2025
NOVEMBER
NEW RENAISSANCE
INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE
VOLUME 2
|
ISSUE 11
117
TOXICITY OF COMBINATION CHEMOTHERAPY REGIMENS AND WAYS TO
REDUCE THEM
¹Suyunova Vazira Utkir qizi
²Nasullayeva Munira Murodullo qizi
³Zaynidinova Baxtiniso Sunnatillo qizi
¹²³Department of General Oncology, Samarkand State Medical University.
https://doi.org/10.5281/zenodo.17588973
Introduction
:
Combination chemotherapy has become the cornerstone of modern cancer treatment,
providing improved survival rates and disease control. However, the use of multiple cytotoxic
agents simultaneously increases the risk of toxicity, which can limit the treatment’s effectiveness
and negatively impact patients’ quality of life. Chemotherapy-induced toxicities may involve
hematological, gastrointestinal, renal, cardiac, and neurological systems, often requiring dose
adjustments or treatment delays. Understanding the mechanisms, risk factors, and management
strategies for these adverse effects is essential to optimize outcomes and maintain therapeutic
efficacy. Combination chemotherapy represents a major therapeutic approach in the management
of various malignancies, offering synergistic antitumor activity and reducing the likelihood of
drug resistance. Despite its clinical advantages, this treatment strategy is often accompanied by a
broad spectrum of toxic reactions that can significantly affect patient outcomes. These toxicities
may result from overlapping pharmacodynamic effects, cumulative organ burden, or altered
metabolic pathways caused by multiple cytotoxic agents. As treatment regimens become more
aggressive, understanding their impact on vital organs and physiological systems has become
increasingly important. Chemotherapy-related toxic effects not only compromise the patient’s
general condition but may also interfere with subsequent treatment cycles, leading to reduced
overall efficacy. Therefore, continuous evaluation of safety profiles and development of
supportive strategies are key to achieving an optimal balance between therapeutic benefit and
tolerability. The integration of preventive measures, early toxicity recognition, and timely
correction of metabolic disturbances can substantially reduce the risks associated with
chemotherapy, ultimately enhancing patient survival and life quality.
Objective
:
The aim of this study was to assess the most common toxicities observed during
combination chemotherapy regimens and to identify effective preventive and therapeutic measures
to minimize these adverse reactions while maintaining optimal antitumor activity.
Materials and Methods:
The study included 60 patients with solid malignant tumors who received combination
chemotherapy regimens, including cisplatin, doxorubicin, cyclophosphamide, and fluorouracil, at
the Department of General Oncology, Samarkand State Medical University. Clinical monitoring,
complete blood count, biochemical tests, and assessment of liver and renal function were
performed before and after each chemotherapy cycle. Toxicities were graded according to the
Common Terminology Criteria for Adverse Events (CTCAE v5.0). Supportive care methods, such
2025
NOVEMBER
NEW RENAISSANCE
INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE
VOLUME 2
|
ISSUE 11
118
as antiemetic prophylaxis, hydration, hepatoprotective agents, and dose modifications, were
applied and analyzed for effectiveness.
Results
:
The study revealed that the most frequent toxicities were nausea and vomiting (73%),
myelosuppression (65%), mucositis (40%), and hepatotoxicity (32%). Severe (grade III–IV)
adverse events were observed in 18% of patients, most commonly associated with cisplatin- and
anthracycline-based regimens. Implementation of preventive measures such as adequate hydration,
use of ondansetron and dexamethasone, administration of granulocyte colony-stimulating factor
(G-CSF), and hepatoprotective therapy significantly reduced the severity and duration of toxicities.
Patients receiving personalized supportive care demonstrated better treatment tolerance and
required fewer chemotherapy dose reductions. During the observation period, a wide range of
adverse effects were documented among patients receiving combination chemotherapy. The
hematological system was the most frequently affected, with varying degrees of neutropenia,
thrombocytopenia, and anemia noted in over half of the participants.
Gastrointestinal disturbances such as nausea, vomiting, and mucosal inflammation
occurred in a majority of cases, often within the first few days following drug administration.
Liver function abnormalities, reflected by elevated transaminase levels, were observed
primarily in regimens containing anthracyclines and platinum compounds. Nephrotoxicity was
recorded in a smaller proportion of patients, mainly those exposed to cisplatin-based combinations.
Preventive interventions including hydration therapy, hepatoprotective supplementation, and
growth factor support demonstrated marked benefits in reducing the duration and severity of
complications. Patients who received proactive care exhibited faster hematologic recovery, fewer
treatment delays, and better overall tolerance compared to those who received standard monitoring
alone.
Discussion
: The results of this study highlight the intricate balance between therapeutic
intensity and treatment-related toxicity in combination chemotherapy. The observed patterns
indicate that adverse reactions are not merely drug-specific but are also influenced by patient-
related factors such as age, nutritional status, comorbid conditions, and genetic variations in drug
metabolism. Regular assessment of biochemical and hematologic indicators is essential for early
detection of complications, allowing for timely intervention before irreversible damage occurs.
Recent advances in supportive oncology have provided several options to mitigate
chemotherapy-induced side effects, including the introduction of novel antiemetic agents,
cytoprotective drugs, and hematopoietic stimulants. Furthermore, adjusting dosage based on
individual pharmacokinetic responses and organ reserve capacity can prevent unnecessary toxicity
without compromising antineoplastic efficacy. Collaborative efforts between oncologists,
pharmacologists, and supportive care specialists are fundamental to designing regimens that are
both effective and tolerable. Continued research into predictive biomarkers and pharmacogenomic
profiling will pave the way for more personalized chemotherapy protocols in the future.
Conclusion
:
Combination chemotherapy remains an effective method in oncologic practice but is
frequently accompanied by multi-organ toxicities. Early detection, appropriate monitoring, and
individualized supportive therapy play a crucial role in minimizing complications and improving
2025
NOVEMBER
NEW RENAISSANCE
INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE
VOLUME 2
|
ISSUE 11
119
patients’ adherence to treatment. Regular assessment of organ function, timely correction of
hematologic parameters, and the use of modern antiemetic and cytoprotective agents can
significantly reduce chemotherapy-induced toxicity without compromising its therapeutic
potential. The findings demonstrate that combination chemotherapy, though highly beneficial in
cancer management, is frequently limited by its potential to induce multi-system toxicities. Early
recognition and comprehensive supportive interventions are crucial for minimizing treatment-
related complications. Individualized monitoring, adequate hydration, antioxidant therapy, and
timely correction of hematologic abnormalities can significantly improve the patient’s ability to
complete therapy as planned. Integration of preventive care protocols into routine oncology
practice will not only enhance treatment safety but also sustain therapeutic outcomes over the long
term. Achieving this balance requires continuous refinement of treatment strategies and
commitment to patient-centered care, ensuring that the benefits of chemotherapy outweigh its
associated risks.
References
:
1.
БЕЛКА, F. S. Р. С. Р. (2022). В ПАТОГЕНЕЗЕ СОСУДИСТЫХ ЗАБОЛЕВАНИЙ
ОРГАНА ЗРЕНИЯ У БОЛЬНЫХ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ.
2.
Жалалова, Д. З., Кадирова, А. М., & Хамракулов, С. Б. (2021). Исходы герпетических
кератоувеитов на фоне лечения препаратом «офтальмоферон» в зависимости от
иммунного статуса пациентов. междисциплинарный подход по заболеваниям
органов головы и шеи, 103.
3.
ЖД, З., and А. БС. "РЕЗУЛЬТАТЫ ОЦЕНКИ УРОВНЯ ЭНДОТЕЛИНА-1 И Д-
ДИМЕРОВ В СЛЕЗНОЙ ЖИДКОСТИ У ПАЦИЕНТОВ С АРТЕРИАЛЬНОЙ
ГИПЕРТЕНЗИЕЙ." SCIENTIFIC JOURNAL OF APPLIED AND MEDICAL
SCIENCES 3.3 (2024): 300-307.
4.
Zhalalova, D. Z. OCT angiography in the assessment of retinal and choreoretinal
microcirculation in patients with uncomplicated arterial hypertension International
Ophthalmological Congress IOC Tashkent 2021.
5.
Zhalalova, D. Z. Evaluation of markers of endothelial dysfunction in tear fluid in patients
with arterial hypertension. Journal of Biomedicine in Amaliet. Tashkent-2022, Volume
No., No. WITH.
6.
Жалалова, Д. З. (2021). Эндотелин-1 ва гомоцистеин даражасини артериал
гипертензия фонида тур пардв узгаришларида эндотелиал дисфункциянинг
маркерлари сифатида текшириш. Биомедицина ва амалиет журнали, 6(5), 203-210.
7.
Jalalova, D., Axmedov, A., Kuryazov, A., & Shernazarov, F. (2022). Combined dental and
eye pathology. Science and innovation, 1(8), 91-100.
8.
Zhalalova, D. Z. (2022). Pulatov US MICROCIRCULATORY DISORDERS IN THE
VASCULAR SYSTEM OF THE BULBAR CONJUNCTIVA WITH INITIAL
MANIFESTATIONS OF INSUFFICIENT BLOOD SUPPLY TO THE BRAIN. European
journal of molecular medicine, 2(5).
9.
Жалалова, Д. З. (2021). ОКТ-ангиография при оценке сосудистого русла сетчатки и
хориоидеи. Биология ва тиббиет муаммолари, 6(130), 211-216.
2025
NOVEMBER
NEW RENAISSANCE
INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE
VOLUME 2
|
ISSUE 11
120
10.
Жалалова, Д. З. (2022). Классификационые критерии изменений сосудов сетчатки
при артериальной гипертензии. In Международная научная конференция
Университетская наука: взгляд в будущее (pp. 56-64).
11.
Долиев, М. Н., Тулакова, Г. Э., Кадырова, А. М., Юсупов, З. А., & Жалалова, Д. З.
(2016). Эффективность комбинированного лечения пациентов с центральной
серозной
хориоретинопатией.
Вестник
Башкирского
государственного
медицинского университета, (2), 64-66.
12.
Жалалова, Д. З. Оценка маркеров эндотелиальной дисфункции в слезной жидкости у
пациентов с артериальной гипертензиейЖурнал «Биомедицина ва амалиет».
Тошкент-2022, Том №, №. С.
13.
Жалалова, Д. З. (2021). ОКТ-ангиография в оценке ретинальной и хореоретинальной
микроциркуляции у пациентов с неосложненой артериальной гипертензией/I
Международный офтальмологческий конгресс IOC Uzbekistan, 2021 г. Ташкент, с, 96.
14.
Shernazarov, F., Jalalova, D., Azimov, A., & CAUSES, S. A. (2022). SYMPTOMS,
APPEARANCE, TREATMENT OF VARICOSE VEINS.
15.
Жалалова, Д. З. (2021). Эндотелин-1 ва гомоцистеин даражасини артериал
гипертензия фонида тур пардв узгаришларида эндотелиал дисфункциянинг
маркерлари сифатида текшириш. Биомедицина ва амалиет журнали, 6(5), 203-210.
16.
Shernazarov, F., Tohirova, J., & Jalalova, D. (2022). Types of hemorrhagic diseases,
changes in newboens, their early diagnosis. Science and innovation, 1(D5), 16-22.
17.
Zhalalova, D. Z. (2022). The content of endothelin and homocysteine in blood and lacrimal
fluid in patients with hypertensive retinopathy Web of Scientist: International Scientific
Research Journal. ISSUE, 2, 958-963.
18.
Shernazarov, F., & Zuhridinovna, J. D. (2022). Microcirculation disorders in the vascular
system of the bulbar conjunctiva in the initial manifestations of cerebral blood supply
deficiency. Science and innovation, 1(Special Issue 2), 515-522.
19.
Zhalalova, D. Z. (2022). Modern aspects of neuroprotektive treatment in hypertensive
retinopathy Web of Scientist: International Scientific Research JournalVolume 3. ISSUE, 2,
949-952.
20.
Жалалова, Д. З. (2009). Метод комбинированного лечения диабетической
ретинопатии. Врач-аспирант, 37(10), 864-868.
21.
Жалалова, Д. З. (2023). Результаты оценки эффективности комплексного лечения у
пациентов с 3-4 стадиями гипертонической ангиоретинопатии. Miasto Przyszłości, 41,
33-36.
22.
ЖД, З., & ИЖ, Ж. (2024). КЛАССИФИКАЦИЯ ГИПЕРТОНИЧЕСКОЙ
РЕТИНОПАТИИ НА ОСНОВЕ ДАННЫХ ОПТИЧЕСКОЙ КОГЕРЕНТНОЙ
ТОМОГРАФИИ. SCIENTIFIC JOURNAL OF APPLIED AND MEDICAL SCIENCES,
3(3), 336-342.
23.
ЗЖД, Ж. (2024). КЛИНИКО-ФУНКЦИОНАЛЬНЫЕ ПОКАЗАТЕЛИ ОРГАНА
ЗРЕНИЯ У ПАЦИЕНТОВ С ИШЕМИЧЕКИМИ ИЗМЕНЕНИЯМИ СОСУДОВ
СЕТЧАТКИ. SCIENTIFIC JOURNAL OF APPLIED AND MEDICAL SCIENCES, 3(3),
286-293.
2025
NOVEMBER
NEW RENAISSANCE
INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE
VOLUME 2
|
ISSUE 11
121
24.
ЖД,
З.
(2024).
ОЦЕНКА
КЛИНИЧЕСКИХ
И
ФУНКЦИОНАЛЬНЫХ
ПОКАЗАТЕЛЕЙ ЭНДОТЕЛИАЛЬНОЙ ДИСФУНКЦИИ В СЛЕЗНОЙ ЖИДКОСТИ
У ПАЦИЕНТОВ С АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ. SCIENTIFIC JOURNAL OF
APPLIED AND MEDICAL SCIENCES, 3(3), 330-335.
25.
Жалалова, Д. З. (2023). Актуальность проблемы изменений глазного дна при
артериальной гипертензии. Miasto Przyszłości, 41, 37-40.
