Optimizing Systemic Therapy in Advanced Gastrointestinal Malignancies: Strategies to Minimize Toxicity and Maximize Tolerability

IF 2.7 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer Pub Date : 2026-09-01 Epub Date: 2026-05-20 DOI:10.1016/j.clcc.2026.05.004

Sabrina Bulancea, Udhayvir S. Grewal, Marta Wronska, Deepak Vadehra, Nicholas Hornstein, Timothy J. Brown, Michael Shusterman

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引用次数: 0

Abstract

Advanced gastrointestinal cancers remain a major global health challenge, with rising incidence especially among younger populations. Systemic chemotherapy continues to be the mainstay of care for most patients, but balancing treatment benefit with tolerability is an ongoing concern. Many patients, especially older adults and those with significant medical comorbidities, may struggle with standard dosing due to side effects, yet they are often underrepresented in clinical trials. As a result, real-world practice often relies on adjusting drug doses and schedules to reduce toxicity without compromising outcomes. Personalizing systemic therapy based on patient factors like age, fitness, and individual response can help improve tolerability and maintain quality of life. Emerging evidence supports the use of modified dosing and frequency, but prospective data remain limited. In this review, we discuss current approaches to optimizing systemic therapy for advanced gastrointestinal cancers and the need for practical, patient-centered care pathways.

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优化晚期胃肠道恶性肿瘤的全身治疗：最小化毒性和最大化耐受性的策略。

晚期胃肠道癌症仍然是一个主要的全球健康挑战，特别是在年轻人群中发病率不断上升。全身性化疗仍然是大多数患者的主要治疗手段，但如何平衡治疗效益和耐受性一直是一个值得关注的问题。许多患者，尤其是老年人和那些有严重合并症的患者，可能由于副作用而难以接受标准剂量，但他们在临床试验中的代表性往往不足。因此，现实世界的实践往往依赖于调整药物剂量和时间表，以减少毒性而不影响结果。根据患者的年龄、健康状况和个体反应等因素进行个性化全身治疗有助于提高耐受性和维持生活质量。新出现的证据支持使用改良的剂量和频率，但前瞻性数据仍然有限。在这篇综述中，我们讨论了目前优化晚期胃肠道癌症全身治疗的方法，以及对实用的、以患者为中心的护理途径的需求。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical colorectal cancer 医学-肿瘤学

CiteScore

5.50

自引率

2.90%

发文量

审稿时长

27 days

期刊介绍： Clinical Colorectal Cancer is a peer-reviewed, quarterly journal that publishes original articles describing various aspects of clinical and translational research of gastrointestinal cancers. Clinical Colorectal Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of colorectal, pancreatic, liver, and other gastrointestinal cancers. The main emphasis is on recent scientific developments in all areas related to gastrointestinal cancers. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.