Comment gérer les complications suivantes des traitement des traitements des cancer du rein avancé:
c) syndrome pied-main
Fatigue occurs in 20% to 50% of patients receiving any targeted therapy and should be managed by dose interruption or reduction. Hypertension,which most often occurs with sunitinib, sorafenib, pazopanib and bevacizumab, should be treated early with any class of antihypertensive agent. Diarrhea is best managed with bulking agents, Lomotil or Imodium. For hand-foot syndrome, which occurs in 20% to 30% ofpatients receiving sunitinib, moisturizing agents may help but if severe enough dose interruption or reduction is warranted. Mucositis can bealleviated by dietary modifications (bland foods), lidocaine/Xylocaine solution or nystatin solution. Proteinuria has been reported with bevacizumab and is best managed by holding the dose until proteinuria reduces.Dyspnea should be managed closely. First evaluate non-drug related causes and obtain an echocardiogram to establish a baseline left ventricular ejection fraction value. If dyspnea is experienced while on an mTOR inhibitor, pneumonitis may be a potential cause and steroid therapy could be considered. Neutropenia and thrombocytopenia, commonly seen with sunitinib or bevacizumab plus IFN-?, should be managed by dose interruption. Hyperglycemia, hypertriglyceridemia and hyperlipidemia,common toxicities of mTOR inhibitors, can be managed by dietary modifications and standard medical therapy. Hypothyroidism occurs in 21% to 84% of patients, and should be treated with replacement therapy.