Biological agents in gastrointestinal cancers: Adverse effects and their management

Nivedita Arora, Arjun Gupta, Preet Paul Singh

Research output: Contribution to journalReview articlepeer-review

14 Scopus citations

Abstract

Biological therapy comprises agents that by virtue of their unique mechanisms of action, are able to specifically incite a response against or target malignant cells. They differ from conventional chemotherapy with regard to mechanisms of action, indications and side effect profile. Biologic agents have revolutionized therapy for a number of malignancies. In the setting of gastrointestinal (GI) malignancies, agents targeting vascular endothelial growth factor (VEGF), human epidermal growth factor receptor 2 (Her2/Neu) and epidermal growth factor receptor (EGFR) have proven to be invaluable additions to chemotherapy. However, these agents bring with them a set of side effects attributable to their unique mechanisms of action. The anti VEGF agents-bevacizumab, aflibercept and ramucirumab, can result in renal and vascular complications such as hypertension, arterial thrombotic events (ATE), proteinuria and GI perforations. The anti EGFR agents classically cause dermatological toxicities, in addition to hypomagnesemia, which can be dose limiting for patients. Trastuzumab, a monoclonal antibody that targets Her2/Neu, is known to cause cardiotoxicity, especially when used with anthracyclines. Use of immunotherapy agents such as nivolumab is associated with the development immune related adverse events (irAEs). The use of these agents is expected to increase over the next few years and it is crucial that patients and practitioners are aware of their adverse effects and current management strategies. This review highlights the adverse events associated with the use of biologic and immunologic therapies in GI cancers, their incidence and current management strategies

Original languageEnglish (US)
Pages (from-to)485-498
Number of pages14
JournalJournal of Gastrointestinal Oncology
Volume8
Issue number3
DOIs
StatePublished - Jun 1 2017

Keywords

  • Adverse effects
  • Biological therapy
  • EGFR inhibitors
  • Gastrointestinal cancer
  • Immunotherapy
  • VEGF inhibitor

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