During World War I (WWI),
soldiers exposed to "mustard gas" were found to have toxic changes,
especially in the skin and in the bone marrow cells.
Exposed troops described the odour of this agent as a stench like mustard or garlic,
hence its common name.
At the same time,
the US Army was studying several chemicals similar to mustard gas in order to develop more powerful weapons.
In the course of that work,
a nitrogenous derivative of mustard gas was first synthesized in the 1930s and later,
was found to work against lymphoma.
The discovery was confirmed during the WWII,
in 1942,
at Yale University,
when pharmacologists Goodman and Gilman tested the cytotoxic properties of extracts of mustard gas (chlormetine,
mustine) in patients with non-Hodgkin's lymphoma and lymphosarcoma.
Thus,
nitrogen mustard was used as model for the development of similar but more effective agents: the alkylating agents.
Over the years,
these drugs have successfully treated many people with cancer.
Classic agents that inhibit cell division include cyclophosphamide,
platins or taxanes.
In contrast,
biologic (targeted) agents work by targeting signalling within the cancer cell.
The first targeted agent was Imatinib,
an extremely effective drug for chronic myeloid leukaemia (CML),
which was approved in 2001.
Other examples of targeted therapy are Bevacizumab (a monoclonal antibody that binds to VEGF),
erlotinib and sunitinib (multi-targeted tyrosine kinase inhibitors).
Nowadays,
oncologic patients are treated with a combination of chemotherapy,
radiation therapy and surgery and,
when necessary,
with targeted agents.
All of these treatments have greatly improved the survival of patients with cancer but can also induce different toxicities.
It is imperative that radiologists be aware of these toxicities and learn to recognize the relevant findings in order to provide a differential diagnosis and thus play an important role in patient care (Table 1).
Table 1.
Toxicity induced by chemotherapeutic and targeted agents
TOXICITY INDUCED BY CHEMOTHERAPEUTIC AGENTS AND TARGETED THERAPIES
|
VASCULAR TOXICITY
|
Arterial thrombotic events
Venous thromboembolism
Pericardial effusion
|
Cisplatin,
gemcitabine,
bevacizumab
Thalidomide,
lenalidomide,
IL2,
platins
ATRA,
imatinib
|
LIVER TOXICITY
|
Fat liver
Veno-occlusive disease
Pseudocirrhosis
|
Irinotecan,
oxaliplatin
Bone marrow transplant,
oxaliplatin,
cyclophosphamide
Any chemotherapeutic agent
|
PANCREATIC TOXICITY
|
Pancreatitis
|
L-asparaginase,
sorafenib,
pazopanib
|
GASTROINTESTINAL TOXICITY
|
Enteritis
Neutropenic colitis
Pneumatosis or perforation
|
5FU,
irinotecan,
cetuximab,
anti-VEGFR and EGFR
5FU,
paclitaxel,
docetaxel
Bevacizumab
|
GENITOURINARY TOXICITY
|
Haemorrhagic cystitis
|
Cyclophosphamide,
iphosphamide
|
The purpose of this presentation is to discuss and illustrate the imaging appearance of abdominal complications resulting from classic chemotherapeutic and targeted agents,
in an organ system based approach.