Pub Date : 2023-03-10DOI: 10.5124/jkma.2023.66.3.180
Eun Hye Lee, S. Kwak, Chi Young Kim, Hye Ran Gwon, Eun Young Kim, Y. Chang
Background: Lung cancer is representative of a high frequency and high mortality disease and ranks at the top in incidence and mortality in Korea, when excluding thyroid cancer. In this manuscript, we focused on current targeted therapies for lung cancer used widely in the medical field.Current Concepts: The majority of patients with lung cancer cannot be treated with surgery only and require chemotherapeutics or radiation therapy. Currently, classical chemotherapeutic agents, targeted agents, and immune checkpoint inhibitors are the most widely used. Recently, the Research and Development of antibody-drug conjugates is gaining attention, and this may become a more widely prescribed treatment in the future. Among the available treatment options, targeted therapy is becoming increasingly feasible and widespread for treating inoperable lung cancers, where driver mutations have been identified, and for adjuvant or neoadjuvant therapies. Next-generation sequencing (NGS) improves the ability to identify driver mutations that were previously difficult to detect and can also be performed on blood samples where no cancer tissue is available for testing. This makes it possible to identify therapeutic targets for targeted therapy more rapidly.Discussion and Conclusion: The most common type of lung cancer in Korea is adenocarcinoma, for which a driver mutation has been identified. Newly developed drugs target previously problematic mutations or cancer cell lines that have acquired resistance induced during the treatment process. The survival rate of patients with lung cancer is expected to improve with the development of tailored treatments for targets identified from the NGS data of the patient. This paper will help clinicians understand the current state of targeted therapies for lung cancer treatment.
{"title":"New targeted therapies for non-small cell lung cancer","authors":"Eun Hye Lee, S. Kwak, Chi Young Kim, Hye Ran Gwon, Eun Young Kim, Y. Chang","doi":"10.5124/jkma.2023.66.3.180","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.3.180","url":null,"abstract":"Background: Lung cancer is representative of a high frequency and high mortality disease and ranks at the top in incidence and mortality in Korea, when excluding thyroid cancer. In this manuscript, we focused on current targeted therapies for lung cancer used widely in the medical field.Current Concepts: The majority of patients with lung cancer cannot be treated with surgery only and require chemotherapeutics or radiation therapy. Currently, classical chemotherapeutic agents, targeted agents, and immune checkpoint inhibitors are the most widely used. Recently, the Research and Development of antibody-drug conjugates is gaining attention, and this may become a more widely prescribed treatment in the future. Among the available treatment options, targeted therapy is becoming increasingly feasible and widespread for treating inoperable lung cancers, where driver mutations have been identified, and for adjuvant or neoadjuvant therapies. Next-generation sequencing (NGS) improves the ability to identify driver mutations that were previously difficult to detect and can also be performed on blood samples where no cancer tissue is available for testing. This makes it possible to identify therapeutic targets for targeted therapy more rapidly.Discussion and Conclusion: The most common type of lung cancer in Korea is adenocarcinoma, for which a driver mutation has been identified. Newly developed drugs target previously problematic mutations or cancer cell lines that have acquired resistance induced during the treatment process. The survival rate of patients with lung cancer is expected to improve with the development of tailored treatments for targets identified from the NGS data of the patient. This paper will help clinicians understand the current state of targeted therapies for lung cancer treatment.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"6 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90563170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-10DOI: 10.5124/jkma.2023.66.3.209
Taek-Young Kim
{"title":"Inje Paik, a pioneer and visionary leader of modern medicine in Korea who practiced Noblesse Oblige","authors":"Taek-Young Kim","doi":"10.5124/jkma.2023.66.3.209","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.3.209","url":null,"abstract":"","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"23 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79402869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-10DOI: 10.5124/jkma.2023.66.3.191
H. Lee
Background: Congenital hypothyroidism is the most common neonatal endocrine disorder, and prompt screening and treatment initiation can prevent developmental delay and growth failure.Current Concepts: The thyroid is the first endocrine gland to develop during embryogenesis. Regulation of thyroid function requires normal development of the hypothalamic-pituitary-thyroid axis, which occurs during the embryonal and neonatal periods. Defects in any of the steps involved in development and differentiation of the gland and regulation of thyroid function lead to permanent congenital hypothyroidism. Neonatal screening test programs to detect congenital hypothyroidism, which are established in 1/3 of the countries worldwide, are cost-effective with high sensitivity and specificity. Advances in molecular testing have expanded knowledge and understanding of thyroid development and function. Prompt initiation of an accurate dose of sodium levothyroxine is recommended. Frequent follow-up, including laboratory test evaluation and dose adjustments are important to maintain thyroid hormone levels within their target ranges.Discussion and Conclusion: A well-established system of newborn screening and treatment of congenital hypothyroidism is useful for management of term infants without other risk factors for this disorder. However, increasing knowledge regarding the role of genetic causes and new criteria for screening and treatment of neonates in special conditions is emerging in clinical practice.
{"title":"Diagnosis and treatment of congenital hypothyroidism","authors":"H. Lee","doi":"10.5124/jkma.2023.66.3.191","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.3.191","url":null,"abstract":"Background: Congenital hypothyroidism is the most common neonatal endocrine disorder, and prompt screening and treatment initiation can prevent developmental delay and growth failure.Current Concepts: The thyroid is the first endocrine gland to develop during embryogenesis. Regulation of thyroid function requires normal development of the hypothalamic-pituitary-thyroid axis, which occurs during the embryonal and neonatal periods. Defects in any of the steps involved in development and differentiation of the gland and regulation of thyroid function lead to permanent congenital hypothyroidism. Neonatal screening test programs to detect congenital hypothyroidism, which are established in 1/3 of the countries worldwide, are cost-effective with high sensitivity and specificity. Advances in molecular testing have expanded knowledge and understanding of thyroid development and function. Prompt initiation of an accurate dose of sodium levothyroxine is recommended. Frequent follow-up, including laboratory test evaluation and dose adjustments are important to maintain thyroid hormone levels within their target ranges.Discussion and Conclusion: A well-established system of newborn screening and treatment of congenital hypothyroidism is useful for management of term infants without other risk factors for this disorder. However, increasing knowledge regarding the role of genetic causes and new criteria for screening and treatment of neonates in special conditions is emerging in clinical practice.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"18 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86121386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-10DOI: 10.5124/jkma.2023.66.3.154
S. Jang
Background: Lung cancer is increasing exponentially as the population ages. To conquer lung cancer, early diagnosis, developing new treatments, and combining multidisciplinary treatment modalities are essential.Current Concepts: Since the national lung cancer screening program for high-risk individuals using low-dose chest computed tomography has launched, the rate of early diagnosis of lung cancer is expected to increase. The development of immune checkpoint inhibitors and target agents is paying off in terms of producing new anticancer drugs. Immune checkpoint inhibitors are administered in combination with existing treatment modalities in various clinical situations, such as for not only patients with metastatic lung cancer but also for those with resectable lung cancer and with surgically unresectable locally advanced disease. These trials dramatically improved survival outcomes. The development of targeted anticancer drugs is also advancing at a rapid pace. The survival rate of patients with lung cancer who have specific gene mutations has greatly improved when targeted anticancer drugs are administered alone or in combination with conventional therapies.Discussion and Conclusion: Early diagnosis of lung cancer and the development of new treatment modalities are greatly improving the prognosis of patients with lung cancer. Attempts to combine conventional and new treatment modalities should continue. It is necessary to discuss changing medical policies for long-term survivors, which will inevitably increase.
{"title":"All-round counterattack to conquer lung cancer","authors":"S. Jang","doi":"10.5124/jkma.2023.66.3.154","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.3.154","url":null,"abstract":"Background: Lung cancer is increasing exponentially as the population ages. To conquer lung cancer, early diagnosis, developing new treatments, and combining multidisciplinary treatment modalities are essential.Current Concepts: Since the national lung cancer screening program for high-risk individuals using low-dose chest computed tomography has launched, the rate of early diagnosis of lung cancer is expected to increase. The development of immune checkpoint inhibitors and target agents is paying off in terms of producing new anticancer drugs. Immune checkpoint inhibitors are administered in combination with existing treatment modalities in various clinical situations, such as for not only patients with metastatic lung cancer but also for those with resectable lung cancer and with surgically unresectable locally advanced disease. These trials dramatically improved survival outcomes. The development of targeted anticancer drugs is also advancing at a rapid pace. The survival rate of patients with lung cancer who have specific gene mutations has greatly improved when targeted anticancer drugs are administered alone or in combination with conventional therapies.Discussion and Conclusion: Early diagnosis of lung cancer and the development of new treatment modalities are greatly improving the prognosis of patients with lung cancer. Attempts to combine conventional and new treatment modalities should continue. It is necessary to discuss changing medical policies for long-term survivors, which will inevitably increase.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"19 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83431722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-10DOI: 10.5124/jkma.2023.66.3.173
Jeong Uk Lim
Background: Low-dose chest computed tomography is being increasingly used to screen for lung cancer, and the proportion of early diagnoses of patients with lung cancer in potentially resectable stages is increasing. After complete resection, reducing the possibility of postoperative relapse is of the utmost priority. In this review, recent updates in adjuvant treatment for resectable non-small cell lung cancer (NSCLC) were briefly explained.Current Concepts: Even though platinum-based adjuvant chemotherapy was traditionally used, there was only a small increase in overall survival and a 15% decrease in relapse.Discussion and Conclusion: With the advent of immunotherapy and epidermal growth factor receptor tyrosine kinase inhibitors, the landscape of adjuvant treatment for completely resectable NSCLC is rapidly changing. The ADAURA study showed that adjuvant osimertinib, regardless of prior platinum-based postoperative chemotherapy, significantly extended disease-free progression survival in epidermal growth factor receptor mutation-positive patients with resectable NSCLC. The IMpower010 study showed that postoperative atezolizumab can be an option in patients without targetable mutations for reducing the possibility of postoperative relapse. Postoperative radiotherapy can be beneficial for patients with lymph node metastases (N2).
{"title":"Adjuvant treatment for resectable non-small cell lung cancer","authors":"Jeong Uk Lim","doi":"10.5124/jkma.2023.66.3.173","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.3.173","url":null,"abstract":"Background: Low-dose chest computed tomography is being increasingly used to screen for lung cancer, and the proportion of early diagnoses of patients with lung cancer in potentially resectable stages is increasing. After complete resection, reducing the possibility of postoperative relapse is of the utmost priority. In this review, recent updates in adjuvant treatment for resectable non-small cell lung cancer (NSCLC) were briefly explained.Current Concepts: Even though platinum-based adjuvant chemotherapy was traditionally used, there was only a small increase in overall survival and a 15% decrease in relapse.Discussion and Conclusion: With the advent of immunotherapy and epidermal growth factor receptor tyrosine kinase inhibitors, the landscape of adjuvant treatment for completely resectable NSCLC is rapidly changing. The ADAURA study showed that adjuvant osimertinib, regardless of prior platinum-based postoperative chemotherapy, significantly extended disease-free progression survival in epidermal growth factor receptor mutation-positive patients with resectable NSCLC. The IMpower010 study showed that postoperative atezolizumab can be an option in patients without targetable mutations for reducing the possibility of postoperative relapse. Postoperative radiotherapy can be beneficial for patients with lymph node metastases (N2).","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"86 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81458217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-10DOI: 10.5124/jkma.2023.66.3.166
J. Eom
Background: Radial probe endobronchial ultrasound (RP-EBUS) has been used in the diagnosis of peripheral lung lesions (PLLs). We reviewed the traditional modality of transbronchial biopsy using RP-EBUS as well as recent developments in improving the diagnostic yield.Current Concepts: Until now, the forceps biopsy of PLLs has played a key role in acquiring tissue samples during the RP-EBUS procedures. Forceps biopsy is a safe and minimally invasive procedure; however, its diagnostic yield was reported to be around 70%, which is significantly lower than that of percutaneous needle aspiration or biopsy. So far, various studies have been conducted to improve the diagnostic yield of the RP-EBUS procedure. The combination of novel navigation systems, such as virtual or electromagnetic navigation bronchoscopies, for locating PLLs in the complex bronchial tree has increased the diagnostic yield of the RP-EBUS procedure. Moreover, newly developed ancillary devices, such as the PeriView FLEX needle or cryobiopsy, as well as traditional modalities such as the guide sheath and brushing cytology, can improve the outcomes of the RP-EBUS procedures. Concerning the bronchoscope size, it has been confirmed that a 3 mm-diameter ultrathin bronchoscope has a higher diagnostic yield than a 4 mm-diameter thin bronchoscope.Discussion and Conclusion: RP-EBUS is a safe and useful method to diagnose PLLs. When traditional and novel modalities are appropriately combined, the diagnostic yield can be increased.
{"title":"The diagnosis of peripheral lung lesions: transbronchial biopsy using a radial probe endobronchial ultrasound","authors":"J. Eom","doi":"10.5124/jkma.2023.66.3.166","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.3.166","url":null,"abstract":"Background: Radial probe endobronchial ultrasound (RP-EBUS) has been used in the diagnosis of peripheral lung lesions (PLLs). We reviewed the traditional modality of transbronchial biopsy using RP-EBUS as well as recent developments in improving the diagnostic yield.Current Concepts: Until now, the forceps biopsy of PLLs has played a key role in acquiring tissue samples during the RP-EBUS procedures. Forceps biopsy is a safe and minimally invasive procedure; however, its diagnostic yield was reported to be around 70%, which is significantly lower than that of percutaneous needle aspiration or biopsy. So far, various studies have been conducted to improve the diagnostic yield of the RP-EBUS procedure. The combination of novel navigation systems, such as virtual or electromagnetic navigation bronchoscopies, for locating PLLs in the complex bronchial tree has increased the diagnostic yield of the RP-EBUS procedure. Moreover, newly developed ancillary devices, such as the PeriView FLEX needle or cryobiopsy, as well as traditional modalities such as the guide sheath and brushing cytology, can improve the outcomes of the RP-EBUS procedures. Concerning the bronchoscope size, it has been confirmed that a 3 mm-diameter ultrathin bronchoscope has a higher diagnostic yield than a 4 mm-diameter thin bronchoscope.Discussion and Conclusion: RP-EBUS is a safe and useful method to diagnose PLLs. When traditional and novel modalities are appropriately combined, the diagnostic yield can be increased.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"23 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88168807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-10DOI: 10.5124/jkma.2023.66.3.160
Dongil Park
Background: Lung cancer is the most common cause of cancer deaths worldwide and accounts for approximately 2 million deaths annually. Despite advances in lung biopsy methods using bronchoscopy, a transthoracic needle biopsy continues to be used widely owing to its excellent accessibility and cost-effectiveness.Current Concepts: Various guidance methods are used during a transthoracic needle biopsy to guide the biopsy needle toward the target lesion. Commonly used modalities include conventional computed tomography, computed tomography fluoroscopy, cone beam computed tomography, and ultrasonography. Complications of a transthoracic needle biopsy include pneumothorax (20.0%), hemorrhage or hemoptysis (11.0%), delayed pneumothorax (1.4%–4.5%), air embolism (0.02%–1.8%), and tumor seeding (0.12%–0.061%).Discussion and Conclusion: Careful selection of the guidance method and needle type, based on the risk factors, the patient’s condition, and location of the lesion is important to achieve high accuracy and low complication rates during a transthoracic needle biopsy. If possible, the bronchoscopic approach should initially be attempted in high-risk groups.
{"title":"Transthoracic needle biopsy for diagnosis of lung cancer","authors":"Dongil Park","doi":"10.5124/jkma.2023.66.3.160","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.3.160","url":null,"abstract":"Background: Lung cancer is the most common cause of cancer deaths worldwide and accounts for approximately 2 million deaths annually. Despite advances in lung biopsy methods using bronchoscopy, a transthoracic needle biopsy continues to be used widely owing to its excellent accessibility and cost-effectiveness.Current Concepts: Various guidance methods are used during a transthoracic needle biopsy to guide the biopsy needle toward the target lesion. Commonly used modalities include conventional computed tomography, computed tomography fluoroscopy, cone beam computed tomography, and ultrasonography. Complications of a transthoracic needle biopsy include pneumothorax (20.0%), hemorrhage or hemoptysis (11.0%), delayed pneumothorax (1.4%–4.5%), air embolism (0.02%–1.8%), and tumor seeding (0.12%–0.061%).Discussion and Conclusion: Careful selection of the guidance method and needle type, based on the risk factors, the patient’s condition, and location of the lesion is important to achieve high accuracy and low complication rates during a transthoracic needle biopsy. If possible, the bronchoscopic approach should initially be attempted in high-risk groups.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"36 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85440123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-10DOI: 10.5124/jkma.2023.66.2.112
J. Cheon
Background: Immunotherapy has become established as a new cancer treatment that enhances patients’ immune systems’ ability to fight cancer. Immune checkpoint inhibitors (ICI) have demonstrated remarkable benefits in the treatment of a range of cancer types. The increasing use of immune-based therapies has exposed a discrete group of immune-related adverse effects. Effective recognition and treatment of ICI-induced toxicities have emerged as essential goals of ICI management.Current Concepts: Gastrointestinal (GI) and hepatic adverse effects of ICI treatment are relatively common. Immune-related GI or hepatic toxicities occur in approximately 30% of patients. The incidence of grade 3 or 4 adverse effects ranges from 0.5% to 2%. The management strategy for immune-related adverse effects depends on their severity. In general, ICI treatment can be continued with close monitoring for mild (grade 1) GI/hepatic toxicities. ICI treatment should be interrupted for most grade 2 to 4 toxicities, and systemic steroid administration is recommended. If steroids are ineffective, immunosuppressive agents such as infliximab may be used. When symptoms and laboratory values revert to grade 1 or less, ICI treatment may be resumed with caution. Grade 4 toxicities warrant permanent discontinuation of ICI treatment.Discussion and Conclusion: Most immune-related GI and hepatic adverse effects are mild to moderate in severity and can be managed with supportive care, steroid therapy, and other immunomodulatory agents. Management of ICI-related toxicities in the GI and hepatic systems requires close collaboration between the patient, the treating oncologist, and other specialists.
{"title":"Management of the adverse effects of cancer immunotherapy with a focus on the gastrointestinal and hepatic systems","authors":"J. Cheon","doi":"10.5124/jkma.2023.66.2.112","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.2.112","url":null,"abstract":"Background: Immunotherapy has become established as a new cancer treatment that enhances patients’ immune systems’ ability to fight cancer. Immune checkpoint inhibitors (ICI) have demonstrated remarkable benefits in the treatment of a range of cancer types. The increasing use of immune-based therapies has exposed a discrete group of immune-related adverse effects. Effective recognition and treatment of ICI-induced toxicities have emerged as essential goals of ICI management.Current Concepts: Gastrointestinal (GI) and hepatic adverse effects of ICI treatment are relatively common. Immune-related GI or hepatic toxicities occur in approximately 30% of patients. The incidence of grade 3 or 4 adverse effects ranges from 0.5% to 2%. The management strategy for immune-related adverse effects depends on their severity. In general, ICI treatment can be continued with close monitoring for mild (grade 1) GI/hepatic toxicities. ICI treatment should be interrupted for most grade 2 to 4 toxicities, and systemic steroid administration is recommended. If steroids are ineffective, immunosuppressive agents such as infliximab may be used. When symptoms and laboratory values revert to grade 1 or less, ICI treatment may be resumed with caution. Grade 4 toxicities warrant permanent discontinuation of ICI treatment.Discussion and Conclusion: Most immune-related GI and hepatic adverse effects are mild to moderate in severity and can be managed with supportive care, steroid therapy, and other immunomodulatory agents. Management of ICI-related toxicities in the GI and hepatic systems requires close collaboration between the patient, the treating oncologist, and other specialists.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"36 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88460834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-10DOI: 10.5124/jkma.2023.66.2.92
J. Hong
Background: Despite the increased incidence of cancer, more effective cancer drugs are being developed and cancer patient survival expectancy has been prolonged. Here, we discuss the contribution of primary healthcare clinics to managing the side effects of cytotoxic chemotherapy and provide a compilation of what is currently being used in this field.Current Concepts: Loperamide is recommended for active use when diarrhea occurs. In severe cases, octreotide can help control diarrhea by reducing small bowel fluid secretion. Mouthwash mixed with salt and sodium bicarbonate is helpful for controlling mucositis, and transdermal fentanyl patches can be used for severe pain. Limited evidence suggests that pilocarpine may be helpful for xerostomia. Neurokinin-1 receptor antagonists, serotonin receptor antagonists, glucocorticoids, metoclopramide, and olanzapine are used for nausea and vomiting. Opioid-related constipation can be relieved without counteracting the analgesic effect of opioids via peripherally acting μ-opioid receptor antagonists. Granulocyte colony-stimulating factor is recommended to treat neutropenic fever. In cases with neutropenia but no fever, the decision to use it should be based on the patient’s condition. Minoxidil can be used for hair loss, and scalp cooling can also be considered, but its practical applications are limited. Topical steroid ointments are used to treat hand-foot syndrome. Selective serotonin re uptake inhibitors are recommended for depression in cancer patients because they have little interaction with other drugs and are well tolerated.Discussion and Conclusion: Due to an increased cancer patient management burden and limited medical resources, primary healthcare practitioners should know these management strategies for cancer patients receiving cytotoxic chemotherapy.
{"title":"Managing the adverse effects of cytotoxic chemotherapy at the level of primary healthcare","authors":"J. Hong","doi":"10.5124/jkma.2023.66.2.92","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.2.92","url":null,"abstract":"Background: Despite the increased incidence of cancer, more effective cancer drugs are being developed and cancer patient survival expectancy has been prolonged. Here, we discuss the contribution of primary healthcare clinics to managing the side effects of cytotoxic chemotherapy and provide a compilation of what is currently being used in this field.Current Concepts: Loperamide is recommended for active use when diarrhea occurs. In severe cases, octreotide can help control diarrhea by reducing small bowel fluid secretion. Mouthwash mixed with salt and sodium bicarbonate is helpful for controlling mucositis, and transdermal fentanyl patches can be used for severe pain. Limited evidence suggests that pilocarpine may be helpful for xerostomia. Neurokinin-1 receptor antagonists, serotonin receptor antagonists, glucocorticoids, metoclopramide, and olanzapine are used for nausea and vomiting. Opioid-related constipation can be relieved without counteracting the analgesic effect of opioids via peripherally acting μ-opioid receptor antagonists. Granulocyte colony-stimulating factor is recommended to treat neutropenic fever. In cases with neutropenia but no fever, the decision to use it should be based on the patient’s condition. Minoxidil can be used for hair loss, and scalp cooling can also be considered, but its practical applications are limited. Topical steroid ointments are used to treat hand-foot syndrome. Selective serotonin re uptake inhibitors are recommended for depression in cancer patients because they have little interaction with other drugs and are well tolerated.Discussion and Conclusion: Due to an increased cancer patient management burden and limited medical resources, primary healthcare practitioners should know these management strategies for cancer patients receiving cytotoxic chemotherapy.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88703147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-10DOI: 10.5124/jkma.2023.66.2.105
Hyewon Ryu
Background: Advances in genomics and molecular biology over the past 20 years have resulted in numerous approved molecular targeted cancer therapies. The two main approaches for targeted cancer therapy are monoclonal antibodies and small molecules. Targeted therapy is expected to exert few side effects, but a new class of toxicities has been reported. Thus, the classical chemotherapy-induced toxicities of alopecia, myelosuppression, mucositis, nausea, and vomiting have been replaced in patients receiving targeted therapies by dermatologic, cardiovascular, gastrointestinal, endocrine, ocular, and pulmonary toxicities, and infusion reactions.Current Concepts: Targeted therapy toxicities vary, but common side effects include skin rash, diarrhea, and stomatitis. Most of these side effects are mild and can be prevented and treated. Rare and dangerous side effects, including pneumonitis, cardiotoxicities, and infusion reactions, can also be induced by targeted therapies. In most cases, toxicities are low grade (grade ≤2) and can be treated effectively, but in some cases, they can be fatal without appropriate intervention. Symptoms can be nonspecific, rendering identification of early symptoms challenging. Physicians should thus be aware of these side effects and manage toxicities appropriately.Discussion and Conclusion: The side effects of targeted therapy exert a critical impact on survival and quality of life. Most patients receiving targeted therapy need help to prevent and relieve toxicities. Management of the toxicities of targeted therapy involves patient monitoring, adjusting therapeutic dose or frequency, and providing supportive care. Serious side effects require early detection and prompt intervention, including discontinuation of targeted therapy and the use of corticosteroids.
{"title":"Management of the adverse effects of targeted therapy for cancer","authors":"Hyewon Ryu","doi":"10.5124/jkma.2023.66.2.105","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.2.105","url":null,"abstract":"Background: Advances in genomics and molecular biology over the past 20 years have resulted in numerous approved molecular targeted cancer therapies. The two main approaches for targeted cancer therapy are monoclonal antibodies and small molecules. Targeted therapy is expected to exert few side effects, but a new class of toxicities has been reported. Thus, the classical chemotherapy-induced toxicities of alopecia, myelosuppression, mucositis, nausea, and vomiting have been replaced in patients receiving targeted therapies by dermatologic, cardiovascular, gastrointestinal, endocrine, ocular, and pulmonary toxicities, and infusion reactions.Current Concepts: Targeted therapy toxicities vary, but common side effects include skin rash, diarrhea, and stomatitis. Most of these side effects are mild and can be prevented and treated. Rare and dangerous side effects, including pneumonitis, cardiotoxicities, and infusion reactions, can also be induced by targeted therapies. In most cases, toxicities are low grade (grade ≤2) and can be treated effectively, but in some cases, they can be fatal without appropriate intervention. Symptoms can be nonspecific, rendering identification of early symptoms challenging. Physicians should thus be aware of these side effects and manage toxicities appropriately.Discussion and Conclusion: The side effects of targeted therapy exert a critical impact on survival and quality of life. Most patients receiving targeted therapy need help to prevent and relieve toxicities. Management of the toxicities of targeted therapy involves patient monitoring, adjusting therapeutic dose or frequency, and providing supportive care. Serious side effects require early detection and prompt intervention, including discontinuation of targeted therapy and the use of corticosteroids.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"51 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73179466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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