibitors: a review. JAMA Oncol 2:1346–1353CrossRefGoogle Scholar
  14. 14.
    Gomes ER, Demoly P (2005) Epidemiology of hypersensitivity drug reactions. Curr Opin Allergy Clin Immunol 5:309–316CrossRefGoogle Scholar
  15. 15.
    Gupta A, De Felice KM, Loftus EV Jr. et al (2015) Systematic review: colitis associated with anti-CTLA‑4 therapy. Aliment Pharmacol Ther 42:406–417CrossRefGoogle Scholar
  16. 16.
    Haanen J, Carbonnel F, Robert C et al (2017) Management of toxicities from immunotherapy: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 28:iv119–iv142CrossRefGoogle Scholar
  17. 17.
    Heinzerling L, Ott PA, Hodi FS et al (2016) Cardiotoxicity associated with CTLA4 and PD1 blocking immunotherapy. J Immunother Cancer 4:50CrossRefGoogle Scholar
  18. 18.
    Howard SC, Jones DP, Pui CH (2011) The tumor lysis syndrome. N Engl J Med 364:1844–1854CrossRefGoogle Scholar
  19. 19.
    Howard SC, Trifilio S, Gregory TK et al (2016) Tumor lysis syndrome in the era of novel and targeted agents in patients with hematologic malignancies: a systematic review. Ann Hematol 95:563–573CrossRefGoogle Scholar
  20. 20.
    Jensen SA, Sorensen JB (2006) Risk factors and prevention of cardiotoxicity induced by 5‑fluorouracil or capecitabine. Cancer Chemother Pharmacol 58:487–493CrossRefGoogle Scholar
  21. 21.
    Jones GL, Will A, Jackson GH et al (2015) Guidelines for the management of tumour lysis syndrome in adults and children with haematological malignancies on behalf of the British Committee for Standards in Haematology. Br J Haematol 169:661–671CrossRefGoogle Scholar
  22. 22.
    Jones RL, Swanton C, Ewer MS (2006) Anthracycline cardiotoxicity. Expert Opin Drug Saf 5:791–809CrossRefGoogle Scholar
  23. 23.
    Lacouture ME, Anadkat MJ, Bensadoun RJ et al (2011) Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities. Support Care Cancer 19:1079–1095CrossRefGoogle Scholar
  24. 24.
    Langer SW, Sehested M, Jensen PB (2009) Anthracycline extravasation: a comprehensive review of experimental and clinical treatments. Tumori 95:273–282CrossRefGoogle Scholar
  25. 25.
    Lenz HJ (2007) Management and preparedness for infusion and hypersensitivity reactions. Oncologist 12:601–609CrossRefGoogle Scholar
  26. 26.
    Ma WW, Saif MW, El-Rayes BF et al (2017) Emergency use of uridine triacetate for the prevention and treatment of life-threatening 5‑fluorouracil and capecitabine toxicity. Cancer 123:345–356CrossRefGoogle Scholar
  27. 27.
    Marthey L, Mateus C, Mussini C et al (2016) Cancer immunotherapy with anti-CTLA‑4 Monoclonal antibodies induces an inflammatory bowel disease. J Crohns Colitis 10:395–401CrossRefGoogle Scholar
  28. 28.
    Mercuro G, Cadeddu C, Piras A et al (2007) Early epirubicin-induced myocardial dysfunction revealed by serial tissue Doppler echocardiography: correlation with inflammatory and oxidative stress markers. Oncologist 12:1124–1133CrossRefGoogle Scholar
  29. 29.
    Miller KK, Gorcey L, Mclellan BN (2014) Chemotherapy-induced hand-foot syndrome and nail changes: a review of clinical presentation, etiology, pathogenesis, and management. J Am Acad Dermatol 71:787–794CrossRefGoogle Scholar
  30. 30.
    Mouridsen HT, Langer SW, Buter J et al (2007) Treatment of anthracycline extravasation with Savene (dexrazoxane): results from two prospective clinical multicentre studies. Ann Oncol 18:546–550CrossRefGoogle Scholar
  31. 31.
    Naidoo J, Page DB, Li BT et al (2015) Toxicities of the anti-PD‑1 and anti-PD-L1 immune checkpoint antibodies. Ann Oncol 26:2375–2391PubMedPubMedCentralGoogle Scholar
  32. 32.
    Perez Fidalgo JA, Garcia Fabregat L, Cervantes A et al (2012) Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. Ann Oncol 23(Suppl 7):vii167–vii173CrossRefGoogle Scholar
  33. 33.
    Reyes-Habito CM, Roh EK (2014) Cutaneous reactions to chemotherapeutic drugs and targeted therapies for cancer: part I. Conventional chemotherapeutic drugs. J Am Acad Dermatol 71:203.e1–203.12 (quiz 215–206)CrossRefGoogle Scholar
  34. 34.
    Robert C, Schachter J, Long GV et al (2015) Pembrolizumab versus Ipilimumab in advanced melanoma. N Engl J Med 372:2521–2532CrossRefGoogle Scholar
  35. 35.
    Rosen AC, Balagula Y, Raisch DW et al (2014) Life-threatening dermatologic adverse events in oncology. Anticancer Drugs 25:225–234CrossRefGoogle Scholar
  36. 36.
    Sara JD, Kaur J, Khodadadi R et al (2018) 5‑fluorouracil and cardiotoxicity: a review. Ther Adv Med Oncol.  https://doi.org/10.1177/1758835918780140 CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Schimmel KJ, Richel DJ, Van Den Brink RB et al (2004) Cardiotoxicity of cytotoxic drugs. Cancer Treat Rev 30:181–191CrossRefGoogle Scholar
  38. 38.
    Sudhoff T, Enderle MD, Pahlke M et al (2004) 5‑Fluorouracil induces arterial vasocontractions. Ann Oncol 15:661–664CrossRefGoogle Scholar
  39. 39.
    Wang DY, Salem JE, Cohen JV et al (2018) Fatal toxic effects associated with immune checkpoint inhibitors: a systematic review and meta-analysis. JAMA Oncol 4:1721–1728CrossRefGoogle Scholar
  40. 40.
    Wengstrom Y, Margulies A (2008) European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs 12:357–361CrossRefGoogle Scholar
  41. 41.
    Zimmer L, Goldinger SM, Hofmann L et al (2016) Neurological, respiratory, musculoskeletal, cardiac and ocular side-effects of anti-PD‑1 therapy. Eur J Cancer 60:210–225CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • Annabel Alig
    • 1
  • Michael von Bergwelt
    • 1
  • Clemens Gießen-Jung
    • 1
    Email author
  1. 1.Medizinische Klinik und Poliklinik III, Klinikum der Universität MünchenLMU MünchenMünchenDeutschland

Personalised recommendations