Drug-induced diarrhea associated with antineoplastic drugs

Diarrhea is the most common adverse reaction of anticancer drugs, as well as radiation therapy of the pelvic organs or abdominal cavity: the incidence of diarrhea of different seveity reaches 80% during chemotherapy and / or radiation therapy; one third of these patients develop severe diarrhea (3rd or 4th degree). Most often, drug-induced diarrhea occurs during chemotherapy, using 5-fluorouracil or irinotecan, taking new anticancer drugs from the classes of checkpoint inhibitors, monoclonal antibodies, tyrosine kinase inhibitors. The most common mechanisms underlying the development of drug-induced diarrhea are damage to the intestinal mucosa, impaired absorption of proteins, carbohydrates, fats, inflammation, a perverse immune response, microflora imbalance, and others. Algorithms for the management of patients with severe diarrhea include suspension (grade 1-2, 3) or complete cessation (grade 4, grade 3) of the use of an antineoplastic agent an inducer, prescribing drugs that reduce intestinal motility (loperamide) while excluding the infectious nature of diarrhea, intravenous methylprednisolone (for example, diarrhea caused by monoclinal antibodies in the absence of suspicion of potential bowel perforation). In cases where drug-induced diarrhea lasts more than 48 hours, or a patient reports symptoms of dehydration, or a fever occurs, urgent hospitalization is necessary. The objective of this review is to analyze scientific literature data on the prevalence, pathophysiological mechanisms and risk factors for the development of diarrhea associated with the intake of anticancer drugs, as well as its prevention and treatment.