Prise en charge des toxicités des thérapies ciblées en oncologie thoracique

Targeted therapies (TC), discovered more than 10 years have improved the median survival of 8-24 months. Inhibitors, antibodies to EGFR and VEGF treatments become first, second and third for cancer in thoracic oncology toxicities have less severe than chemotherapy, but may modify the therapeutic strategy. The main objective is to present the toxicities of TC and modality of care. Dermal toxicity is the main adverse event (AE) of anti-EGFR. Study show that the initiation of treatment with hydrocortisone and doxycicline six weeks before the introduction of anti-EGFR could reduce the incidence of folliculitis. The occurrence of hypertension, thromboembolic or hemorrhagic disorders is specific to certain lands at risk. Treatments of hypertension are preferred ACE inhibitors or AA2 which unlike diuretics, calcium channel blockers or beta blockers or worsen renal failure or proteinuria and do not cause QT prolongation. Proteinuria greater than or equal to 2 g/24 h requires suspension or discontinuation of treatment. Avail and E4599 studies show that anti-VEGF are behind grade 5 bleeding in patients: squamous cell carcinoma with tumor proximal tumor vascular axis cavitated primary or tumor. Thromboembolic risk increased only in patients with a history of arterial thrombosis. The final judgment of antiVEGF is only recommended for grade IV thrombosis. Diarrhea, EI anti EGFR are well controlled by supportive care. The gastrointestinal perforation is rare in patients treated with bevacizumab (1-2%). The importance is to know the land at risk to reduce the incidence of these toxicities.