Patients who will receive chemotherapy require careful assessment of liver function prior to treatment to determine which drugs are not appropriate, and which drug need dose modification. Many medications, alcohol has their more or less hepatotoxic effect, so because of their immunocompromise state, some body are prone to liver infection, including viral hepatitis. Lamivudine is effective in treating hepatitis B reactivation during chemotherapy. Now, the increased use of high-dose regimens with bone marrow or stem-cell support has been shown the drugs toxicities complication more, which does not observed in with conventional doses. Clinical judgment and a high index of suspicion remain critical tool in preventing and treating hepatic manifestations of cancer chemotherapy.

Nephrotoxicity is an inherent adverse effect of certain anticancer drugs. Mechanisms of chemotherapy-induced renal dysfunction generally include damage to vascular or structures of the kidneys, hemolytic uremic syndrome and prerenal perfusion deficits. Patients with cancer are frequently at risk of renal impairment secondary to disease-related and iatrogenic causes. This article reviews the prevention and management of anticancer drug-induced renal dysfunction. Cisplatin and carboplatin cause dose-related renal dysfunction. In addition to elevation of serum creatinine levels and uremia, electrolyte abnormalities, such as hypomagnesemia and hypokalemia, are well known adverse effects of cisplatin. Methotrexate can cause elevation of serum creatinine levels, uremia and hematuria. Acute renal failure is reported after high dose methotrexate therapy. Urinary alkalization and hydration confer protection against methotrexate-induced renal dysfunction. Dose- and age-related proximal tubular damage is an adverse effect of ifosfamide. In addition to renal wasting of electrolytes, glucose and amino acids, Fanconi syndrome and rickets after ifosfamide administration have been reported in the literature. Hemolytic uremia is a rare but serious adverse effect of gemcitabine.

Digestive complications are frequent dose-limiting side-effect of chemotherapy. Diarrhea and constipation can affect quality of life and alter optimum treatment efficacy. The incidence and the severity of these toxicities have to be systematically evaluated in order to provide specific curative and preventive treatments. This review shows the recommended guidelines for the treatment of chemotherapy-induced diarrhea and the recent therapeutic approaches. The management of gastrointestinal graft-versus-host disease and neutropenic enterocolitis is also described. Prevention and early recognition is critical to avoid sever life-threatening complications and improve quality of life.

Mucositis is a significant dose-limiting factor associated with cancer chemotherapy and radiotherapy. For exact management, an early diagnosis and precise evaluation are surely required. A basis of the prevention and care of stomatitis is maintaining cleanliness and moisture in the mouth. The medical treatment plans of oral mucositis are a measure against infection, and prevention against symptoms, and are restoration of a tissue damage, and treatment to sharp pain. However, there is no still established prevention method. As for the present condition, in the clinical practice, there are many portions depending on experiential knowledge. In this paper, it outlined including Empiric therapy about measures of oral mucositis.

Nausea and vomiting are the most distressing side effects reported by patients undergoing CDDP-based cancer chemotherapy. Dopamine receptor antagonists and corticosteroids are used as anti-emetics for chemotherapy induced nausea and vomiting. Recently, a highly selective 5-HT3 receptor antagonist are proved to demonstrate antiemetic activity. 5-HT3 receptor antagonists are developed such as Granisetron, Ondansetron, Ramosetron, Azasetron. For acute emesis, complete control of vomiting was achieved in 80% of patients receiving 5-HT3 receptor antagonists. Though, it is reported to be only 20% effective for the complete control of delayed emesis. Psychiatric medications sometimes play a prominent role in the control of persisting emesis, particularly anticipatory or conditioned nausea. Nausea and vomiting are well controlled using various anti-emetics considering patient's condition and chemotherapy schedule.

Bone marrow suppression is one of the most popular side effects of cancer chemotherapy. Bone marrow suppression includes neutropenia, anemia and thrombocytopenia. Clinical application of cytokine is useful in the treatment of bone marrow suppression due to cancer chemotherapy. Granulocyte colony-stimulating factor(G-CSF) is useful in the treatment of neutropenia. Erythropoietin(EPO) is useful is the treatment of anemia. However, EPO is not widely used in Japan yet. Clinical application of varions cytokines will bring forth much improvement in the treatment of bone marrow suppression due to cancer chemotherapy.

Combination chemotherapy for leukemia develops bone marrow suppression. Infection or hemorrhage disorders the treatment, and may influence the clinical result. The caring staff must understand the pathology of bone marrow suppression. Visitors observe the hospital rules. Foods are also limited, city water and uncooked foods are prohibited. To keep oral cavity clean, pretreatment of some decayed teeth, and frequent gargling with sterilized water are needed. Defecation control is important. Sitz bath or shower toilet is helpful. Hand cleaning is essential for before a meal, after defecation and after a going out. Bathing is fundamental to cleaning body. No bathing is dirty. Medical catheters are checked up every day. Thrombocytopenia(< 30,000/microliter) develops a spontaneous bleeding. Severe thrombocytopenia(< 10,000/microliter) does a fatal organ bleeding.

In 1998, the National Cancer Institute (NCI) made an effort to revise and expand the Common Toxicity Criteria (CTC) in cancer treatment. New CTC version 2.0 includes more than 279 individual adverse events with more than 24 of these applicable to adverse reaction category. The Radiation Therapy Oncology Group(RTOG) Acute Radiation Morbidity Scoring Criteria and BMT Complex/Multi-Component Events were added to New CTC version 2.0. CTC version 2.0 represents an improvement in the evaluation and grading of toxicity for all modalities in cancer treatment.

The chemotherapy at home is most different from the conventional chemotherapy because of the condition not to watch patients all the time. In order to avoid serious side effect it is necessary to administrate some drugs continuously or together. It is useful to use portable pump system. It is also important to educate patients about the chemotherapy at home and to establish the observation system against the trouble from the chemotherapy at home. As the chemotherapy at home is safe if we know the side effect well, this type of chemotherapy will become the one of main branch in the chemotherapy of colorectal cancer.

Clinical oncologists and physicians handling anticancer drugs need to be thoroughly aware of anticancer drug adverse reactions, and have all the necessary skills to deal with such events if they occur. This chapter discusses anticancer drug adverse reactions requiring fluid replacement. Adverse reactions that require fluid replacement are in general considered serious. Most are at least grade 3 events (serious/high toxicity) based on the NCI-CTC ver 2 classification and require immediate treatment. Here we discuss the general view of fluid replacement for dehydration caused by gastrointestinal toxicity, fluid replacement for nephrotoxicity, hemorrhagic cystitis, tumor lysis syndrome that sometimes requires substantial fluid replacement and SIADH that is a condition requiring a prudent approach to fluid therapy, including also specific methods of fluid replacement.

Chemotherapy is frequently adopted for patients with malignancy, as one of type of multidisciplinary treatment. Each chemotherapeutic drug has the potential to induce various adverse events in the patients receiving chemotherapy. Before the application of chemotherapy, sufficient knowledge for chemotherapeutic drugs and careful evaluation for patients are indispensable to avoid severe adverse events, since uncontrolled adverse events cause a markedly lower quality of life, incompletion of the treatment modality and life-threatening of patients. The onset of each adverse event is influenced by the host condition, e.g., sex, age, allergic status, complication, nutritional condition, the administration method, e.g., dose, route, course, combined agents, and combined therapy, e.g., radiotherapy. Frequent adverse events are discussed in terms of the onset.

The toxicity of cancer treatment affects adversely the QOL of patients and limits the intensity of treatment that can be administered. In this article, characteristics of these each adverse reactions are described. In the last decade, several means have been developed that offer possible prevention and reduction from the adverse effects of a range of cancer treatment. Furthermore, recently, practice guidelines are systematically developed to assist the practitioner and patients decision about appropriate management for specific clinical circumstances. However, it is important to realize that these guidelines cannot always account for individual variation among patients. 'Close clinical monitoring, early recognition of toxicities and toxicity syndromes, aggressive therapeutic interventions, and withholding therapy in the presence of severe treatment related toxicities' is always required.

Hand-foot syndrome (HFS) is a rare adverse reaction to oral fluoropyrimidine TS-1, which contains the dihydropyrimidine dehydrogenase (DPD) inhibitor. We treated a recurrent gastric cancer patient with chronic renal failure who developed grade 2 HFS, grade 2 conjunctivitis and grade 3 stomatitis soon after TS-1 administration. Those symptoms improved with the administration of vitamin B6, topical emollient therapy, and so on. We thought that the continuous elevation of serum 5-FU concentration, due to the accumulation of DPD inhibitor from the renal dysfunction, led to the development of HFS, although the participation of 5-FU metabolites such as F-beta-alanine cannot be ruled out.

Effects of toremifene (TOR) in combination with paclitaxel (TXL) on various human breast cancer cell lines were evaluated. TOR and TXL exhibited additive effects on estrogen receptor (ER)-positive cancer cell lines, MCF-7 and T-47D, and a sub-additive effect on a tamoxifen (TAM)-resistant line, T-47D/TAM. To all three ER-negative cancer cell lines, the combined treatment also showed additive effects on MDA-MB-134VI, MDA-MB-231 and MDA-MB-453. Furthermore, a synergistic effect was observed on a multi-drug resistant (MDR) line, Adr. This synergistic effect was more potent in the combination with TOR than that with TAM. The combined treatment increased intracellular TXL, and the accumulation by TOR was 1.5-fold that by TAM. Consequently, the ratio of G2M arrested cells was higher, with statistical significance, in the TOR combination than in the TAM combination. In addition, these synergistic effects in MDR cells were also observed in the combination of TXL with major clinical active metabolites, N-desmethyl-TOR (TOR-1) and 4-hydroxy-TOR (TOR-2). These results suggest that the combination therapy of TOR and TXL might be an effective clinical treatment for breast cancer patients.

To investigate feasibility and toxicity of weekly paclitaxel administration in the adjuvant therapy of primary breast cancer.

Wide inter-individual difference has been documented for various drug metabolizing enzymes(DMEs) and drug transporters. Some of the single nucleotide polymorphisms(SNPs) existing in the genes encoding DMEs and drug transporters have been associated with the deficiency of DMEs and the transporters. In the case of therapeutic drugs that undergo metabolism by a single DME, serious adverse effect might occur for patients who are devoid of the DME. Function of a number of DMEs and transporters are likely to affect drug effectiveness of three anti-cancer agents, irinotecan, taxol and 5-fluorouracil. Genetic polymorphisms of the genes related to the effectiveness of these drugs are discussed from the aspect of effects of the genetic polymorphisms on their metabolism and disposition.

Dose adjustment of drug administration for each patient has been performed based on counts of some factors such as body surface area, age of the patient, performance status, renal and/or liver function. Pharmacokinetic and pharmacodynamic analyses have been investigated by measuring the plasma concentration of a drug and observing the drug effects. However, prior to drug administration it is difficult to predict unexpected, severe drug toxicity, which depends on the individual differences among patients. Recent progress in human genome analysis has been providing tools for new approaches to disease treatment based on individual differences using genetic information. This review focuses on the drug metabolizing enzyme and its genetic polymorphisms in cancer chemotherapy. We describe the recent findings on pharmacogenomics between toxicity and the genetic polymorphisms of the thiopurine methyltransferase (TPMT) gene, dihydropyrimidine dehydrogenase (DPYD) gene, methylenetetrahydrofolate reductase (MTHFR) gene, and uridine diphosphate glucuronosyltransferase (UGT1A1 and UGT1A7) gene. We need to accumulate clinical data based on the variation of genetic profiling as well as pharmacogenetic information. Such data will help tailor cancer chemotherapy to an individual's predisposition in the near future.