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Shaikh F, Dupuis LL, Alexander S, Gupta A, Mertens L, Nathan PC. Cardioprotection and Second Malignant Neoplasms Associated With Dexrazoxane in Children Receiving Anthracycline Chemotherapy: A Systematic Review and Meta-Analysis. J Natl Cancer Inst 2015; 108:djv357. [DOI: 10.1093/jnci/djv357] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 10/22/2015] [Indexed: 01/11/2023] Open
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152
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Prevention and Management of Radiation-induced Late Gastrointestinal Toxicity. Clin Oncol (R Coll Radiol) 2015; 27:656-67. [DOI: 10.1016/j.clon.2015.06.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 05/26/2015] [Accepted: 06/09/2015] [Indexed: 12/18/2022]
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Abstract
Oral mucositis induced by conventional cytotoxic cancer therapies is a common and significant clinical problem in oncology. Mucositis symptoms, which include severe pain, may lead to dose reductions and unplanned interruptions of chemotherapy and/or radiotherapy, and often affect patients' quality of life. In addition, ulcerative mucositis represents a risk factor for local or systemic infectious complications that may be life-threatening in immunosuppressed patients. The development of biologically based targeted cancer therapies, which aim to block the growth, spread, and survival of tumors by interfering with specific molecular targets, may have reduced mucosal injury, but did not eliminate it. This article will review the epidemiology, pathobiology, and management of oral mucositis associated with conventional cytotoxic therapies for malignant diseases and will briefly summarize emerging information on oral mucosal injury associated with targeted therapies. Considerations for future research aimed at the development of more efficient and effective supportive care approaches will be presented, with emphasis on the contribution of dental researchers and clinicians in these efforts.
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Brown SA, Sandhu N, Herrmann J. Systems biology approaches to adverse drug effects: the example of cardio-oncology. Nat Rev Clin Oncol 2015; 12:718-31. [PMID: 26462128 DOI: 10.1038/nrclinonc.2015.168] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Increased awareness of the cardiovascular toxic effects of chemotherapy has led to the emergence of cardio-oncology (or onco-cardiology), which focuses on screening, monitoring and treatment of patients with cardiovascular dysfunctions resulting from chemotherapy. Anthracyclines, such as doxorubicin, and HER2 inhibitors, such as trastuzumab, both have cardiotoxic effects. The biological rationale, mechanisms of action and cardiotoxicity profiles of these two classes of drugs, however, are completely different, suggesting that cardiotoxic effects can occur in a range of different ways. Advances in genomics and proteomics have implicated several genomic variants and biological pathways that can influence the susceptibility to cardiotoxicity from these, and other drugs. Established pathways include multidrug resistance proteins, energy utilization pathways, oxidative stress, cytoskeletal regulation and apoptosis. Gene-expression profiles that have revealed perturbed pathways have vastly increased our knowledge of the complex processes involved in crosstalk between tumours and cardiac function. Utilization of mathematical and computational modelling can complement pharmacogenomics and improve individual patient outcomes. Such endeavours should enable identification of variations in cardiotoxicity, particularly in those patients who are at risk of not recovering, even with the institution of cardioprotective therapy. The application of systems biology holds substantial potential to advance our understanding of chemotherapy-induced cardiotoxicity.
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Affiliation(s)
- Sherry-Ann Brown
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Nicole Sandhu
- Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Joerg Herrmann
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Ha CS, Michalek JE, Elledge R, Kelly KR, Ganapathy S, Su H, Jenkins CA, Argiris A, Swords R, Eng TY, Karnad A, Crownover RL, Swanson GP, Goros M, Pollock BH, Yuan ZM. p53-based strategy to reduce hematological toxicity of chemotherapy: A proof of principle study. Mol Oncol 2015; 10:148-56. [PMID: 26440706 DOI: 10.1016/j.molonc.2015.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 08/29/2015] [Accepted: 09/08/2015] [Indexed: 11/30/2022] Open
Abstract
p53 activation is a primary mechanism underlying pathological responses to DNA damaging agents such as chemotherapy and radiotherapy. Our recent animal studies showed that low dose arsenic (LDA)-induced transient p53 inhibition selectively protected normal tissues from chemotherapy-induced toxicity. Study objectives were to: 1) define the lowest safe dose of arsenic trioxide that transiently blocks p53 activation in patients and 2) assess the potential of LDA to decrease hematological toxicity from chemotherapy. Patients scheduled to receive minimum 4 cycles of myelosuppressive chemotherapy were eligible. For objective 1, dose escalation of LDA started at 0.005 mg/kg/day for 3 days. This dose satisfied objective 1 and was administered before chemotherapy cycles 2, 4, and 6 for objective 2. p53 level in peripheral lymphocytes was measured on day 1 of each cycle by ELISA assay. Chemotherapy cycles 1, 3, and 5 served as the baseline for the subsequent cycles of 2, 4, and 6 respectively. If p53 level for the subsequent cycle was lower (or higher) than the baseline cycle, p53 was defined as "suppressed" (or "activated") for the pair of cycles. Repeated measures linear models of CBC in terms of day, cycle, p53 activity and interaction terms were used. Twenty-six patients treated with 3 week cycle regimens form the base of analyses. The mean white blood cell, hemoglobin and absolute neutrophil counts were significantly higher in the "suppressed" relative to the "activated" group. These data support the proof of principle that suppression of p53 could lead to protection of bone marrow in patients receiving chemotherapy. This trial is registered in ClinicalTrials.gov. Identifier: NCT01428128.
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Affiliation(s)
- Chul S Ha
- Department of Radiation Oncology, 7703 Floyd Curl Drive, University of Texas Health Science Center at San Antonio, TX 78229, United States.
| | - Joel E Michalek
- Department of Epidemiology and Biostatistics, 7703 Floyd Curl Drive, University of Texas Health Science Center at San Antonio, TX 78229, United States
| | - Richard Elledge
- Division of Hematology/Oncology, Department of Medicine, 7703 Floyd Curl Drive, University of Texas Health Science Center at San Antonio, TX 78229, United States
| | - Kevin R Kelly
- Division of Hematology/Oncology, Department of Medicine, 7703 Floyd Curl Drive, University of Texas Health Science Center at San Antonio, TX 78229, United States
| | - Suthakar Ganapathy
- Department of Radiation Oncology, 7703 Floyd Curl Drive, University of Texas Health Science Center at San Antonio, TX 78229, United States
| | - Hang Su
- Department of Radiation Oncology, 7703 Floyd Curl Drive, University of Texas Health Science Center at San Antonio, TX 78229, United States
| | - Carol A Jenkins
- Department of Radiation Oncology, 7703 Floyd Curl Drive, University of Texas Health Science Center at San Antonio, TX 78229, United States
| | - Athanassios Argiris
- Division of Hematology/Oncology, Department of Medicine, 7703 Floyd Curl Drive, University of Texas Health Science Center at San Antonio, TX 78229, United States
| | - Ronan Swords
- Division of Hematology/Oncology, Department of Medicine, 7703 Floyd Curl Drive, University of Texas Health Science Center at San Antonio, TX 78229, United States
| | - Tony Y Eng
- Department of Radiation Oncology, 7703 Floyd Curl Drive, University of Texas Health Science Center at San Antonio, TX 78229, United States
| | - Anand Karnad
- Division of Hematology/Oncology, Department of Medicine, 7703 Floyd Curl Drive, University of Texas Health Science Center at San Antonio, TX 78229, United States
| | - Richard L Crownover
- Department of Radiation Oncology, 7703 Floyd Curl Drive, University of Texas Health Science Center at San Antonio, TX 78229, United States
| | - Gregory P Swanson
- Department of Radiation Oncology, 7703 Floyd Curl Drive, University of Texas Health Science Center at San Antonio, TX 78229, United States
| | - Martin Goros
- Department of Epidemiology and Biostatistics, 7703 Floyd Curl Drive, University of Texas Health Science Center at San Antonio, TX 78229, United States
| | - Brad H Pollock
- Department of Epidemiology and Biostatistics, 7703 Floyd Curl Drive, University of Texas Health Science Center at San Antonio, TX 78229, United States
| | - Zhi-Min Yuan
- Department of Radiation Oncology, 7703 Floyd Curl Drive, University of Texas Health Science Center at San Antonio, TX 78229, United States
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Allison RR. Radiobiological modifiers in clinical radiation oncology: current reality and future potential. Future Oncol 2015; 10:2359-79. [PMID: 25525845 DOI: 10.2217/fon.14.174] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Radiation therapy can successfully ablate tumors. However, the same ionization process that destroys a cancer can also permanently damage surrounding organs resulting in unwanted clinical morbidity. Therefore, modern radiation therapy attempts to minimize dose to normal tissue to prevent side effects. Still, as tumors and normal tissues intercalate, the risk of normal tissue injury often may prevent tumoricidal doses of radiation therapy to be delivered. This paper will review current outcomes and limitations of radiobiological modifiers that may selectively enhance the radiosensitivity of tumors as well as parallel techniques that may protect normal tissues from radiation injury. Future endeavors based in part upon newly elucidated genetic pathways will be highlighted.
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Chow EJ, Asselin BL, Schwartz CL, Doody DR, Leisenring WM, Aggarwal S, Baker KS, Bhatia S, Constine LS, Freyer DR, Lipshultz SE, Armenian SH. Late Mortality After Dexrazoxane Treatment: A Report From the Children's Oncology Group. J Clin Oncol 2015; 33:2639-45. [PMID: 26014292 PMCID: PMC4534526 DOI: 10.1200/jco.2014.59.4473] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Given concerns that dexrazoxane may reduce treatment efficacy, induce second cancers, and thus compromise overall survival among children, we examined long-term overall and cause-specific mortality and disease relapse rates from three randomized clinical trials. PATIENTS AND METHODS Children's Oncology Group trials P9404 (T-cell acute lymphoblastic leukemia/lymphoma; n = 537), P9425 (intermediate/high-risk Hodgkin lymphoma; n = 216), and P9426 (low-risk Hodgkin lymphoma; n = 255) were conducted between 1996 and 2001. Each trial randomly assigned patients to doxorubicin with or without dexrazoxane. The dexrazoxane:doxorubicin dose ratio was 10:1, and the cumulative protocol-specified doxorubicin dose was 100 to 360 mg/m(2). Dexrazoxane was given as an intravenous bolus before each doxorubicin dose. Data from all three trials were linked with the National Death Index to determine overall and cause-specific mortality by dexrazoxane status. RESULTS Among 1,008 patients (507 received dexrazoxane) with a median follow-up of 12.6 years (range, 0 to 15.5 years), 132 died (67 received dexrazoxane). Overall mortality did not vary by dexrazoxane status (12.8% with dexrazoxane at 10 years v 12.2% without; hazard ratio [HR], 1.03; 95% CI, 0.73 to 1.45). Findings were similar when each trial was examined separately. Dexrazoxane also was not significantly associated with differential causes of death. The original cancer caused 76.5% of all deaths (HR, 0.90; 95% CI, 0.61 to 1.32) followed by second cancers (13.6% of deaths; HR, 1.24; 95% CI, 0.49 to 3.15). Specifically, dexrazoxane was not associated with deaths from acute myeloid leukemia/myelodysplasia or cardiovascular events. CONCLUSION Among pediatric patients with leukemia or lymphoma, after extended follow-up, dexrazoxane use did not seem to compromise long-term survival.
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Affiliation(s)
- Eric J Chow
- Eric J. Chow, David R. Doody, Wendy M. Leisenring, and K. Scott Baker, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington, Seattle, WA; Barbara L. Asselin and Louis S. Constine, University of Rochester Medical Center and School of Medicine, Rochester, NY; Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX; Sanjeev Aggarwal and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University, Detroit, MI; Smita Bhatia, University of Alabama, Birmingham, AL; David R. Freyer, Children's Hospital Los Angeles, University of Southern California, Los Angeles; and Saro H. Armenian, City of Hope Cancer Center, Duarte, CA.
| | - Barbara L Asselin
- Eric J. Chow, David R. Doody, Wendy M. Leisenring, and K. Scott Baker, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington, Seattle, WA; Barbara L. Asselin and Louis S. Constine, University of Rochester Medical Center and School of Medicine, Rochester, NY; Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX; Sanjeev Aggarwal and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University, Detroit, MI; Smita Bhatia, University of Alabama, Birmingham, AL; David R. Freyer, Children's Hospital Los Angeles, University of Southern California, Los Angeles; and Saro H. Armenian, City of Hope Cancer Center, Duarte, CA
| | - Cindy L Schwartz
- Eric J. Chow, David R. Doody, Wendy M. Leisenring, and K. Scott Baker, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington, Seattle, WA; Barbara L. Asselin and Louis S. Constine, University of Rochester Medical Center and School of Medicine, Rochester, NY; Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX; Sanjeev Aggarwal and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University, Detroit, MI; Smita Bhatia, University of Alabama, Birmingham, AL; David R. Freyer, Children's Hospital Los Angeles, University of Southern California, Los Angeles; and Saro H. Armenian, City of Hope Cancer Center, Duarte, CA
| | - David R Doody
- Eric J. Chow, David R. Doody, Wendy M. Leisenring, and K. Scott Baker, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington, Seattle, WA; Barbara L. Asselin and Louis S. Constine, University of Rochester Medical Center and School of Medicine, Rochester, NY; Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX; Sanjeev Aggarwal and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University, Detroit, MI; Smita Bhatia, University of Alabama, Birmingham, AL; David R. Freyer, Children's Hospital Los Angeles, University of Southern California, Los Angeles; and Saro H. Armenian, City of Hope Cancer Center, Duarte, CA
| | - Wendy M Leisenring
- Eric J. Chow, David R. Doody, Wendy M. Leisenring, and K. Scott Baker, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington, Seattle, WA; Barbara L. Asselin and Louis S. Constine, University of Rochester Medical Center and School of Medicine, Rochester, NY; Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX; Sanjeev Aggarwal and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University, Detroit, MI; Smita Bhatia, University of Alabama, Birmingham, AL; David R. Freyer, Children's Hospital Los Angeles, University of Southern California, Los Angeles; and Saro H. Armenian, City of Hope Cancer Center, Duarte, CA
| | - Sanjeev Aggarwal
- Eric J. Chow, David R. Doody, Wendy M. Leisenring, and K. Scott Baker, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington, Seattle, WA; Barbara L. Asselin and Louis S. Constine, University of Rochester Medical Center and School of Medicine, Rochester, NY; Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX; Sanjeev Aggarwal and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University, Detroit, MI; Smita Bhatia, University of Alabama, Birmingham, AL; David R. Freyer, Children's Hospital Los Angeles, University of Southern California, Los Angeles; and Saro H. Armenian, City of Hope Cancer Center, Duarte, CA
| | - K Scott Baker
- Eric J. Chow, David R. Doody, Wendy M. Leisenring, and K. Scott Baker, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington, Seattle, WA; Barbara L. Asselin and Louis S. Constine, University of Rochester Medical Center and School of Medicine, Rochester, NY; Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX; Sanjeev Aggarwal and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University, Detroit, MI; Smita Bhatia, University of Alabama, Birmingham, AL; David R. Freyer, Children's Hospital Los Angeles, University of Southern California, Los Angeles; and Saro H. Armenian, City of Hope Cancer Center, Duarte, CA
| | - Smita Bhatia
- Eric J. Chow, David R. Doody, Wendy M. Leisenring, and K. Scott Baker, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington, Seattle, WA; Barbara L. Asselin and Louis S. Constine, University of Rochester Medical Center and School of Medicine, Rochester, NY; Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX; Sanjeev Aggarwal and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University, Detroit, MI; Smita Bhatia, University of Alabama, Birmingham, AL; David R. Freyer, Children's Hospital Los Angeles, University of Southern California, Los Angeles; and Saro H. Armenian, City of Hope Cancer Center, Duarte, CA
| | - Louis S Constine
- Eric J. Chow, David R. Doody, Wendy M. Leisenring, and K. Scott Baker, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington, Seattle, WA; Barbara L. Asselin and Louis S. Constine, University of Rochester Medical Center and School of Medicine, Rochester, NY; Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX; Sanjeev Aggarwal and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University, Detroit, MI; Smita Bhatia, University of Alabama, Birmingham, AL; David R. Freyer, Children's Hospital Los Angeles, University of Southern California, Los Angeles; and Saro H. Armenian, City of Hope Cancer Center, Duarte, CA
| | - David R Freyer
- Eric J. Chow, David R. Doody, Wendy M. Leisenring, and K. Scott Baker, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington, Seattle, WA; Barbara L. Asselin and Louis S. Constine, University of Rochester Medical Center and School of Medicine, Rochester, NY; Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX; Sanjeev Aggarwal and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University, Detroit, MI; Smita Bhatia, University of Alabama, Birmingham, AL; David R. Freyer, Children's Hospital Los Angeles, University of Southern California, Los Angeles; and Saro H. Armenian, City of Hope Cancer Center, Duarte, CA
| | - Steven E Lipshultz
- Eric J. Chow, David R. Doody, Wendy M. Leisenring, and K. Scott Baker, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington, Seattle, WA; Barbara L. Asselin and Louis S. Constine, University of Rochester Medical Center and School of Medicine, Rochester, NY; Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX; Sanjeev Aggarwal and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University, Detroit, MI; Smita Bhatia, University of Alabama, Birmingham, AL; David R. Freyer, Children's Hospital Los Angeles, University of Southern California, Los Angeles; and Saro H. Armenian, City of Hope Cancer Center, Duarte, CA
| | - Saro H Armenian
- Eric J. Chow, David R. Doody, Wendy M. Leisenring, and K. Scott Baker, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington, Seattle, WA; Barbara L. Asselin and Louis S. Constine, University of Rochester Medical Center and School of Medicine, Rochester, NY; Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX; Sanjeev Aggarwal and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University, Detroit, MI; Smita Bhatia, University of Alabama, Birmingham, AL; David R. Freyer, Children's Hospital Los Angeles, University of Southern California, Los Angeles; and Saro H. Armenian, City of Hope Cancer Center, Duarte, CA
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Harada K, Ferdous T, Horinaga D, Uchida K, Mano T, Mishima K, Park S, Hanazawa H, Takahashi S, Okita A, Fukunaga M, Maruta J, Kami N, Shibuya K, Ueyama Y. Efficacy of elemental diet on prevention for chemoradiotherapy-induced oral mucositis in patients with oral squamous cell carcinoma. Support Care Cancer 2015; 24:953-959. [DOI: 10.1007/s00520-015-2866-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/27/2015] [Indexed: 12/13/2022]
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Experimental determination of diagnostic window of cardiac troponins in the development of chronic anthracycline cardiotoxicity and estimation of its predictive value. Int J Cardiol 2015; 201:358-67. [PMID: 26310978 DOI: 10.1016/j.ijcard.2015.07.103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 06/17/2015] [Accepted: 07/30/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Cardiac troponins (cTns) seem to be more sensitive for the detection of anthracycline cardiotoxicity than the currently recommended method of monitoring LV systolic function. However, the optimal timing of blood sampling remains unknown. Hence, the aims of the present study were to determine the precise diagnostic window for cTns during the development of chronic anthracycline cardiotoxicity and to evaluate their predictive value. METHODS Cardiotoxicity was induced in rabbits with daunorubicin (3mg/kg, weekly, for 8 weeks). Blood samples were collected 2-168 h after the 1st, 5th and 8th drug administrations, and concentrations of cTns were determined using highly sensitive assays: hs cTnT (Roche) and hs cTnI (Abbott). RESULTS The plasma levels of cTns progressively increased with the rising number of chemotherapy cycles. While only a mild non-significant increase in both cTn levels occurred after the first daunorubicin dose, a significant rise was observed after the 5th and 8th administrations. Two hours after these administrations, a significant increase occurred with a peak between 4-6h and a decline until 24h. Discrete cTn release continued even after cessation of the therapy. While greater variability of cTn levels was observed around the peak concentrations, the values did not correspond well with the severity of LV systolic dysfunction. Unlike AMI in cardiotoxicity, cTn elevations may be better associated with cumulative dose and concentrations at steady state than cmax. CONCLUSIONS To the best of our knowledge, this is the first study to precisely describe the diagnostic window and predictive value of cTns in anthracycline cardiotoxicity.
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161
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Hamo CE, Bloom MW. Getting to the Heart of the Matter: An Overview of Cardiac Toxicity Related to Cancer Therapy. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 9:47-51. [PMID: 26309419 PMCID: PMC4525792 DOI: 10.4137/cmc.s19704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/01/2015] [Accepted: 07/08/2015] [Indexed: 02/06/2023]
Abstract
With the improvement in cancer survival, long-term cardiotoxicity has become an area of increased interest. Various cancer therapies, including chemotherapy and radiation therapy can lead to cardiac toxicities with both acute and chronic manifestations. Awareness and early recognition can lead to improvement in cardiac survival and patient outcomes. The focus of this review is to summarize the cancer therapy agents most often associated with cardiovascular side effects, highlighting their mechanism of action and strategies for surveillance and prevention.
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Affiliation(s)
- Carine E Hamo
- Department of Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Michelle Weisfelner Bloom
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA
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An update on the risk prediction and prevention of anticancer therapy-induced cardiotoxicity. Curr Opin Oncol 2015; 26:590-9. [PMID: 25233068 DOI: 10.1097/cco.0000000000000132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Cardiotoxicity is a well established complication of anticancer therapy. As cancer survivorship and life expectancy for cancer patients improves, the morbidity and mortality of anticancer therapy-related cardiotoxicity has become more problematic. It is of utmost importance to identify patients at the highest risk for the development of cardiotoxicity and to determine strategies for prevention, early detection and treatment. RECENT FINDINGS Clinical risk factors, biomarkers, advanced cardiac imaging and pharmacogenomics may be used to classify patients at risk for therapy-induced cardiotoxicity. A much broader armamentarium of imaging modalities for risk prediction, in addition to simple two-dimensional echocardiogram and radionucleotide angiography, has also shown clinical utility in identifying early-onset cardiotoxicity and areas of reversible myocardial injury. Exciting new research aimed at predicting cardiotoxicity and developing cardioprotective strategies may lead to changes in the administration of cardiotoxic chemotherapies. SUMMARY Personalized assessments of the risks and benefits of therapy should be used as opposed to standardized dosing and schedules. Patients at higher risk for cardiotoxicity should receive closer monitoring, cardioprotective agents, dose adjustment or alternative regimens in an effort to reduce cardiovascular morbidity and mortality. Future research will hopefully define specific risk prediction tools and clinical protocols to prevent irreversible cardiotoxicity.
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Abdel-Rahman O, Alorabi M. Use of angiotensin-converting enzyme inhibitors in the prophylaxis of anthracycline or trastuzumab-related cardiac dysfunction: preclinical and clinical considerations. Expert Rev Anticancer Ther 2015; 15:829-837. [DOI: 10.1586/14737140.2015.1047766] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Petek BJ, Greenman C, Herrmann J, Ewer MS, Jones RL. Cardio-oncology: an ongoing evolution. Future Oncol 2015. [DOI: 10.2217/fon.15.89] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Cancer survivorship has been greatly impacted with the development of modern cancer treatments. While significant strides have been made in managing many types of cancer, now physicians face new challenges. Over the past decades, cardiovascular events in cancer survivors have increased in prevalence, driving the development of multidisciplinary cardio-oncology programs. Additionally, as cancer patients live longer, their risk of developing secondary cardiovascular events increases. The rapid development of novel cancer therapies will continue to generate questions of cardiac risk and cardiac protection in cancer patients over time. We wish to outline the development of cardio-oncology in its present state, and provide future perspectives for the discipline.
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Affiliation(s)
- Bradley J Petek
- School of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Chris Greenman
- Division of Cardiology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Joerg Herrmann
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Michael S Ewer
- Department of Cardiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Robin L Jones
- Sarcoma Unit, The Institute of Cancer Research & The Royal Marsden Hospital, Fulham Road, SW3 6JJ, London, UK
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Karasawa T, Steyger PS. An integrated view of cisplatin-induced nephrotoxicity and ototoxicity. Toxicol Lett 2015; 237:219-27. [PMID: 26101797 DOI: 10.1016/j.toxlet.2015.06.012] [Citation(s) in RCA: 324] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 06/06/2015] [Accepted: 06/14/2015] [Indexed: 12/20/2022]
Abstract
Cisplatin is one of the most widely-used drugs to treat cancers. However, its nephrotoxic and ototoxic side-effects remain major clinical limitations. Recent studies have improved our understanding of the molecular mechanisms of cisplatin-induced nephrotoxicity and ototoxicity. While cisplatin binding to DNA is the major cytotoxic mechanism in proliferating (cancer) cells, nephrotoxicity and ototoxicity appear to result from toxic levels of reactive oxygen species and protein dysregulation within various cellular compartments. In this review, we discuss molecular mechanisms of cisplatin-induced nephrotoxicity and ototoxicity. We also discuss potential clinical strategies to prevent nephrotoxicity and ototoxicity and their current limitations.
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Affiliation(s)
- Takatoshi Karasawa
- Oregon Hearing Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Peter S Steyger
- Oregon Hearing Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States.
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Faught LN, Greff MJE, Rieder MJ, Koren G. Drug-induced acute kidney injury in children. Br J Clin Pharmacol 2015; 80:901-9. [PMID: 25395343 DOI: 10.1111/bcp.12554] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/12/2014] [Indexed: 12/14/2022] Open
Abstract
Acute kidney injury (AKI) is a serious problem occurring in anywhere between 8 and 30% of children in the intensive care unit. Up to 25% of these cases are believed to be the result of pharmacotherapy. In this review we have focused on several relevant drugs and/or drug classes, which are known to cause AKI in children, including cancer chemotherapeutics, non-steroidal anti-inflammatory drugs and antimicrobials. AKI demonstrates a steady association with increased long term risk of poor outcomes including chronic kidney disease and death as determined by the extent of injury. For this reason it is important to understand the causality and implications of these drugs and drug classes. Children occupy a unique patient population, advocating the importance of understanding how they are affected dissimilarly compared with adults. While the kidney itself is likely more susceptible to injury than other organs, the inherent toxicity of these drugs also plays a major role in the resulting AKI. Mechanisms involved in the toxicity of these drugs include oxidative damage, hypersensitivity reactions, altered haemodynamics and tubule obstruction and may affect the glomerulus and/or the tubules. Understanding these mechanisms is critical in determining the most effective strategies for treatment and/or prevention, whether these strategies are less toxic versions of the same drugs or add-on agents to mitigate the toxic effect of the existing therapy.
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Affiliation(s)
- Lauren N Faught
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada.,Ivey Chair in Molecular Toxicology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Michael J Rieder
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada.,Department of Pediatrics, Western University, London, Ontario, Canada.,CIHR-GSK Chair in Paediatric Clinical Pharmacology, Children's Hospital of Western Ontario, London, Ontario, Canada.,Department of Medicine, Western University, London, Ontario, Canada
| | - Gideon Koren
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada.,Ivey Chair in Molecular Toxicology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Pediatrics, Western University, London, Ontario, Canada.,Department of Medicine, Western University, London, Ontario, Canada.,Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pharmacology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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168
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O'Hare M, Murphy K, Mookadam F, Sharma A, Lee H. Cardio-oncology Part II: the monitoring, prevention, detection and treatment of chemotherapeutic cardiac toxicity. Expert Rev Cardiovasc Ther 2015; 13:519-27. [PMID: 25864865 DOI: 10.1586/14779072.2015.1027686] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cancer treatment has advanced in recent years with new drugs, complex regimes and multiple modalities of treatment; which has improved survival of cancer patients. Cardiotoxicity from chemotherapy is an emerging, important issue. Currently, echocardiographic evaluation of ejection fraction is the most commonly employed diagnostic tool for detecting chemotherapy-induced cardiotoxicity. However, novel echocardiographic techniques assessing myocardial mechanics using strain imaging can detect earlier changes. New imaging techniques and biomarkers can risk stratify patients to identify those requiring closer monitoring. Cardiologists collaborating with oncologists can detect and treat cardiovascular chemotherapeutic complications earlier, reducing morbidity and mortality. While cardiac MRI and multigated acquisition nuclear scanning are alternatives, echocardiography has become the mainstream for assessing cardiac function due to its portability, efficiency and low cost. Current recommendations regarding cardiac monitoring of cancer patients are based on expert consensus opinion. There is a need for prospective controlled trials to support specific guidelines.
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Affiliation(s)
- Meabh O'Hare
- From the Division of Cardiovascular Diseases, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
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169
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Gong B, Morris MD. Raman spectroscopy monitors adverse bone sequelae of cancer radiotherapy. CHINESE CHEM LETT 2015. [DOI: 10.1016/j.cclet.2014.11.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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170
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Rohlfing S, Aurich M, Schöning T, Ho AD, Witzens-Harig M. Nonpegylated Liposomal Doxorubicin as a Component of R-CHOP Is an Effective and Safe Alternative to Conventional Doxorubicin in the Treatment of Patients With Diffuse Large B-Cell Lymphoma and Preexisting Cardiac Diseases. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:458-63. [PMID: 25899891 DOI: 10.1016/j.clml.2015.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 03/12/2015] [Accepted: 03/18/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim of this retrospective analysis was to investigate the efficacy and safety of nonpegylated liposomal doxorubicin (NPLD) as part of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) in patients with diffuse large B-cell lymphoma (DLBCL) and preexisting cardiac diseases. PATIENTS AND METHODS Twenty-five patients were evaluated, median age was 73 (range 24-85) years, 23 patients received NPLD as part of their first-line therapy. Most patients suffered from more than 1 cardiac disease and in 14 patients left ventricular ejection fraction (LVEF) was reduced. One hundred nineteen cycles of NPLD were applied with a median of 5 (range 2-8) cycles per patient. Median dose per cycle was 95 mg (50 mg/m(2)). RESULTS The overall response rate was 96% (44% complete remission, 52% partial remission). After a median follow-up of 23 months, 4 patients had disease relapse. Seven patients died, translating to an estimated 3-year progression-free and overall survival of 66% and 73%, respectively. Reasons for death were progressive disease or infection in 2 patients each and cardiovascular disease in 3 patients. After chemotherapy, LVEF decreased significantly in 28% and improved in 12% of patients, whereas median LVEF did not change (51% vs. 50%). No higher frequencies of decreased LVEF was observed in the group of patients with preexisting reduced LVEF. Five adverse events induced therapy termination: 2 myocardial infarctions, 2 pneumonias, and 1 reduced condition. No hand-foot-syndrome was observed. CONCLUSION NPLD as a component of R-CHOP is an effective treatment in patients with DLBCL and preexisting cardiac diseases, whereas cardiac events were observed in 36% of patients in this cardiac high-risk group. However, these results need to be confirmed in a prospective randomized trial.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/pharmacology
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/pharmacology
- Cyclophosphamide/therapeutic use
- Disease-Free Survival
- Doxorubicin/administration & dosage
- Doxorubicin/analogs & derivatives
- Doxorubicin/pharmacology
- Doxorubicin/therapeutic use
- Female
- Heart Diseases/drug therapy
- Humans
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Polyethylene Glycols/administration & dosage
- Polyethylene Glycols/pharmacology
- Polyethylene Glycols/therapeutic use
- Prednisone/administration & dosage
- Prednisone/pharmacology
- Prednisone/therapeutic use
- Retrospective Studies
- Rituximab
- Treatment Outcome
- Vincristine/administration & dosage
- Vincristine/pharmacology
- Vincristine/therapeutic use
- Young Adult
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Affiliation(s)
- Sarah Rohlfing
- Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany.
| | - Matthias Aurich
- Department of Cardiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Tilman Schöning
- Pharmacy, University Hospital of Heidelberg, Heidelberg, Germany
| | - Anthony D Ho
- Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Mathias Witzens-Harig
- Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany
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171
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Nguyen DT, Shayani S, Palmer J, Dagis A, Forman SJ, Epstein J, Spielberger R. Palifermin for prevention of oral mucositis in allogeneic hematopoietic stem cell transplantation: a single-institution retrospective evaluation. Support Care Cancer 2015; 23:3141-7. [DOI: 10.1007/s00520-015-2688-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 02/23/2015] [Indexed: 10/23/2022]
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172
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The changes in cardiac physiology with aging and the implications for the treating oncologist. J Geriatr Oncol 2015; 6:178-84. [PMID: 25758027 DOI: 10.1016/j.jgo.2015.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/16/2015] [Accepted: 02/19/2015] [Indexed: 12/27/2022]
Abstract
The link between cancer, cardiovascular disease, and aging is well documented. In this review, we highlight the physiologic and pathologic changes associated with the cardiovascular aging process, the role they play when interfaced with various cancer therapies and the implications for the treating oncologist.
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173
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Zhao H, Xie P, Li X, Zhu W, Sun X, Sun X, Chen X, Xing L, Yu J. A prospective phase II trial of EGCG in treatment of acute radiation-induced esophagitis for stage III lung cancer. Radiother Oncol 2015; 114:351-6. [PMID: 25769379 DOI: 10.1016/j.radonc.2015.02.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/10/2015] [Accepted: 02/15/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acute radiation-induced esophagitis (ARIE) is one of main toxicities complicated by thoracic radiotherapy, influencing patients' quality of life and radiotherapy proceeding seriously. It is difficult to be cured rapidly so far. Our phase I trial preliminarily showed that EGCG may be a promising strategy in the treatment of ARIE. MATERIALS AND METHODS We prospectively enrolled patients with stage III lung cancer from the Shandong Tumor Hospital & Institute in China from January 2013 to September 2014. All patients received concurrent or sequential chemo-radiotherapy, or radiotherapy only. EGCG was administrated once ARIE appeared. EGCG was given with the concentration of 440μmol/L during radiotherapy and additionally two weeks after radiotherapy. RTOG score, dysphagia and pain related to esophagitis were recorded every week. RESULTS Thirty-seven patients with stage IIIA and IIIB lung cancer were enrolled in this trial. In comparison to the original, the RTOG score in the 1st, 2nd, 3rd, 4th, 5th week after EGCG prescription and the 1st, 2nd week after radiotherapy decreased significantly (P=0.002, 0.000, 0.000, 0.001, 0.102, 0.000, 0.000, respectively). The pain score of each week was significantly lower than the baseline (P=0.000, 0.000, 0.000, 0.000, 0.006, 0.000, 0.000, respectively). CONCLUSION This trial confirmed that the oral administration of EGCG is an effective and safe method to deal with ARIE. A phase III randomized controlled trial is expected to further corroborate the consequence of EGCG in ARIE treatment.
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Affiliation(s)
- Hanxi Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Provincial Key Laboratory of Radiation Oncology, Jinan, China
| | - Peng Xie
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Provincial Key Laboratory of Radiation Oncology, Jinan, China; Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, China
| | - Xiaolin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Provincial Key Laboratory of Radiation Oncology, Jinan, China
| | - Wanqi Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Provincial Key Laboratory of Radiation Oncology, Jinan, China
| | - Xindong Sun
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Provincial Key Laboratory of Radiation Oncology, Jinan, China
| | - Xiaorong Sun
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Provincial Key Laboratory of Radiation Oncology, Jinan, China
| | - Xiaoting Chen
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Provincial Key Laboratory of Radiation Oncology, Jinan, China
| | - Ligang Xing
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Provincial Key Laboratory of Radiation Oncology, Jinan, China.
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Provincial Key Laboratory of Radiation Oncology, Jinan, China
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Abstract
Cancer survivorship should be defined starting not from completion of treatment, but from the time of diagnosis. Assessing and controlling the cancer patient's cardiovascular risk before, during, and after treatment is crucial to improving their overall outcome. There are many cancer therapies, including but not limited to anthracyclines, radiation, and vascular signaling pathway inhibitors which should be considered nontraditional cardiovascular risk factors with significant morbidity. Monitoring novel populations, such as a younger age group, for ischemic coronary disease or congestive heart failure (CHF) is not intuitive to many clinicians. Symptoms of CHF and coronary artery disease overlap with common side effects of cancer and cancer treatment. Cancer survivors may also have fewer typical symptoms of cardiovascular disease. Increased surveillance and aggressive control of cardiovascular disease is important in cancer patients both while undergoing active treatment and in the long term. Despite the increasing interest in cardio-oncology, data-driven guidelines are lacking due to small study sizes and low event rates over a short period of time. Most practice guidelines have been based on clinical practice and expert opinion. The list of cardiotoxic cancer therapies continues to grow each year. This review is not intended to be a comprehensive review of all cancer therapy toxicity, but will focus on recent literature regarding prevention of CHF and coronary artery disease (CAD) during active cancer therapy as well as current screening guidelines for long-term survivors.
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175
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Gonella S, di Pasquale T, Palese A. Preventive Measures for Cyclophosphamide-Related Hemorrhagic Cystitis in Blood and Bone Marrow Transplantation: An Italian Multicenter Retrospective Study. Clin J Oncol Nurs 2015; 19:E8-E14. [DOI: 10.1188/15.cjon.e8-e14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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176
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Anderson JM, Campbell K. Assessment of Interventions to Prevent Drug-Induced Hearing Loss. FREE RADICALS IN ENT PATHOLOGY 2015. [DOI: 10.1007/978-3-319-13473-4_12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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177
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178
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Bloy N, Pol J, Manic G, Vitale I, Eggermont A, Galon J, Tartour E, Zitvogel L, Kroemer G, Galluzzi L. Trial Watch: Radioimmunotherapy for oncological indications. Oncoimmunology 2014; 3:e954929. [PMID: 25941606 DOI: 10.4161/21624011.2014.954929] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 07/18/2014] [Indexed: 02/06/2023] Open
Abstract
During the past two decades, it has become increasingly clear that the antineoplastic effects of radiation therapy do not simply reflect the ability of X-, β- and γ-rays to damage transformed cells and directly cause their permanent proliferative arrest or demise, but also involve cancer cell-extrinsic mechanisms. Indeed, among other activities, radiotherapy has been shown to favor the establishment of tumor-specific immune responses that operate systemically, underpinning the so-called 'out-of-field' or 'abscopal' effect. Thus, ionizing rays appear to elicit immunogenic cell death, a functionally peculiar variant of apoptosis associated with the emission of a particularly immunostimulatory combination of damage-associated molecular patterns. In line with this notion, radiation therapy fosters, and thus exacerbates, the antineoplastic effects of various treatment modalities, including surgery, chemotherapy and various immunotherapeutic agents. Here, we summarize recent advances in the use of ionizing rays as a means to induce or potentiate therapeutically relevant anticancer immune responses. In addition, we present clinical trials initiated during the past 12 months to test the actual benefit of radioimmunotherapy in cancer patients.
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Affiliation(s)
- Norma Bloy
- Gustave Roussy Cancer Campus ; Villejuif, France ; INSERM, U1138 ; Paris, France ; Equipe 11 labellisée par la Ligue Nationale contre le Cancer; Centre de Recherche des Cordeliers ; Paris, France ; Université Paris-Sud/Paris XI ; Paris, France
| | - Jonathan Pol
- Gustave Roussy Cancer Campus ; Villejuif, France ; INSERM, U1138 ; Paris, France ; Equipe 11 labellisée par la Ligue Nationale contre le Cancer; Centre de Recherche des Cordeliers ; Paris, France
| | - Gwenola Manic
- Regina Elena National Cancer Institute ; Rome, Italy
| | - Ilio Vitale
- Regina Elena National Cancer Institute ; Rome, Italy
| | | | - Jérôme Galon
- INSERM, U1138 ; Paris, France ; Université Paris Descartes/Paris V; Sorbonne Paris Cité ; Paris, France ; Université Pierre et Marie Curie/Paris VI ; Paris, France ; Laboratory of Integrative Cancer Immunology, Centre de Recherche des Cordeliers ; Paris, France
| | - Eric Tartour
- Université Paris Descartes/Paris V; Sorbonne Paris Cité ; Paris, France ; INSERM, U970 ; Paris, France ; Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP ; Paris, France
| | - Laurence Zitvogel
- Gustave Roussy Cancer Campus ; Villejuif, France ; INSERM, U1015; CICBT507 ; Villejuif, France
| | - Guido Kroemer
- INSERM, U1138 ; Paris, France ; Equipe 11 labellisée par la Ligue Nationale contre le Cancer; Centre de Recherche des Cordeliers ; Paris, France ; Université Paris Descartes/Paris V; Sorbonne Paris Cité ; Paris, France ; Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP ; Paris, France ; Metabolomics and Cell Biology Platforms; Gustave Roussy Cancer Campus ; Villejuif, France
| | - Lorenzo Galluzzi
- Gustave Roussy Cancer Campus ; Villejuif, France ; Equipe 11 labellisée par la Ligue Nationale contre le Cancer; Centre de Recherche des Cordeliers ; Paris, France ; Université Paris Descartes/Paris V; Sorbonne Paris Cité ; Paris, France
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179
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Enzymatic and non-enzymatic mechanisms of dimesna metabolism. Amino Acids 2014; 47:511-23. [DOI: 10.1007/s00726-014-1882-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 11/22/2014] [Indexed: 10/24/2022]
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180
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Yu AF, Steingart RM, Fuster V. Cardiomyopathy associated with cancer therapy. J Card Fail 2014; 20:841-52. [PMID: 25151211 PMCID: PMC5972392 DOI: 10.1016/j.cardfail.2014.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/08/2014] [Accepted: 08/14/2014] [Indexed: 01/03/2023]
Abstract
Chemotherapy-associated cardiomyopathy is a well known cardiotoxicity of contemporary cancer treatment and a cause of increasing concern for both cardiologists and oncologists. As cancer outcomes improve, cardiovascular disease has become a leading cause of morbidity and mortality among cancer survivors. Asymptomatic or symptomatic left ventricular systolic dysfunction in the setting of cardiotoxic chemotherapy is an important entity to recognize. Early diagnosis of cardiac injury through the use of novel blood-based biomarkers or noninvasive imaging modalities may allow for the initiation of cardioprotective medications or modification of chemotherapy regimen to minimize or prevent further damage. Several clinical trials are currently underway to determine the efficacy of cardioprotective medications for the prevention of chemotherapy-associated cardiomyopathy. Implementing a strategy that includes both early detection and prevention of cardiotoxicity will likely have a significant impact on the overall prognosis of cancer survivors. Continued coordination of care between cardiologists and oncologists remains critical to maximizing the oncologic benefit of cancer therapy while minimizing any early or late cardiovascular effects.
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Affiliation(s)
- Anthony F Yu
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Richard M Steingart
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Valentin Fuster
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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181
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Sastre J, Argilés G, Benavides M, Feliú J, García-Alfonso P, García-Carbonero R, Grávalos C, Guillén-Ponce C, Martínez-Villacampa M, Pericay C. Clinical management of regorafenib in the treatment of patients with advanced colorectal cancer. Clin Transl Oncol 2014; 16:942-53. [PMID: 25223744 PMCID: PMC4194027 DOI: 10.1007/s12094-014-1212-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 08/01/2014] [Indexed: 12/19/2022]
Abstract
Colorectal cancer is one of the most common tumors worldwide and at least 50 % of patients with this disease develop metastases. In this setting, additional treatment options are needed for patients presenting disease progression after exhausting all standard therapies. Regorafenib is an orally administered multikinase inhibitor which has been shown to provide survival benefits to patients with metastatic colorectal cancer (mCRC). Although most adverse events (AEs) associated with regorafenib may resolve within the first 8 weeks of treatment, some of them may require dose reduction or treatment interruption. Overall, while remaining aware of the safety profile of regorafenib and how to manage the most common toxicities related to its use, this drug should be considered a new standard of care for patients with pretreated mCRC. This review addresses practical aspects of its use, such as dosing, patient monitoring, and management of the most common regorafenib-related AEs.
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Affiliation(s)
- J Sastre
- Medical Oncology Department, Clinic San Carlos University Hospital (Center Affiliated with the Red Tematica de Investigacion Cooperativa en Cancer, Instituto Carlos III, Spanish Ministry of Science and Innovation), Calle Profesor Martín Lagos, s/n, 28040, Madrid, Spain,
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182
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Yeom H, Lim J, Yoo SH, Lee W. A new posture-correcting system using a vector angle model for preventing forward head posture. BIOTECHNOL BIOTEC EQ 2014; 28:S6-S13. [PMID: 26019611 PMCID: PMC4433962 DOI: 10.1080/13102818.2014.949040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 06/19/2014] [Indexed: 11/13/2022] Open
Abstract
In modern society many people are afflicted with muscle pain in the neck and shoulders mainly caused by incorrect posture. The number of patients having neck pain is increasing as usage of digital devices becomes more frequent. If patients could be notified how inappropriate their postures are in real time, the number of patients could be lower. Unfortunately, there is no digitized standard way of diagnosis for forward head posture. This study applies a concept based on a vector related to two angles which are acquired from the neck and the head, so that a device can diagnose the posture by measuring and analysing the angles. To obtain the vector, integral calculations of displacement of the head are needed. As a result, with this device, patients’ faulty posture can be easily detected.
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Affiliation(s)
- Hojun Yeom
- Department of Bio Medical Engineering, Eulji University , Seongnam-si , Gyeonggi-do , Korea
| | - Juhun Lim
- Department of Bio Medical Engineering, Eulji University , Seongnam-si , Gyeonggi-do , Korea
| | - Sung Hak Yoo
- Department of Bio Medical Engineering, Eulji University , Seongnam-si , Gyeonggi-do , Korea
| | - Woocheol Lee
- Department of Bio Medical Engineering, Eulji University , Seongnam-si , Gyeonggi-do , Korea
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183
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Stachowiak P, Kornacewicz-Jach Z, Safranow K. Prognostic role of troponin and natriuretic peptides as biomarkers for deterioration of left ventricular ejection fraction after chemotherapy. Arch Med Sci 2014; 10:1007-18. [PMID: 25395954 PMCID: PMC4223124 DOI: 10.5114/aoms.2013.34987] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 11/12/2012] [Accepted: 12/22/2012] [Indexed: 11/24/2022] Open
Abstract
Cardiotoxicity due to anthracyclines, trastuzumab and other potential cardiotoxic drugs is still a problem of modern chemotherapy. For years researchers have tried to find biological markers that can predict changes in the heart. The most thoroughly tested markers are troponin and natriuretic peptides. Some studies have proven that these markers can indeed be useful. In studies which have shown the predictive role of troponin I the assessment of this marker was performed very frequently. It is not possible to carry out such serial measurements in many centers because of typical 1-day hospital stay times. The predictive role of natriuretic peptides still needs further investigation. This review considers the newest research from recent years.
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Affiliation(s)
- Paweł Stachowiak
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
| | | | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Szczecin, Poland
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184
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Jacobs C, Graham ID, Makarski J, Chassé M, Fergusson D, Hutton B, Clemons M. Clinical practice guidelines and consensus statements in oncology--an assessment of their methodological quality. PLoS One 2014; 9:e110469. [PMID: 25329669 PMCID: PMC4201546 DOI: 10.1371/journal.pone.0110469] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/22/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Consensus statements and clinical practice guidelines are widely available for enhancing the care of cancer patients. Despite subtle differences in their definition and purpose, these terms are often used interchangeably. We systematically assessed the methodological quality of consensus statements and clinical practice guidelines published in three commonly read, geographically diverse, cancer-specific journals. Methods Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. METHODS Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. FINDINGS Thirty-four consensus statements and 67 clinical practice guidelines were evaluated. The rigour of development score for consensus statements over the three journals was 32% lower than that of clinical practice guidelines. The editorial independence score was 15% lower for consensus statements than clinical practice guidelines. One journal scored consistently lower than the others over both domains. No journals adhered to all the items related to the transparency of document development. One journal's consensus statements endorsed a product made by the sponsoring pharmaceutical company in 64% of cases. CONCLUSION Guidance documents are an essential part of oncology care and should be subjected to a rigorous and validated development process. Consensus statements had lower methodological quality than clinical practice guidelines using AGREE II. At a minimum, journals should ensure that that all consensus statements and clinical practice guidelines adhere to AGREE II criteria. Journals should consider explicitly requiring guidelines to declare pharmaceutical company sponsorship and to identify the sponsor's product to enhance transparency.
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Affiliation(s)
- Carmel Jacobs
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian D. Graham
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute and University of Ottawa, Department of Medicine, Ottawa, Ontario, Canada
| | | | - Michaël Chassé
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean Fergusson
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute and University of Ottawa, Department of Medicine, Ottawa, Ontario, Canada
| | - Brian Hutton
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark Clemons
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute and University of Ottawa, Department of Medicine, Ottawa, Ontario, Canada
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185
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Lipshultz SE, Diamond MB, Franco VI, Aggarwal S, Leger K, Santos MV, Sallan SE, Chow EJ. Managing chemotherapy-related cardiotoxicity in survivors of childhood cancers. Paediatr Drugs 2014; 16:373-89. [PMID: 25134924 PMCID: PMC4417358 DOI: 10.1007/s40272-014-0085-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In the US, children diagnosed with cancer are living longer, but not without consequences from the same drugs that cured their cancer. In these patients, cardiovascular disease is the leading cause of non-cancer-related morbidity and mortality. Although this review focuses on anthracycline-related cardiomyopathy in childhood cancer survivors, the global lifetime risk of other cardiovascular diseases such as atherosclerosis, arrhythmias and intracardiac conduction abnormalities, hypertension, and stroke also are increased. Besides anthracyclines, newer molecularly targeted agents, such as vascular endothelial growth factor receptor and tyrosine kinase inhibitors, also have been associated with acute hypertension, cardiomyopathy, and increased risk of ischemic cardiac events and arrhythmias, and are summarized here. This review also covers other risk factors for chemotherapy-related cardiotoxicity (including both modifiable and non-modifiable factors), monitoring strategies (including both blood and imaging-based biomarkers) during and following cancer treatment, and discusses the management of cardiotoxicity (including prevention strategies such as cardioprotection by use of dexrazoxane).
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Affiliation(s)
- Steven E Lipshultz
- Department of Pediatrics, Wayne State University School of Medicine and the Children's Research Center of Michigan at the Children's Hospital of Michigan, 3901 Beaubien Boulevard, Suite 1K40, Detroit, MI, 48201, USA,
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186
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Chemotherapy-Induced Cardiomyopathy in the Elderly. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0414-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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187
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Preemptive Cardioprotective Strategies in Patients Receiving Chemotherapy. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0406-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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188
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Chi KH, Chiou TJ, Li CP, Chen SY, Chao Y. MS-20, a chemotherapeutical adjuvant, reduces chemo-associated fatigue and appetite loss in cancer patients. Nutr Cancer 2014; 66:1211-9. [PMID: 25256137 DOI: 10.1080/01635581.2014.951731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A small pilot study of the fermented soybean extract MicrSoy-20(MS-20) demonstrated its ability to restore chemotherapy-induced immunosuppression and improve quality of life (QoL). This randomized, cross-over, comparative trial was conducted to confirm the effects of MS-20 on QoL and to understand its underlying mechanism when used in conjunction with chemotherapy. One hundred forty-three patients undergoing cancer chemotherapy were randomly assigned to 2 groups. Group 1 was administered MS-20 for 1 wk followed by 3 wk of concomitant MS-20 plus chemotherapy. Group 2 was administered chemotherapy for 3 wk. QoL was assessed by the EORTC/QLQ-C30 questionnaire and visual analogue scales (VAS). Changes in immunological parameters and antioxidant profiles were also examined. Significant increases were observed in EORTC/QLQ-C30 scores for physical (4.45, P = 0.023) and social (3.99, P = 0.023) functioning in Group 1 patients compared to Group 2 patients. VAS scores for fatigue and appetite loss significantly improved with MS-20 treatment (P < 0.001). Group 1 patients exhibited smaller decreases in peripheral blood mononuclear cells compared to Group 2 patients (P = 0.026). Other immunological parameters, antioxidant, and safety profiles were not significantly different between treatment groups. Addition of MS-20 as an adjuvant to chemotherapy can be effective in improving QoL for cancer patients.
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Affiliation(s)
- Kwan-Hwa Chi
- a Department of Radiation Therapy and Oncology , Shin-Kong Wu Ho-Su Memorial Hospital , Taipei , Taiwan
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189
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Lemmo W. Potential interactions of prescription and over‐the‐counter medications having antioxidant capabilities with radiation and chemotherapy. Int J Cancer 2014; 137:2525-33. [DOI: 10.1002/ijc.29208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/01/2014] [Accepted: 08/12/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Walter Lemmo
- LEMMO Integrated Cancer Care Inc.Vancouver Canada
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190
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Abstract
For more than half a century, the different properties of dexrazoxane have captured the attention of scientists and clinicians. Presently, dexrazoxane is licensed in many parts of the world for two different indications: prevention of cardiotoxicity from anthracycline-based chemotherapy, and prevention of tissue injuries after extravasation of anthracyclines. This article reviews the historical, preclinical, and clinical background for the use of dexrazoxane for these indications.
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Affiliation(s)
- Seppo W Langer
- Thoracic and Neuroendocrine Section, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
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191
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Bradstock KF, Link E, Collins M, Di Iulio J, Lewis ID, Schwarer A, Enno A, Marlton P, Hahn U, Szer J, Cull G, Seymour JF. A randomized trial of prophylactic palifermin on gastrointestinal toxicity after intensive induction therapy for acute myeloid leukaemia. Br J Haematol 2014; 167:618-25. [DOI: 10.1111/bjh.13086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/02/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Emma Link
- Biostatistics and Clinical Trials; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
| | - Marnie Collins
- Biostatistics and Clinical Trials; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
| | - Juliana Di Iulio
- Biostatistics and Clinical Trials; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
| | - Ian D. Lewis
- Division of Haematology; SA Pathology and University of Adelaide; Adelaide SA Australia
| | | | - Arno Enno
- Mater Hospital; Newcastle NSW Australia
| | - Paula Marlton
- Princess Alexandra Hospital and School of Medicine; University of Queensland; Brisbane Qld Australia
| | - Uwe Hahn
- Queen Elizabeth Hospital; Adelaide SA Australia
| | - Jeff Szer
- Royal Melbourne Hospital; Parkville Vic. Australia
| | - Gavin Cull
- Sir Charles Gairdiner Hospital; Perth WA Australia
| | - John F. Seymour
- Department of Haematology; Peter MacCallum Cancer Centre; East Melbourne Vic. Australia
- University of Melbourne; Parkville Vic. Australia
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192
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CSAPO MELINDA, LAZAR LIVIU. Chemotherapy-Induced Cardiotoxicity: Pathophysiology and Prevention. CLUJUL MEDICAL (1957) 2014; 87:135-42. [PMID: 26528012 PMCID: PMC4508592 DOI: 10.15386/cjmed-339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 08/25/2014] [Accepted: 08/29/2014] [Indexed: 01/09/2023]
Abstract
Along with the remarkable progress registered in oncological treatment that led to increased survival of cancer patients, treatment-related comorbidities have also become an issue for these long-term survivors. Of particular interest is the development of cardiotoxic events, which, even when asymptomatic, not only have a negative impact on the patient`s cardiac prognosis, but also considerably restrict therapeutic opportunities. The pathophysiology of cytostatic-induced cardiotoxicity implies a series of complex and intricate mechanisms, whose understanding enables the development of preventive and therapeutic strategies. Securing cardiac function is an ongoing challenge for the pharmaceutical industry and the physicians who have to deal currently with these adverse reactions. This review focuses on the main mechanism of cardiac toxicity induced by anticancer drugs and especially on the current strategies applied for preventing and minimizing the cardiac side effects.
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Affiliation(s)
| | - LIVIU LAZAR
- Faculty of Medicine and Pharmacy, University of Oradea, Romania
- Oradea Municipal Hospital, Romania
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193
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Chemotherapy-Induced Cardiotoxicity: Detection, Prevention, and Management. Can J Cardiol 2014; 30:869-78. [DOI: 10.1016/j.cjca.2014.04.029] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 01/05/2023] Open
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194
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Accordino MK, Neugut AI, Hershman DL. Cardiac effects of anticancer therapy in the elderly. J Clin Oncol 2014; 32:2654-61. [PMID: 25071122 DOI: 10.1200/jco.2013.55.0459] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Cancer incidence increases with age, and as life expectancy increases, the number of elderly patients with cancer is increasing. Cancer treatments, including chemotherapy and radiotherapy, have significant short- and long-term effects on cardiovascular function. These cardiotoxic effects can be acute, such as changes in electrocardiogram (ECG), arrhythmias, ischemia, and pericarditis and/or myocarditis-like syndromes, or they can be chronic, such as ventricular dysfunction. Anticancer therapies can also have indirect effects, such as alterations in blood pressure, or can cause metabolic abnormalities that subsequently increase risk for cardiac events. In this review, we explore both observational and clinical trial evidence of cardiac risk in the elderly. In both observational and clinical trial data, risk of cardiotoxicity with anthracycline-based chemotherapy increases with age. However, it is less clear whether the association between age and cardiotoxicity exists for newer treatments. The association may not be well demonstrated as a result of under-representation of elderly patients in clinical trials and avoidance of these therapies in this population. In addition, we discuss strategies for surveillance and prevention of cardiotoxicity in the elderly. In the elderly, it is important to be aware of the potential for cardiotoxicity during long-term follow-up and to consider both prevention and surveillance of these late effects.
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Affiliation(s)
| | - Alfred I Neugut
- All authors: Columbia University Medical Center, New York, NY
| | - Dawn L Hershman
- All authors: Columbia University Medical Center, New York, NY.
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195
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Robinson D, Schulz G, Langley R, Donze K, Winchester K, Rodgers C. Evidence-Based Practice Recommendations for Hydration in Children and Adolescents With Cancer Receiving Intravenous Cyclophosphamide. J Pediatr Oncol Nurs 2014; 31:191-199. [PMID: 24799445 PMCID: PMC5206805 DOI: 10.1177/1043454214532024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hemorrhagic cystitis is a known complication of cyclophosphamide, an antineoplastic agent used to treat a variety of oncologic diseases in children. Hydration can prevent hemorrhagic cystitis; however, use varies in clinical practice. A team was assembled to develop evidence-based practice recommendations to address the following question: in a population of children with cancer, what is the appropriate pre- and posthydration for the administration of different dose levels of intravenous cyclophosphamide to prevent bladder toxicity? The purpose was to identify the appropriate rate, duration, and route of hydration to prevent bladder toxicity with low, intermediate, and high dose cyclophosphamide. After a systematic search of the literature, 15 pieces of evidence were evaluated and used. There is a moderate level of quality evidence related to hydration for high dose cyclophosphamide and very low quality evidence related to intermediate or low dose cyclophosphamide. Three general recommendations were made for hydration associated with cyclophosphamide. There is a need for further research related to the prevention of bladder toxicity in children with cancer receiving cyclophosphamide.
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Affiliation(s)
| | - Ginny Schulz
- Saint Louis Children's Hospital, St Louis, MO, USA
| | | | - Kevin Donze
- Saint Louis Children's Hospital, St Louis, MO, USA
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196
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Yamashita T, Araki K, Tomifuji M, Kamide D, Tanaka Y, Shiotani A. A traditional Japanese medicine--Hangeshashinto (TJ-14)--alleviates chemoradiation-induced mucositis and improves rates of treatment completion. Support Care Cancer 2014; 23:29-35. [PMID: 24943276 DOI: 10.1007/s00520-014-2315-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 06/08/2014] [Indexed: 01/27/2023]
Abstract
PURPOSE Oral mucositis induced by radiation or chemoradiation can cause devastating quality of life issues for patients undergoing treatment for head and neck cancer. In this study, we investigated the efficacy of a traditional Japanese medicine-Hangeshashinto (TJ-14)-for (chemo)radiation-induced oral mucositis. METHODS Eighty patients who underwent whole neck radiation of >60 Gy with or without chemotherapy (high-dose cisplatin or low-dose docetaxel) were enrolled in this retrospective study; 40 had received TJ-14 during treatment, and 40 had not (controls). Factors related to alleviation of oral mucositis were identified by multivariate logistic regression analysis. Rates of completion of (chemo)radiation treatments were compared between the patients who received TJ-14 and the control group according to the treatment regimen. The comparison of the nutrition status between groups was also performed. RESULTS Multivariate analysis indicated that the use of TJ-14 (p = 0.019), gender (p = 0.024), and primary tumor location (p = 0.028) were significant factors associated with the severity of oral mucositis. TJ-14 was associated with a significantly improved rate of completion of chemoradiation with cisplatin (p = 0.002). In the investigation of nutritional status, only serum albumin was significantly maintained better in the TJ-14 group than the control group in terms of mean change before and after (chemo)radiation (p = 0.024). CONCLUSIONS The present study indicates that TJ-14 is effective for ameliorating oral mucositis induced by (chemo)radiation in patients with head and neck cancers. TJ-14 was associated with improved completion rates of chemoradiation treatments with cisplatin. A randomized controlled trial is necessary to confirm the efficacy of TJ-14 for chemoradiation-induced mucositis in head and neck cancer patients.
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Affiliation(s)
- Taku Yamashita
- Department of Otorhinolaryngology-Head & Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 3598513, Japan,
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197
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Mechanisms of radiation-induced sensorineural hearing loss and radioprotection. Hear Res 2014; 312:60-8. [DOI: 10.1016/j.heares.2014.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 02/12/2014] [Accepted: 03/07/2014] [Indexed: 12/20/2022]
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198
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Amifostine acts upon mitochondria to stimulate growth of bone marrow and regulate cytokines. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014. [PMID: 23852495 DOI: 10.1007/978-1-4614-7411-1_27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Amifostine is a first-line cytoprotective drug used to prevent radiotherapy-induced or chemotherapy-induced injuries. However, its mechanism of action is not well understood. In this study, freshly harvested bone marrow cells were treated with amifostine and analyzed with a series of mitochondrial indices. In vitro results showed that bone marrow cells treated with amifostine 0.5 h before irradiation (0.5 Gy) experienced several benefits, as compared to vehicle controls, including (1) reduced reactive oxygen species levels, which reduced the production of free radicals; (2) better preservation of mitochondria, as indicated by MitoTracker-positive staining and the increased intensity of staining; (3) reduced apoptosis, as demonstrated by Annexin V staining; and (4) a better proliferation rate, as illustrated by MTT assay. Our in vitro studies showed that amifostine-treated mice exhibited (1) higher ATP production; (2) reduced plasma IL-2 levels, suppressing the immune response triggered by radiotoxicity; and (3) enhanced radiation-induced production of granulocyte colony-stimulating factor. All of these processes benefit recovery from radiation-induced damage.
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199
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Greene J, Hennessy B. The role of anthracyclines in the treatment of early breast cancer. J Oncol Pharm Pract 2014; 21:201-12. [DOI: 10.1177/1078155214531513] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We review the use of anthracyclines, their associated cardiotoxicity, and the role of taxanes in the treatment of early breast cancer. The efficacy of anthracyclines has been proven in multiple large cohort trials and meta-analyses. The addition of a taxane to an anthracycline-based regimen in the adjuvant setting has improved the disease-free survival and overall survival in patients with early breast cancer. The use of the monoclonal antibody trastuzumab combined with an anthracycline and taxane regimen has had significant benefit both in disease-free survival and overall survival in patients with human epidermal growth factor receptor 2(HER2)–positive disease. However, the development of significant cardiotoxicity related to anthracyclines and the emergence of newer agents that appear to limit the cardiotoxicity but with similar anticancer efficacy have called the role of anthracyclines into doubt. Taxane/trastuzumab-based chemotherapy without anthracyclines is now a widely accepted adjuvant regimen in patients with HER2–positive early breast cancer. Indeed, the use of taxanes in early breast cancer has overtaken the use of anthracyclines, particularly in women with HER2–positive breast cancer. Concerns regarding anthracycline cardiotoxicity and positive data from taxane-based regimens likely have contributed to this change in practice. Ongoing trials will determine whether taxane-based chemotherapy has equivalent efficacy to anthracycline-based regimens in adjuvant therapy of HER2–negative early breast cancer. Moving forward, the use of anthracyclines as initial chemotherapy in early breast cancer may continue to be replaced by taxane-based and novel regimens in the future.
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200
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Park S, Yoon J, Bae S, Park M, Kang C, Ke Q, Lee D, Kang PM. Therapeutic use of H2O2-responsive anti-oxidant polymer nanoparticles for doxorubicin-induced cardiomyopathy. Biomaterials 2014; 35:5944-53. [PMID: 24767791 DOI: 10.1016/j.biomaterials.2014.03.084] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 03/28/2014] [Indexed: 11/15/2022]
Abstract
Doxorubicin (DOX) is a commonly used anti-neoplastic agent but its clinical use is limited due to serious hepatic and cardiac side effects. DOX-induced toxicity is mainly associated with overproduction of reactive species oxygen (ROS) such as hydrogen peroxide (H2O2). We have recently developed H2O2-responsive anti-oxidant polymer, polyoxalate containing vanillyl alcohol (PVAX), which is designed to rapidly scavenge H2O2 and release vanillyl alcohol with anti-oxidant, anti-inflammatory and anti-apoptotic properties. In this study, we report that PVAX nanoparticles are novel therapeutic agents for treating DOX-induced cardiac and hepatic toxicity. Intraperitoneal injection of PVAX nanoparticles (4 mg/kg/day) resulted in significant inhibition in apoptosis in liver and heart of DOX-treated mice by suppressing the activation of poly (ADP ribose) polymerase 1 (PARP-1) and caspase-3. PVAX treatment also prevented DOX-induced cardiac dysfunction. Furthermore, survival rate (vehicle = 35% vs. PVAX = 75%; p < 0.05) was significantly improved in a PVAX nanoparticles-treated group compared with vehicle treated groups. Taken together, we anticipate that PVAX nanoparticles could be a highly specific and potent treatment modality in DOX-induced cardiac and hepatic toxicity.
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Affiliation(s)
- Seunggyu Park
- Department of BIN Fusion Technology, Chonbuk National University, Dukjin 664-14, Jeonju, Chonbuk 561-756, South Korea
| | - Jooheung Yoon
- Cardiovascular Institute, Beth Israel Deaconess Medical Center and Harvard Medical School, 3 Blackfan Circle, Boston, MA 02215, USA
| | - Soochan Bae
- Cardiovascular Institute, Beth Israel Deaconess Medical Center and Harvard Medical School, 3 Blackfan Circle, Boston, MA 02215, USA
| | - Minhyung Park
- Department of BIN Fusion Technology, Chonbuk National University, Dukjin 664-14, Jeonju, Chonbuk 561-756, South Korea
| | - Changsun Kang
- Department of BIN Fusion Technology, Chonbuk National University, Dukjin 664-14, Jeonju, Chonbuk 561-756, South Korea
| | - Qingen Ke
- Cardiovascular Institute, Beth Israel Deaconess Medical Center and Harvard Medical School, 3 Blackfan Circle, Boston, MA 02215, USA
| | - Dongwon Lee
- Department of BIN Fusion Technology, Chonbuk National University, Dukjin 664-14, Jeonju, Chonbuk 561-756, South Korea; Polymer Fusion Research Center, Department of Polymer⋅Nano Science and Technology, Chonbuk National University, Dukjin 664-14, Jeonju, Chonbuk 561-756, South Korea.
| | - Peter M Kang
- Department of BIN Fusion Technology, Chonbuk National University, Dukjin 664-14, Jeonju, Chonbuk 561-756, South Korea; Cardiovascular Institute, Beth Israel Deaconess Medical Center and Harvard Medical School, 3 Blackfan Circle, Boston, MA 02215, USA.
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