JOURNAL OF THE CZECH PHARMACEUTICAL SOCIETY AND THE SLOVAK PHARMACEUTICAL SOCIETY

Čes. slov. farm. 2025, 74(1):8-13 | DOI: 10.36290/csf.2025.003

Management of gastrointestinal adverse effects of cancer treatment part 2: Nausea, vomiting, immune-related gastrointestinal adverse effects

doc. PharmDr. Jan Juřica, Ph.D.1,2,3, PharmDr. Miroslav Turjap, Ph.D.4
1 Farmakologický ústav, Lékařská fakulta, Masarykova univerzita, Brno
2 Ústav farmakologie a toxikologie, Farmaceutická fakulta, Masarykova univerzita Brno
3 Ústavní lékárna, Masarykův onkologický ústav, Brno
4 Oddělení klinické farmacie, Lékárna FN Ostrava

Gastrointestinal adverse effects are common in patients with cancer and can be exacerbated by the disease itself. These adverse effects lead to decreased quality of life and may result in discontinuation of therapy and worsening of treatment outcomes. In extreme cases, adverse effects may even result in patient death. Oncology therapy has undergone significant changes in recent decades, introducing a range of new treatments. Unfortunately, these advancements have also brought about a previously unseen spectrum of adverse effects. The first separate part of this article was devoted to diarrhoea, constipation, mucositis and anorexia. This second part discusses nausea, vomiting, and immune-related gastrointestinal adverse events of anticancer chemotherapy and immunotherapy and discusses the appropriate management of these complications.

Keywords: gastrointestinal adverse effects, chemotherapy, immunotherapy, nausea, vomiting, immune-related adverse events

Accepted: March 3, 2025; Published: March 20, 2025  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Juřica J, Turjap M. Management of gastrointestinal adverse effects of cancer treatment part 2: Nausea, vomiting, immune-related gastrointestinal adverse effects. Čes. slov. farm. 2025;74(1):8-13. doi: 10.36290/csf.2025.003.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • PDF will be unlocked 20.3.2026

    References

    1. Bacon CG, Giovannucci E, Testa M, Glass TA, Kawachi I. The association of treatment-related symptoms with quality-of-life outcomes for localized prostate carcinoma patients. Cancer. Feb 01 2002;94(3):862-71. doi:10.1002/cncr.10248. Go to original source... Go to PubMed...
    2. Kiss I. Modrá kniha České onkologické společnosti. vol 30. Masarykův onkologický ústav; 2024.
    3. du Bois A, Meerpohl HG, Vach W, Kommoss FG, Fenzl E, Pfleiderer A. Course, patterns, and risk-factors for chemotherapy-induced emesis in cisplatin-pretreated patients: a study with ondansetron. Eur J Cancer. 1992;28(2-3):450-7. doi:10.1016/s0959-8049(05)80075-9. Go to original source... Go to PubMed...
    4. NCCN. NCCN Guidelines Antiemesis. 1220232024. p. 81.
    5. Kennedy SKF, Goodall S, Lee SF, et al. 2020 ASCO, 2023 NCCN, 2023 MASCC/ESMO, and 2019 CCO: a comparison of antiemetic guidelines for the treatment of chemotherapy-induced nausea and vomiting in cancer patients. Support Care Cancer. Apr 10 2024;32(5):280. doi:10.1007/s00520-024-08462-x. Go to original source... Go to PubMed...
    6. NCCN. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Colon Cancer. 2022. p. 1-198.
    7. Saito R, Takano Y, Kamiya HO. Roles of substance P and NK(1) receptor in the brainstem in the development of emesis. J Pharmacol Sci. Feb 2003;91(2):87-94. doi:10.1254/jphs.91.87. Go to original source... Go to PubMed...
    8. Gupta K, Walton R, Kataria S. Chemotherapy-induced nausea and vomiting: pathogenesis, recommendations, and new trends. Cancer treatment and research communications. 2021;26:100278. Go to original source... Go to PubMed...
    9. Herrstedt J, Clark-Snow R, Ruhlmann CH, et al. 2023 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting. ESMO Open. Feb 2024;9(2):102195. doi:10.1016/j.esmoop.2023.102195. Go to original source... Go to PubMed...
    10. Hesketh PJ. Chemotherapy-induced nausea and vomiting. N Engl J Med. Jun 5 2008;358(23):2482-94. doi:10.1056/NEJMra0706547 358/23/2482 [pii] Go to original source... Go to PubMed...
    11. Scotté F, Schwartzberg L, Iihara H, et al. 2023 updated MASCC/ESMO Consensus recommendations: Prevention of nausea and vomiting following moderately emetic risk antineoplastic agents. Support Care Cancer. Dec 20 2023;32(1):45. doi:10.1007/s00520-023-08222-3. Go to original source... Go to PubMed...
    12. (NCCN) NCCN. NCCN Guidelines Antiemesis. 1220232024. p. 366.
    13. Brygger L, Herrstedt J, (AgeCare) AoGCR. 5-Hydroxytryptamine3 receptor antagonists and cardiac side effects. Expert Opin Drug Saf. Oct 2014;13(10):1407-22. doi:10.1517/14740338.2014.954546. Go to original source... Go to PubMed...
    14. Chow R, Tsao M, Chiu L, et al. Efficacy of the combination neurokinin-1 receptor antagonist, palonosetron, and dexamethasone compared to others for the prophylaxis of chemotherapy-induced nausea and vomiting: a systematic review and meta-analysis of randomized controlled trials. Ann Palliat Med. Apr 2018;7(2):221-233. doi:10.21037/apm.2018.03.09 Go to original source... Go to PubMed...
    15. Popovic M, Warr DG, Deangelis C, et al. Efficacy and safety of palonosetron for the prophylaxis of chemotherapy-induced nausea and vomiting (CINV): a systematic review and meta-analysis of randomized controlled trials. Support Care Cancer. Jun 2014;22(6):1685-97. doi:10.1007/s00520-014-2175-6. Go to original source... Go to PubMed...
    16. Postow MA, Chesney J, Pavlick AC, et al. Nivolumab and ipilimumab versus ipilimumab in untreated melanoma. N Engl J Med. May 21 2015;372(21):2006-17. doi:10.1056/NEJMoa1414428. Go to original source... Go to PubMed...
    17. Shulgin B, Kosinsky Y, Omelchenko A, et al. Dose dependence of treatment-related adverse events for immune checkpoint inhibitor therapies: a model-based meta-analysis. Oncoimmunology. May 21 2020;9(1):1748982. doi:10.1080/2162402X.2020.1748982 Go to original source... Go to PubMed...
    18. Jeay M, Carbonnel F, Robert C, Mussini C, Bellanger C, Meyer A. Chronic gastrointestinal immune-related adverse events in patients exposed to immune checkpoint inhibitors. Clin Res Hepatol Gastroenterol. Apr 2024;48(4):102311. doi:10.1016/j.clinre.2024.102311. Go to original source... Go to PubMed...
    19. Pernot S, Ramtohul T, Taieb J. Checkpoint inhibitors and gastrointestinal immune-related adverse events. Curr Opin Oncol. Jul 2016;28(4):264-8. doi:10.1097/CCO.0000000000000292 Go to original source... Go to PubMed...
    20. Naidoo J, Page DB, Li BT, et al. Toxicities of the anti-PD-1 and anti-PD-L1 immune checkpoint antibodies. Ann Oncol. Jul 2016;27(7):1362. doi:10.1093/annonc/mdw141. Go to original source... Go to PubMed...
    21. Gupta A, De Felice KM, Loftus EV, Khanna S. Systematic review: colitis associated with anti-CTLA-4 therapy. Aliment Pharmacol Ther. Aug 2015;42(4):406-17. doi:10.1111/apt.13281 Go to original source... Go to PubMed...
    22. Beck KE, Blansfield JA, Tran KQ, et al. Enterocolitis in patients with cancer after antibody blockade of cytotoxic T-lymphocyte-associated antigen 4. J Clin Oncol. May 20 2006;24(15):2283-9. doi:10.1200/JCO.2005.04.5716. Go to original source... Go to PubMed...
    23. Attia P, Phan GQ, Maker AV, et al. Autoimmunity correlates with tumor regression in patients with metastatic melanoma treated with anti-cytotoxic T-lymphocyte antigen-4. J Clin Oncol. Sep 01 2005;23(25):6043-53. doi:10.1200/JCO.2005.06.205. Go to original source... Go to PubMed...
    24. Tran T, Tran NGT, Ho V. Checkpoint Inhibitors and the Gut. J Clin Med. Feb 04 2022;11(3)doi:10.3390/jcm11030824. Go to original source... Go to PubMed...
    25. Thompson JA, Schneider BJ, Brahmer J, et al. Management of Immunotherapy-Related Toxicities, Version 1.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw2024. p. 1-155.
    26. Schneider BJ, Naidoo J, Santomasso BD, et al. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update. J Clin Oncol. Dec 20 2021;39(36):4073-4126. doi:10.1200/JCO.21.01440. Go to original source... Go to PubMed...
    27. Haanen J, Obeid M, Spain L, et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. Dec 2022;33(12):1217-1238. doi:10.1016/j.annonc.2022.10.001. Go to original source... Go to PubMed...
    28. De Velasco G, Je Y, Bossé D, et al. Comprehensive Meta-analysis of Key Immune-Related Adverse Events from CTLA-4 and PD-1/PD-L1 Inhibitors in Cancer Patients. Cancer Immunol Res. Apr 2017;5(4):312-318. doi:10.1158/2326-6066.CIR-16-0237. Go to original source... Go to PubMed...
    29. Larkin J, Hodi FS, Wolchok JD. Combined Nivolumab and Ipilimumab or Monotherapy in Untreated Melanoma. N Engl J Med. Sep 24 2015;373(13):1270-1. doi:10.1056/NEJMc1509660 Go to original source...
    30. Larkin J, Del Vecchio M, Mandalá M, et al. Adjuvant Nivolumab versus Ipilimumab in Resected Stage III/IV Melanoma: 5-Year Efficacy and Biomarker Results from CheckMate 238. Clin Cancer Res. Sep 01 2023;29(17):3352-3361. doi:10.1158/1078-0432.CCR-22-3145. Go to original source... Go to PubMed...
    31. O'Reilly M, Mellotte G, Ryan B, O'Connor A. Gastrointestinal side effects of cancer treatments. Ther Adv Chronic Dis. 2020;11:2040622320970354. doi:10.1177/2040622320970354 Go to original source... Go to PubMed...
    32. Heinzerling L, Goldinger SM. A review of serious adverse effects under treatment with checkpoint inhibitors. Curr Opin Oncol. Mar 2017;29(2):136-144. doi:10.1097/CCO.0000000000000358. Go to original source... Go to PubMed...
    33. Shivaji UN, Jeffery L, Gui X, et al. Immune checkpoint inhibitor-associated gastrointestinal and hepatic adverse events and their management. Therap Adv Gastroenterol. 2019;12:1756284819884196. doi:10.1177/1756284819884196. Go to original source... Go to PubMed...
    34. Bergqvist V, Hertervig E, Gedeon P, et al. Vedolizumab treatment for immune checkpoint inhibitor-induced enterocolitis. Cancer Immunol Immunother. May 2017;66(5):581-592. doi:10.1007/s00262-017-1962-6. Go to original source... Go to PubMed...
    35. Postow M, Johnson D. Toxicities associated with immune checkpoint inhibitors. In: UpToDate, editor. 2024.
    36. Grover S, Rahma OE, Hashemi N, Lim RM. Gastrointestinal and hepatic toxicities of checkpoint inhibitors: algorithms for management. American Society of Clinical Oncology Educational Book. 2018;38:13-19. Go to original source... Go to PubMed...
    37. Aguilar-Nájera O, Velasco-Zamora JA, Torre A. Overlap syndromes of autoimmune hepatitis: diagnosis and treatment. Rev Gastroenterol Mex. 2015 Apr-Jun 2015;80(2):150-9. doi:10.1016/j.rgmx.2015.04.001. Go to original source... Go to PubMed...
    38. Tan CK, Ho D, Wang LM, Kumar R. Drug-induced autoimmune hepatitis: A minireview. World Journal of Gastroenterology. 2022;28(24):2654. Go to original source... Go to PubMed...
    39. NCCN. NCCN Clinical Practice Guidelines in Oncology: Management of Immunotherapy-Related Toxicities. Version 12024 - December 7, 20232024.
    40. Bhatia S, Huber BR, Upton MP, Thompson JA. Inflammatory enteric neuropathy with severe constipation after ipilimumab treatment for melanoma: a case report. J Immunother. 2009;32(2):203-5. doi:10.1097/CJI.0b013e318193a206. Go to original source... Go to PubMed...
    41. Gaudy-Marqueste C, Monestier S, Franques J, Cantais E, Richard MA, Grob JJ. A severe case of ipilimumab-induced guillain-barré syndrome revealed by an occlusive enteric neuropathy: a differential diagnosis for ipilimumab-induced colitis. J Immunother. Jan 2013;36(1):77-8. doi:10.1097/CJI.0b013e31827807dd. Go to original source... Go to PubMed...

    Return to the content


    Czech and Slovak Pharmacy

    Madam, Sir,
    please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
    Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

    I declare:

    1. that I have met the above instruction
    2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited

    No
    Yes

    If your statement is not true, please be aware
    that brings the risk of danger to their health or the health of others.