What are the symptoms of chemotherapy for metastatic gastric adenocarcinoma?

Symptoms of Chemotherapy for Metastatic Gastric Adenocarcinoma

Chemotherapy for metastatic gastric adenocarcinoma commonly causes significant side effects including fatigue, nausea, vomiting, diarrhea, and neutropenia, which can impact quality of life but must be balanced against the survival benefit of treatment. 1

Common Symptoms by Frequency and Severity

Gastrointestinal Symptoms

• Nausea and vomiting:

  • Occurs in up to 20% of patients at grade 3 or higher severity 1
  • May be associated with luminal obstruction requiring endoscopic evaluation 1
  • Requires management according to antiemesis guidelines

• Diarrhea:

  • One of the most frequent severe adverse events (26.6% at grade 3 or higher) 1
  • More common with certain regimens (particularly those containing fluoropyrimidines)

• Stomatitis and mucosal inflammation:

  • Common in HER2-positive patients receiving trastuzumab with chemotherapy 1
  • Can affect food intake and nutrition

• Changes in taste (dysgeusia):

  • Particularly common with platinum-based regimens 1
  • Can persist throughout treatment cycles 2

Hematologic Toxicities

• Neutropenia:

  • Particularly severe with trastuzumab plus chemotherapy 3
  • Can lead to febrile neutropenia and infectious complications
  • May require dose modifications or growth factor support

• Anemia:

  • Common adverse event that may require transfusion support 1
  • Contributes to fatigue and reduced quality of life

• Thrombocytopenia:

  • More common with certain regimens, particularly platinum-based combinations 1

Constitutional Symptoms

• Fatigue:

  • One of the most common symptoms (15.5% at grade 3 or higher) 1
  • Tends to be cumulative over treatment cycles 2
  • Can significantly impact quality of life and daily functioning

• Fever:

  • Common with many chemotherapy regimens 1
  • May indicate infection in neutropenic patients

Regimen-Specific Symptoms

HER2-Targeted Therapy (Trastuzumab) Related

• Cardiac dysfunction:

  • Requires monitoring of ejection fraction 3
  • Can lead to congestive heart failure in 0.5% of patients 3

• Pulmonary toxicity:

  • Includes dyspnea, interstitial pneumonitis, pleural effusions 3
  • More severe in patients with pre-existing lung disease 3

• Infusion reactions:

  • Can range from mild to severe 3
  • Usually occur during or shortly after administration

Platinum-Based Regimens

• Neuropathy:
  • Particularly with oxaliplatin (17.6% grade 3-4 with modified FOLFOX) 1
  • Presents as numbness/tingling in hands/feet 2
  • May persist after treatment completion

Symptom Management Approach

1. Pre-emptive management:

   • Antiemetics before and during chemotherapy
   • Early intervention for diarrhea
   • Nutritional support for patients with significant GI symptoms

2. Monitoring during treatment:

   • Regular assessment of symptom occurrence, severity, and distress 2
   • CBC monitoring for hematologic toxicities
   • Cardiac monitoring with trastuzumab

3. Supportive care:

   • Pain control with appropriate medications 1
   • Management of obstruction symptoms if present 1
   • Nutritional counseling for patients with significant GI symptoms 1

Important Considerations

• Symptoms vary based on specific chemotherapy regimen, with oxaliplatin generally preferred over cisplatin due to lower toxicity 1
• Symptom patterns change over the course of treatment, with some improving and others worsening 2
• The addition of targeted therapies like trastuzumab adds specific side effects but improves survival in HER2-positive disease 1
• Advanced age and poor performance status increase risk of severe symptoms and may require dose modifications

Understanding these symptoms is essential for appropriate management and maintaining quality of life during treatment for metastatic gastric adenocarcinoma.