[Fat Bear Science] Skin rash, diarrhea, elevated transaminase... Ten questions about taking targeted drugs have professional answers. Write them down quickly!

In addition to traditional surgery, radiotherapy and chemotherapy, the advent of targeted drugs in recent years has brought about tremendous changes in the treatment of malignant tumors. Taking lung cancer, which has the highest morbidity and mortality rate, as an example, many patients in the middle and late stages have significantly extended and improved their survival time and quality of life after using targeted drugs.

At the same time, patients often ask doctors some questions: For example, can I take Chinese medicine while taking targeted drugs? Can I stop taking the medicine if the treatment effect is good? How to use targeted drugs correctly and in a standardized manner to maximize the benefits of patients, prolong survival time and reduce side effects is a concern for most cancer patients. Today, let's talk about taking targeted drugs.

1

What should I do if I get a rash while taking targeted drugs?

Skin rash is one of the most common side effects of taking targeted drugs. In targeted treatment of lung cancer, the appearance of skin rash may indicate a better therapeutic effect. Skin rash usually appears on the face, chest and back. If the subjective symptoms of the rash are mild (such as itching and tenderness) and have little impact on daily life, there is no need to stop taking oral targeted drugs. You can use hydrocortisone ointment, clindamycin ointment or erythromycin ointment appropriately, and take oral drugs such as loratadine. If the symptoms are severe or accompanied by infection, you need to see a dermatologist or oncologist, and the doctor will decide whether to suspend the targeted drug.

2

What should I do if I have diarrhea while taking targeted drugs?

Diarrhea is also one of the most common side effects of targeted drugs. If the frequency of diarrhea is less than 4 times, patients are advised to eat a light diet, avoid foods that aggravate diarrhea, such as spicy and greasy foods, and continue with the current targeted drug treatment. If the frequency of diarrhea is 4-6 times a day, antidiarrheal treatment is required. Commonly used drugs include Imodium and Felocell. If the diarrhea does not improve after treatment or if it occurs more than 7 times a day, you need to contact your doctor to reduce the dosage or stop the medication.

3

What should I do if my transaminase level rises while taking targeted drugs?

Many targeted drugs may cause liver damage after taking them, which is manifested as elevated transaminases. Liver damage can occur within 7 days to 6 months after targeted therapy. If the cancer patient has a history of liver disease such as viral hepatitis, alcoholic liver disease, etc., he needs to inform the doctor when seeing a doctor and choose targeted drugs that cause less damage to liver function. If there is a slight elevation of transaminase, you can continue to take oral targeted drugs while taking liver-protecting drugs under the guidance of a doctor. If it is significantly elevated, you need to see a doctor immediately, suspend the targeted drug while receiving liver-protecting treatment, and decide whether to reduce or adjust the targeted drug after liver function recovers.

4

What should I do if I develop oral mucositis or oral ulcers while taking targeted drugs?

Oral mucositis and oral ulcers may occur when taking targeted drugs, which may manifest as oral pain, dysphagia, etc. At present, the oral health status of the Chinese population is not optimistic, and the incidence of caries, periodontitis and oral mucositis is high. Before using targeted drugs, oral health education guidance should be received to reduce the occurrence of oral mucositis and oral ulcers related to targeted drugs. If oral mucositis and oral ulcers occur, you can use a mouthwash containing sodium bicarbonate and chlorhexidine after meals. If oral ulcers are accompanied by pain, you can use lidocaine solution or lidocaine gel to apply to the ulcer before eating. While taking targeted drugs, pay attention to keeping the mouth clean, avoid stimulation from tobacco and alcohol, use a soft-bristled toothbrush, etc. If severe oral mucositis and ulcers with infection occur, you need to see a doctor in time, use antibacterial drugs as appropriate, and suspend or adjust targeted drug treatment.

5

Can I take oral Chinese medicine while taking targeted drugs?

Generally speaking, Chinese medicine has two strategies for tumor treatment: "attack" and "defense". "Attack" refers to anti-tumor treatment, but there is a possibility of increased burden on liver and kidney functions, leading to side effects such as liver and kidney damage. "Defense" means that when side effects occur in targeted drug anti-tumor treatment, Chinese medicine conditioning is given to improve patient symptoms. Therefore, patients can take some Chinese medicine conditioning when taking targeted drugs, but should avoid using Chinese medicine with strong anti-tumor effects, so as not to increase the burden on the patient's liver, kidneys and other organs, leading to aggravated side effects.

6

Can I reduce the dosage or stop taking targeted drugs? What should I do if I miss a dose?

Once targeted drugs take effect, the anti-tumor effect lasts for a long time. If the dosage is reduced or stopped rashly, it may lead to tumor resistance and tumor recurrence and metastasis. In addition to the progression of the disease or the side effects that the body cannot tolerate after using targeted drugs, the dosage cannot be reduced or stopped at will. Targeted drugs are recommended to be taken at a fixed time every day, such as gefitinib 250mg once a day, starting with 1 tablet orally at 7 am today, 1 tablet orally at 7 am tomorrow, and so on. Take it at 7 am every day. If you miss a dose, you can make up for it if there are more than 12 hours before the next time, but if it is less than 12 hours, you don’t need to make up for it. If the patient has a poor memory, you can use alarm clock reminders and other means to reduce or avoid missed doses.

7

What should you pay attention to when taking targeted drugs and diet?

During the medication period, patients may experience weakened gastrointestinal function. You can choose highly nutritious and easily digestible foods such as rice porridge, soy milk, milk or crucian carp soup to reduce the burden on the gastrointestinal tract; eat more green leafy vegetables and fruits. During targeted therapy, nausea, vomiting, oral ulcers and gastrointestinal discomfort may occur. During this period, you can eat more seasonal vegetables and fruits to supplement vitamins, which can reduce the side effects of drugs; during targeted therapy, reduce the amount of spicy, irritating and pickled foods, such as spicy hot pot, dry pot, barbecue, salted fish and bacon, so as not to increase the gastrointestinal burden and aggravate gastrointestinal discomfort.

8

Can I take health supplements while taking targeted drugs?

Health care products are foods with specific health functions or for the purpose of supplementing vitamins and minerals. They are not medicines and do not have a therapeutic effect. Instead, they focus on prevention. They correct and supplement certain minor problems in the body. Cancer patients should carefully choose health care products and consider whether there are drug contraindications and conflicts between health care products and targeted drugs. You should follow the doctor's advice and evaluate the choice of health care products from a professional perspective. You should avoid indiscriminate use and abuse of health care products. You should choose regular health care products that are suitable for you under the guidance of a doctor.

9

What should we pay attention to when taking targeted drugs with other drugs at the same time?

Most targeted drugs need to be metabolized by a special protein (CYP3A4 enzyme) in the liver, but drugs such as glucocorticoids, rifampicin, isoniazid, carbamazepine, etc. can stimulate the production of CYP3A4 enzyme, causing the CYP3A4 enzyme content to be too high, and the metabolism rate of targeted drugs is too fast. Before they have time to play an anti-cancer role, they are metabolized, which greatly reduces the efficacy of targeted drugs. However, drugs such as amiodarone, clarithromycin, cimetidine, erythromycin, and voriconazole will inhibit the production of CYP3A4 enzymes, slow down the metabolism of targeted drugs, increase the concentration of targeted drugs in the blood, and increase the toxic and side effects of targeted drugs. Therefore, when taking targeted drugs, try to avoid taking the above drugs at the same time. If the above medications are really needed, it is recommended to listen to the doctor's advice and take the two drugs at least 2 hours apart. Some fruits such as grapefruit and pomegranate have some ingredients that can inhibit the activity of CYP3A4 enzymes, and will also interfere with the body's absorption and utilization of targeted drugs, affecting the efficacy of the drugs. Therefore, you cannot eat these fruits when taking targeted drugs.

10

What should I do if targeted drugs don’t work well?

After using targeted drugs for a period of time, the tumor may become less sensitive to the targeted drugs, resulting in a decrease in the effectiveness of the targeted drugs and the disease may progress. If this happens, a pathological biopsy can be performed again (if it is difficult to obtain a specimen, blood can also be used) and genetic testing can be performed. If new gene mutations appear, new targeted drugs may be selected. If there are no new mutations, other treatment methods such as chemotherapy and radiotherapy can be selected.

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Yu Huiqing

Director of the Palliative Care Department/Pain Center/Special Care Ward, Chongqing University Cancer Hospital, chief physician, and master’s supervisor.

Diagnosis and treatment of lung nodules; particularly good at oncology diagnosis and treatment techniques such as chemotherapy, targeted therapy, biological immunotherapy for common malignant tumors such as lung cancer, digestive system tumors, bone tumors, as well as cancer pain, nutrition, salvage therapy and supportive therapy for advanced cancer.

Clinic hours: Monday morning (tumor), Wednesday morning (nutrition)

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Wang Sixiong

Deputy Chief Physician of Palliative Care Department/Pain Center/Special Care Ward, Affiliated Cancer Hospital of Chongqing University.

He specializes in chemotherapy and targeted therapy for malignant tumors such as lung cancer, colorectal cancer, liver cancer, gastric cancer, esophageal cancer, sarcoma, standardized diagnosis and treatment of cancer pain, nutritional support and palliative care for patients with malignant tumors, and salvage and supportive care for advanced cancers.

Clinic hours: Friday all day

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