Proliferation and differentiation of gastrointestinal cells in relation to therapy

Gastrointestinal toxicity of chemotherapeutic agents

Chemotherapy-induced toxicities commonly occur in sites within the gastrointestinal (GI) tract and account for dose-limiting effects. These toxicities are major contributing factors to dose reduction, delays, and cessation of cancer treatment. Through intensive therapies including surgery, combination chemotherapy, hormonal therapy, and targeted therapy, an increasing number of patients with cancer are experiencing improved survival and long-term disease-free survival, as well as palliation of disease-related symptoms. Thus, GI toxicities should be predicted and appropriate interventions initiated to prevent them when possible and provide effective supportive measures and comprehensive follow-up care. This review will discuss the etiology, incidence, prevention, and treatment of GI toxicities of cancer chemotherapy.

Protective effect of alpha-tocopherol in head and neck cancer radiation-induced mucositis: a double-blind randomized trial

BACKGROUND

the study was designed to test whether vitamin E (VE) provides oral mucosal protection in patients with irradiated cancers of the head and neck.

METHODS

Fifty-four patients with cancer of the oral cavity and oropharynx were randomly assigned to rinse the oral cavity in an oil solution containing either VE or placebo before every conventional fraction of 2 Gy and again 8 to 12 hours later during the 5 to 7 weeks of radiotherapy (RT).

RESULTS

Thirty-six events/167 patient-weeks (21.6%) and 54 events/161 patient-weeks (33.5%) of symptomatic mucositis were observed in VE and placebo groups, respectively (p =.038). VE reduced the risk by 36%. Subjective data at the end of the treatment revealed that VE decreased pain grades 2 to 3 during RT (3 of 28 patients vs 14 of 26 patients, p =.0001). No significant influence was detected in survival.

CONCLUSION

VE decreased the incidence of symptomatic oral radio-induced mucositis in patients with cancer of the oropharynx and oral cavity.

Treatment of cultured human colon carcinoma cells with fluorinated pyrimidines

The shape of the initial part of the dose-dependent response curve of LoVo cells, an established human colon carcinoma cell line, exposed for 1 hr to graded concentrations of 5-FU depended on the medium supplement, i.e., fetal calf serum (FCS), in which the cells were treated and subsequently incubated for colony-formation. At concentrations of 50--100 micrograms/ml (equivalent to peak plasma levels following an in vivo bolus dose of 15 mg/kg) cell kill was completely prevented by FCS. The serum did not contain thymidine (TdR) but had significant amounts of uridine (UR). When 5-FU was delivered in dialyzed FCS, concentrations of 50--100 micrograms/ml achieved only a modest 15% cell kill after 1 hour treatment. Regardless of medium supplement, the killing effect of 5-FU did not increase beyond concentrations greater than 2,000 micrograms/ml. Increasing the exposure interval dramatically increased the killing of LoVo cells by 5-FU, although the effects of medium supplement on the degree of cell survival persisted for about 12 hours. Virtually all of the incorporated 5-FU was transformed into 5-FUR, and a very small proportion eventually was incorporated into nucleic acids, suggesting that the killing effect of 5-FU on LoVo cells is mediated mostly by ribosidation and not by conversion into the deoxyribonucleoside. This conclusion is supported by the failure of 5-FUdR to kill LoVo cells after a treatment interval of one hour, even at concentrations of 5000 micrograms/ml; yet after the same exposure interval, 5-FUR effectively killed cells at concentrations of 50--100 micrograms/ml. TdR afforded no protection from cell kill by 5-FU. In contrast, UR was capable of protecting LoVo cells from the lethal effects of both 5-FU and 5-FUR even at concentrations as low as 10 micrograms/ml. Ftorafur exposed to LoVo cells for 1 hour had a slight killing effect (about 20--25%) at concentrations ranging up to 2000 micrograms/ml. Although the lethal effect of ftorafur was slightly increased after longer periods of incubation, it failed to reach 90% even after intervals of 48 hours. The results on cellular sensitivity that we obtained for LoVo cells treated with various fluorinated pyrimidines differ substantially from those of other investigators who used different methods to assess cell killing on nonhuman and noncolonic cell systems. The predictive relevance of these data as compared to those obtained in other systems is justified by the suboptimal results with these agents in clinical practice.