A new era in understanding and managing chronic gastrointestinal (GI) consequences of cancer treatment


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Jervoise Andreyev1
1The Royal Marsden NHS Foundation Trust, London, UK

Abstract

Toxicity is an inevitable consequence of cancer treatment. Most routinely used clinical scoring systems fail to identify important toxicities and as a result the frequency, severity and impact on patients' lives of chronic GI consequences of cancer therapies has historically not been fully recognised by clinicians. Nor has it received the attention that it deserves in terms of research. Yet the iatrogenically driven morbidity of cancer treatments is an important human model of GI disease and has already yielded new insights which can be applied to benign and malignant diseases.

In the last 15 years, a largely unheralded but spectacular revolution in understanding why toxicity develops, how it should be measured, managed and described has gathered speed. Clinical studies now show that applying this new understanding allows much GI toxicity previously widely regarded as incurable to be ameliorated. In addition, it is increasingly clear that novel approaches to predicting risk of toxicity will allow the new emerging methods of preventing toxicity, to be targeted more accurately.  

It is also increasingly understood that the 'consequential effect' has a critical role in the development of chronic toxicity and that it is driven by factors beyond the control of the oncologist. One of the most important of these is the composition of the gut microbiota; another is the role of the immune system. Introducing techniques already used by other disciplines to manipulate these factors will deliver future great rewards in terms of reducing chronic toxicity.

GI toxicity is a major limiting factor to the advance of oncological treatments. Many new solutions have emerged but require the harnessing of a multidisciplinary approach in a way that oncology has rarely used up to this point.