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Around ~10% of the western population carries a genetic variant in UGT1A1 that leads to poor drug metabolism and results in a higher risk for severe toxicity (Innocenti et al., 2004).
Risk factors for severe toxicity were: performance status 3; hepatic impairment; renal impairment.
Of the 243 cases, 21 cases had to stop adjuvant chemotherapy for severe toxicity.
However, all of these 5-FU-based regimens are inconvenient to administer and have the potential for severe toxicity (i.e. renal toxicity, emesis).
The evidence needed to decide whether to start a patient with RA on methotrexate or not might be extrapolated from data on risk factors for severe toxicity.
67 Because of considerable interpatient variability, TDM is essential to identify patients at high risk for severe toxicity, and the need for increased hydration or prolonged LV rescue.
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Five trials were identified totaling 2939 patients, of whom 1471 were randomized to an arm not containing P and 1468 received therapy containing P. There was no difference between the non-P and P groups for severe toxicities (incidence rate ratio [IRR] = 0.82, p = 0.712, I2 = 97.9%).
Chemotherapy could be delayed ≤3 weeks for severe toxicities.
Early identification of patients at risk of severe toxicity allows for early intervention to reduce morbidity and mortality; equally important is the identification of those cases at risk of developing chemoresistance.
Bentonite clays exhibit high adsorptive capacity for contaminants, including aflatoxin B1 (aFB1), a mycotoxin responsible for causing severe toxicity in several species including pigs, poultry and man.
These possible benefits and the high rate of severe toxicity define a very narrow therapeutic index for concurrent gemcitabine-based chemoradiation given by this schedule of administration.
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