Does Chemotherapy-Induced Gastrointestinal Mucositis Affect the Bioavailability and Efficacy of Anti-Infective Drugs?

Antimicrobial prophylaxis is increasingly being used in patients with hematological malignancies receiving high-dose chemotherapy and hematopoietic stem cell transplantation (HSCT). However, few studies have focused on the potential impact of gastrointestinal mucositis (GI-M), a frequently observed...

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Bibliographic Details
Published in:Biomedicines 2021-10, Vol.9 (10), p.1389
Main Authors: da Silva Ferreira, Ana Rita, Märtson, Anne-Grete, de Boer, Alyse, Wardill, Hannah R., Alffenaar, Jan-Willem, Harmsen, Hermie J. M., Tissing, Wim J. E.
Format: Article
Language:English
Subjects:
antibiotics
Bioavailability
cancer
Cancer therapies
Chemotherapy
Constipation
Cytokines
Diarrhea
Digestive system
DNA damage
Drug dosages
drug pharmacokinetics
Enzymes
Gastric motility
gastrointestinal mucositis
Gastrointestinal tract
gut microbiota
Hematopoietic stem cells
Immunosuppressive agents
Inflammation
Intestinal microflora
Intestinal motility
Intestine
Microbiota
Microenvironments
Motility
Mucosa
Mucositis
Oral administration
Permeability
Prophylaxis
Review
Small intestine
Stem cell transplantation
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Summary:Antimicrobial prophylaxis is increasingly being used in patients with hematological malignancies receiving high-dose chemotherapy and hematopoietic stem cell transplantation (HSCT). However, few studies have focused on the potential impact of gastrointestinal mucositis (GI-M), a frequently observed side effect of chemotherapy in patients with cancer that affects the gastrointestinal microenvironment, on drug absorption. In this review, we discuss how chemotherapy leads to an overall loss of mucosal surface area and consequently to uncontrolled transport across the barrier. The barrier function is depending on intestinal luminal pH, intestinal motility, and diet. Another factor contributing to drug absorption is the gut microbiota, as it modulates the bioavailability of orally administrated drugs by altering the gastrointestinal properties. To better understand the complex interplay of factors in GI-M and drug absorption we suggest: (i) the longitudinal characterization of the impact of GI-M severity on drug exposure in patients, (ii) the development of tools to predict drug absorption, and (iii) strategies that allow the support of the gut microbiota. These studies will provide relevant data to better design strategies to reduce the severity and impact of GI-M in patients with cancer.
ISSN:2227-9059
2227-9059
DOI:10.3390/biomedicines9101389