Análise da toxicidade de uma Fluoropirimidina em Protocolo Quimioterápico
DOI:
https://doi.org/10.5902/2236583436138Keywords:
Colorectal cancer, FOLFOX, FOLFIRI, Drug toxicity, ChemotherapyAbstract
Introduction: Colorectal cancer (CRC) is the third most common cause of cancer in the world. In its treatment, are used chemotherapeutic agents whose toxicities influence the quality of life of these patients. Objective: Evaluate the most frequent toxicities based on the effects of 5-fluorouracil in patients with colorectal neoplasm submitted to 5-fluorouracil chemotherapy in combination with folinic acid, oxaliplatin (FOLFOX) and irinotecan (FOLFIRI). Methods: A cross-sectional study conducted in a Brazilian public institution in patients with previous diagnosis of colorectal cancer who received cycles of infusional chemotherapy for 48 hours every two weeks for a total of 12 cycles or 24 weeks of treatment. The studied variables were obtained by reviewing medical records, through a survey in the medical and statistical archive service (SAME). Results: Age ranged from 35 to 84 years old, with a mean of 60,75 years, being 56.25% of the female gender and 43.75% of the male. The most commonly observed toxicities were nausea, stomach pain and muscle weakness. No patient was in stages 0 and I, 25% (n = 4) in II, 31.25% (n = 5) in III and 43.75% (n = 7) in IV. Conclusion: It is noted that fluorpyrimidines continue to be the mainstay in the treatment of cancer. Thus, in this perspective the identification of the enzymatic activity of Dihydropyrimidine Dehydrogenase (DPD) is strongly related to the pharmacology of 5-FU, therefore, the determination of this enzyme before the beginning of therapy has been shown to be fundamental to identify patients at high risk of disease severe and life-threatening toxicity.Downloads
References
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015 Mar; 65 (2): 87-108.
Torre LA, Siegel RL, Ward EM, Jemal A. Global câncer incidence and mortality rates and trends - an update. Cancer Epidemiol Biomarkers Prev. 2016; 25: 16-27.
Brasil. Agência Nacional de Vigilância Sanitária, Projeto diretrizes 2001. Diagnóstico, Estadiamento e Tratamento Cirúrgico e Multidisciplinar do Câncer Colorretal. Disponível em http://portal.anvisa.gov.br/wps/portal/anvisa/home Agência de Vigilância Sanitária.
Oliveira JDV, Medeiros CAD, Meira DD. Avaliação da sobrevida e qualidade de vida de pacientes com câncer colorretal. R. Bras. Farm. Hosp. Serv. Saúde São Paulo v.1 n.1 p.6-11 set./dez. 2010.
Brasil. Agência Nacional de Vigilância Sanitária, Portaria nº 958, de 26 de setembro de 2004. Aprova as Diretrizes Diagnósticas e Terapêuticas do Câncer de Cólon e Reto. Ministério da Saúde, Secretaria de Atenção à Saúde.
Hahn RZ, Galarza AF, Schneider A, Antunes MV, Schwartsmann G, Linden R. Improved determination of uracil and dihydrouracil in plasma after a loading oral dose of uracil using high-performance liquid chromatography with photodiode array detection and porous graphitic carbon stationary phase. Clin Biochem. 2015 Sep; 48 (13-14): 915-8
André T, Louvet C, Maindrault-Goebel F, Couteau C, Mabro M, Lotz JP, et al. CPT-11 (Irinotecan) Addition to Bimonthly, High-dose Leucovorin and Bolus and Continuous-infusion 5-Fluorouracil (FOLFIRI) for Pretreated Metastatic Colorectal Cancer. Eur J Cancer. 1999 Sep;35 (9):1343-7.
De Gramont A, Tournigand C, Louvet C, Andre T, Molitor JL, Raymond E, et al. Oxaliplatine, acide folinique et 5- fluorouracile folfox) en seconde ligne thérapeutique du cancer colorectal métastasé. Rev Med Interne. Elsevier, Paris. 1997; 18:769-75.
De Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol. 2000;18: 2938-47.
Inca, Instituto Nacional de Câncer. Estimativa 2016- Incidência de Câncer no Brasil. Disponível em: http://www.inca.gov.br/wcm/dncc/2015/estimativa-2016.asp
Hubbard JM. Management of Colorectal Cancer in Older Adults. Clin Geriatr Med. 2016; 32: 97-111
Campos FGCM, Figueiredo MN, Monteiro M, Nahas SC e Cecconello I. Incidência de câncer colorretal em pacientes jovens. Rev. Col. Bras. Cir.2017; 44 (2): 208-215.
Ana Luiza Reis Vasques e Marco Aurélio Peres. Tendência temporal da mortalidade por câncer de cólon e reto em Santa Catarina no período entre 1980 a 2006* Epidemiol. Serv. Saúde, Brasília, 19 (2): 91-100, abr-jun 2010.
Valadão M; Leal RA; Barbosa LC; Carneiro M; Muharre RJ. Perfil dos Pacientes Portadores de Câncer Colorretal Operados em um Hospital Geral: Necessitamos de um Programa de Rastreamento Acessível e Efetivo. Rev bras Coloproct, 2010; 30(2): 160-166.
Mendes CRS; Sapucaia RA; Ferreira LSDM. Tratamento cirúrgico do câncer colorretal: série histórica de três anos de um serviço em Salvador, Bahia. Rev bras Coloproct, 2011; 30(4): 440-443.
Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Rastreamento / Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Básica. – Brasília: Ministério da Saúde, 2010.
Almeida EPM, Gutiérrez MGR, Adami NP. Monitoramento e avaliação dos efeitos colaterais da quimioterapia em pacientes com câncer de cólon. Rev Latino-am Enfermagem 2004 setembro-outubro; 12 (5): 760-6.
Roque VMN, Forones NM. Avaliação da qualidade de vida e toxicidades em pacientes com câncer colorretal tratados com quimioterapia adjuvante baseada em fluoropirimidinas. Arq Gastroenterol; 43 (2): abr./jun. 2006.
Zaanan A, Gauthier M, Malka D, Locher C, Gornet JM, Thirot Bidault A, et al. Secondline chemotherapy with fluorouracil, leucovorin, and irinotecan (FOLFIRI regimen) in patients with advanced small bowel adenocarcinoma after failure of firstline platinumbased chemotherapy. Cancer. 2011; 117: 1422-8.
Dranitsaris G, Shah A, Spirovski B, Vincent M. Severe diarrhea in patients with advanced-stage colorectal câncer receiving FOLFOX or FOLFIRI chemotherapy: the development of a risk prediction tool. Clin Colorectal Cancer. 2007; 6: 367-73.
Almeida EPM. Ocorrência e intensidade de náuseas, vômito e diarreia, em pacientes com neoplasia de cólon em quimioterapia ambulatorial – indicadores para avaliar resultados das orientações de enfermagem [tese]. São Paulo: Universidade Federal de São Paulo; 2000.
T. Aparicio, J Desramé, T Lecomte, E Mitry, J Belloc, I Etienney, et al. Oxaliplatin- or irinotecan-based chemotherapy for metastatic colorectal cancer in the elderly. British Journal of Cancer (2003); 89 (8), 1439-1444.
Tournigand C, André T, Achille E, Lledo G, Flesh M, Mery-Mignard D, et al. FOLFIRI Followed by FOLFOX6 or the Reverse Sequence in Advanced Colorectal Cancer: A Randomized GERCOR Study. J Clin Oncol. 2004 Jan 15; 22 (2): 229-37.
François E, Berdah JF, Chamorey E, Lesbats G, Teissier E, Codoul JF, et al. Use of the folinic acid/5-fluorouracil/irinotecan (FOLFIRI 1) regimen in elderly patients as a first-line treatment for metastatic colorectal cancer: a Phase II study. Cancer Chemother Pharmacol. 2008 Nov; 62 (6): 931-6.
Stein BN, Petrelli NJ, Douglass HO, Driscoll DL, Arcangeli G, Meropol NJ, et al. Age and Sex Are Independent Predictors of 5-Fluorouracil Toxicity. Cancer. 1995 Jan 1; 75 (1):11-7.
Boisdron-Celle M, Remaud G, Traore S, Poirier AL, Gamelin L, Morel A, et al. 5-Fluorouracil-related severe toxicity: A comparison of different methods for the pretherapeutic detection of dihydropyrimidine dehydrogenase deficiency. Cancer Lett. 2007 May 8; 249 (2): 271-82.
Meulendijks, D, Cats A , Beijnen JH, Schellens JHM. Improving safety of fluoropyrimidine chemotherapy by individualizing treatment based on dihydropyrimidine dehydrogenase activity – Ready for clinical practice? Cancer Treatment Reviews 50 (2016) 23–34.
