[Adequate supportive treatment in therapeutic use of "biologicals" for GI tumours in oncosurgery--what does the surgeon need to know?]

Abstract

Background: Along with the increasing use and inauguration of novel antineoplastic substances (inhibitors, antibodies [Ab]) at various levels of the tumour cell-specific intracellular signalling (transduction cascade) on the cell surface and within the cell as well as messengers ["biologicals", "targeted therapy"]), a new quality, intensity and complexity of adverse effects was simultaneously developed, which have become more and more relevant even to oncosurgeons.

Aim: A summary is given of clinically obtained expertise including recommendations for a competent approach, management and use of biologicals for targeted therapy in case of abnormal or adverse effects as well as toxic reactions, which are compared with available data from the literature and provided as systematic short review on the clinically used substances and drugs in GI tumour lesions.

Methods: The compact overview is based on the authors' daily clinical experiences including a selective and comparative literature search in PubMed (searching strategy using the following terms: "supportive treatment/therapy", "biological[s]").

Results: The discussed profile of biologicals comprises: Herceptin®/Trastuzumab (Her2 neu-AK), Erbitux®/Cetuximab (EGFR-AK), Glivec®/Imatinib, Sutent®/Sunitinib and Nexavar®/Sorafenib (multikinase inhibitors)--reference to haematological and oncological literature for MabThera®/Rituximab and Sprycel®/Dasatinib; Tasigna®/Nilotinib. All of them induce more or less severe, partially single or combined, known (haematological, gastroenterological, neurological and dermatological [according to the WHO classification]) or completely novel (GI perforation in case of Avastin®; apparent predominance of neurological and dermatological) adverse effects, which show (in the majority of cases) substance- and/or drug-specific properties in the spectrum of adverse effects, which can be sufficiently managed. These circumstances increase the requirements for the expertise of today's responsible oncologists/oncosurgeons.

Discussion: The management of "biologicals"-associated adverse effects can be considered a novel aspect in the overall concept of oncological care, which shows a partially known as well as novel phenomenology and, thus, requires adapted therapeutic approaches.