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Oral chemotherapy: potential benefits and limitations

Quimioterapia oral: beneficios y limitaciones potenciales

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Abstract

Although oral chemotherapeutic agents have been available for the last 50 years, some reservations about their efficacy and the limited interest of pharmaceutical companies have hampered their widespread use. This situation will probably change in the near future as several new oral anticancer agents have been approved and there are more in development.

Convenience and easiness of administration make of oral chemotherapy an attractive option. It avoids the complications and costs derived from intravenous chemotherapy, while maintaining the patients' quality of life. It also allows the replacement of drugs that require protracted administration periods. On the other hand, variable bioavailability and non-compliance appear as the main problems: the former depends on the pharmacological characteristics of the compound, whereas the latter involves time to train the patients and their families and to perform a close follow-up.

With an increasing number of oral agents emerging (both traditional cytotoxic and novel, targeted agents), we can expect that oral chemotherapy will become part of daily practice rather than the exception.

Resumen

A pesar de que los citostáticos orales han estado disponibles desde hace 50 años, las dudas sobre su eficacia y el escaso interés de la industria farmacéutica en su promoción frenaron inicialmente su empleo. Sin embargo, durante los últimos años, esta situación ha cambiado, se han comercializado nuevos citostáticos orales y se encuentran en fase de desarrollo un número aún mayor, por lo que cabe esperar que en los próximos años el tratamiento oral del cáncer vaya adquiriendo una mayor relevancia.

Entre los posibles argumentos a favor de la quimioterapia oral destacan las preferencias de los enfermos y la comodidad de su administración. Además, evita las complicaciones y los costes asociados al empleo de la vía intravenosa, puede reducir el impacto negativo del tratamiento sobre la calidad de vida de los pacientes y permite la sustitución de fármacos que requieren su administración intravenosa durante períodos prolongados de tiempo. Sin embargo también existen argumentos en contra de su empleo. El principal sería la escasez de estudios aleatorizados, dirigidos a comprobar la equivalencia de la administración de los citostáticos por vía oral e intravenosa. Otras limitaciones serían la variabilidad de su biodisponibilidad y el riesgo de no adherencia al tratamiento. Aunque la primera depende de las características del preparado farmacológico, para evitar lo segundo es preciso dedicar tiempo a educar al enfermo y a su familia en el cumplimiento del tratamiento y realizar un estrecho seguimiento del mismo.

Conforme vaya aumentando el número de fármacos orales disponibles, ya sean citostáticos tradicionales o nuevas terapias dirigidas, y se vaya demostrando su eficacia, la quimioterapia oral dejará de ser una excepción para convertirse en algo cotidiano.

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Authors and Affiliations

  1. Service of Oncology, Hospital La Paz, Madrid, Spain

    Jaime Feliu Batlle, Enrique Espinosa Arranz, Javier de Castro Carpeño, Enrique Casado Sáez, Pilar Zamora Auñón, Andrés Redondo Sánchez & Manuel González Barón

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  1. Jaime Feliu Batlle
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Correspondence to Jaime Feliu Batlle.

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Batlle, J.F., Arranz, E.E., de Castro Carpeño, J. et al. Oral chemotherapy: potential benefits and limitations. Rev Oncol 6, 335–340 (2004). https://doi.org/10.1007/BF02710062

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