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Abstract
Background Targeted therapy has emerged as a promising treatment for cancers. Despite their therapeutic potential, tyrosine kinase inhibitors (TKIs) are limited by drug toxicity and adverse effects (AEs), leading to treatment failure. Gastrointestinal (GI) effects from targeted therapy include diarrhea, rectal hemorrhage, dyspepsia, and colitis. This pilot study aims to assess the efficacy of WMT in patients undergoing TKIs-GI AEs.
Methods This prospective study was conducted in The Second Affiliated Hospital of Nanjing Medical University and evaluated patients with cancer who underwent WMT. The CACTE was used to assess gastrointestinal symptoms. The GI symptoms include diarrhea, abdominal pain, bleeding, and abdominal distension. The symptom questionnaires were administered in person at baseline during hospital visits, and 8 weeks post-WMT. The Vienna rectoscope score (VRS) was utilized to evaluate the patient’s clinical endoscopic description.
Results In total, 24 patients underwent 66 times WMTs in 8 weeks. Lung cancer was the most prevalent cancer type observed in 37.5% of the study cohort. Diarrhea was universally present (100%), followed by abdominal pain (54.2%) as the subsequent common GI symptom among these patients. The clinical response rates were observed at 75.0% (18/24) for the entire patient cohort, with rates of 76.5% (12/16) in the VEGFR group and 71.4% (6/8) in the EGFR group (IDDF2024-ABS-0250 Figure 1A). Besides, clinical asymptomatic rates were noted at 29.2% for all patients, 31.25% in the VEGFR group, and 25% in the EGFR group (IDDF2024-ABS-0250 Figure 1B). Notably, diarrhea and abdominal pain exhibited notable alleviation (IDDF2024-ABS-0250 Figure 1C). Moreover, a significant reduction was observed in the total CTCAE grades within each group compared to the baseline (IDDF2024-ABS-0250 Figure 1D). Notably, seven patients (43.75%) exhibited normal endoscopic results, while eight patients (50.00%) showed signs of inflammation, and one patient (6.25%) presented with ulcers. The inflammation is predominantly localized in the right colon. Among the patients with inflammatory findings, the median endoscopic score was 2 (IQR, 1-3; IDDF2024-ABS-0250 Figure 2).
Conclusions WMT can effectively alleviate TKI-associated GI AEs, which are not limited to the management of diarrhea but also include abdominal pain, bleeding, and other GI symptoms. WMT as an integrative treatment can provide a good clinical idea for recurrent or refractory GI AEs.