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Hall EA, Hagemann TM, Shelton CM, Jasmin HM, Calvasina AN, Anghelescu DL. A Narrative Review of Pain in Pediatric Oncology: The Opioid Option. Paediatr Drugs 2024:10.1007/s40272-024-00640-y. [PMID: 38954225 DOI: 10.1007/s40272-024-00640-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/04/2024]
Abstract
Opioid therapy is the mainstay for managing pain in pediatric oncology. This narrative review describes the current literature regarding opioids for pediatric cancer pain. The review explores the multifaceted landscape of opioid utilization in this population, including the role of opioids in certain clinical circumstances, modalities of opioid delivery, unique opioids, outpatient and at-home pain management strategies, and other key concepts such as breakthrough pain. This review highlights the importance of individualized dosing and multimodal approaches to enhance efficacy and minimize adverse effects. Drawing from a wide range of evidence, this review offers insights to optimize pediatric oncology pain management.
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Affiliation(s)
- Elizabeth A Hall
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Tracy M Hagemann
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Nashville, TN, USA
| | - Chasity M Shelton
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Hilary M Jasmin
- Health Sciences Library, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alexis N Calvasina
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Doralina L Anghelescu
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
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Kwan KR, Skokan S, Blesh-Boren T, Vogel J, Harter N, Ford JB. Chemotherapeutic metabolism presenting as a recalcitrant case of hand-foot syndrome and mucositis. J Oncol Pharm Pract 2024; 30:584-588. [PMID: 38204187 DOI: 10.1177/10781552241226595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Mercaptopurine (6MP) and methotrexate (MTX) are commonly used for maintenance chemotherapy for acute lymphoblastic leukemia (ALL). These medications have been associated with various side effects such as myelosuppression, colitis, and thyroiditis in addition to numerous cutaneous adverse events. Cutaneous side-effects most reported include mucositis, alopecia, xerosis, and pruritus. We report an interesting case of hand-foot syndrome to 6MP in a child on maintenance therapy for B-cell ALL from an alteration in medication metabolism. CASE We report a 10-year-old male on maintenance chemotherapy for pre-Bcell ALL who presented to the hospital with worsening oral lesions and erythematous, fissured plaques on the palms and soles. Maintenance therapy consisted of IV vincristine and 5-day pulse of steroids every 12 weeks, daily 6MP, and weekly MTX, which were increased to ≥ 150% of standard dosing due to persistent absolute neutrophil counts > 1500. Metabolites obtained on admission demonstrated elevated 6MMP metabolites at 35,761 (normal < 5700). TPMT and NUDT15 enzyme activity were normal and no alterations in genotyping were discovered. OUTCOME Patient's oral chemotherapy, including both 6MP and MTX, were stopped and allopurinol 100 mg daily was initiated, which lead to overall improvement. DISCUSSION Clinical findings of acute mucositis and worsening of hand-foot syndrome, in the setting of inadequate myelosuppression in a child on maintenance therapy for ALL should raise concerns to consider altered metabolism pathway leading to toxic metabolite buildup. Allopurinol can play in improving cutaneous manifestation and chemotherapeutic dosing in patients with altered metabolism.
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Affiliation(s)
- Kevin R Kwan
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shayna Skokan
- Creighton University School of Pharmacy, Omaha, NE, USA
| | | | | | - Nicole Harter
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
- Children's Nebraska, Omaha, NE, USA
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Abdul Kareem S, Joseph SG, Wilson A, Kareem SA, Kunjumon Vilapurathu J. Incidence and severity of hand-foot syndrome in cancer patients receiving infusional 5-fluorouracil or oral capecitabine-containing chemotherapy regimens. J Oncol Pharm Pract 2024:10781552241228175. [PMID: 38263642 DOI: 10.1177/10781552241228175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND Hand-foot syndrome is a common adverse effect of 5-fluorouracil infusion or oral capecitabine. Several types of research have shown that clinical presentations of hand-foot syndrome vary by ethnicity, so we tried to look at the incidence and severity of hand-foot syndrome in individuals receiving infusional 5-fluorouracil or oral capecitabine at a tertiary care hospital in central Kerala, India. AIM To determine the incidence and severity of hand-foot syndrome in cancer patients receiving infusional 5-fluorouracil or oral capecitabine chemotherapy regimen. METHODOLOGY A prospective cohort study was conducted at the oncology department of a tertiary care hospital in Kerala, India. Our study subjects were those who underwent chemotherapy with infusional 5-fluorouracil or oral capecitabine and later developed hand-foot syndrome. The patients who developed hand-foot syndrome after chemotherapy were assessed to determine the incidence of hand-foot syndrome. Also, the severity of hand-foot syndrome among cancer patients was estimated using CTCAE version 5.0. RESULTS Out of 104 study participants, 76.90% (N = 80) of the patients had hand-foot syndrome, whereas 23.07% (N = 24) did not. The onset of hand-foot syndrome symptoms varied depending on the patient. Most patients (60%) displayed grade-one symptoms in their third cycle. The remaining patients showed grade-one symptoms in cycle one (3.75%), cycle two (17.5%), and cycle four (18.75%). The study also showed t no association between the incidence of hand-foot syndrome and the type of regimen. CONCLUSION The majority of the patients suffered from hand-foot syndrome. As well, most of the patients were afflicted by grade one hand-foot syndrome.
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Affiliation(s)
- Sulaikha Abdul Kareem
- Department of Pharmacy Practice, Nirmala College of Pharmacy, Muvattupuzha, KL, India
| | - Simi Grace Joseph
- Department of Pharmacy Practice, Nirmala College of Pharmacy, Muvattupuzha, KL, India
| | - Aneena Wilson
- Department of Pharmacy Practice, Nirmala College of Pharmacy, Muvattupuzha, KL, India
| | - Shahnaz Abdul Kareem
- Department of Pharmacy Practice, Nirmala College of Pharmacy, Muvattupuzha, KL, India
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Parisi R, Shah H, Shear NH, Ziv M, Markova A, Dodiuk-Gad RP. A Review of Bullous Dermatologic Adverse Events Associated with Anti-Cancer Therapy. Biomedicines 2023; 11:biomedicines11020323. [PMID: 36830860 PMCID: PMC9953054 DOI: 10.3390/biomedicines11020323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
The rapid evolution of anti-cancer therapy (including chemotherapy, targeted therapy, and immunotherapy) in recent years has led to a more favorable efficacy and safety profile for a growing cancer population, and the improvement of overall survival and reduction of morbidity for many cancers. Anti-cancer therapy improves outcomes for cancer patients; however, many classes of anti-cancer therapy have been implicated in the induction of bullous dermatologic adverse events (DAE), leading to reduced patient quality of life and in some cases discontinuation of life-prolonging or palliative therapy. Timely and effective management of adverse events is critical for reducing treatment interruptions and preserving an anti-tumor effect. Bullous DAE may be limited to the skin or have systemic involvement with greater risk of morbidity and mortality. We present the epidemiology, diagnosis, pathogenesis, and management of bullous DAE secondary to anti-cancer therapies to enable clinicians to optimize management for these patients.
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Affiliation(s)
- Rose Parisi
- Albany Medical College, Albany, NY 12208, USA
| | - Hemali Shah
- Albany Medical College, Albany, NY 12208, USA
| | - Neil H. Shear
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Michael Ziv
- Department of Dermatology, Emek Medical Center, Afula 1834111, Israel
| | - Alina Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
- Weill Cornell Medical College, Cornell University, New York, NY 10021, USA
- Correspondence:
| | - Roni P. Dodiuk-Gad
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Dermatology, Emek Medical Center, Afula 1834111, Israel
- Department of Dermatology, Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa 3525433, Israel
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Mathiyazhagan G, Aggarwal S, Chauhan P, Gupta A, Kashyap R. High-Dose Methotrexate-Induced Dermatological Eruption: A Rare Manifestation of Chemotoxicity. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1748939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Gopinathan Mathiyazhagan
- Department of Haematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shilpi Aggarwal
- Department of Haematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priyanka Chauhan
- Department of Haematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anshul Gupta
- Department of Haematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajesh Kashyap
- Department of Haematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Whorton AE, Razzak AN, Jha P. Hand-Foot Syndrome Presentation Post-Capecitabine Treatment in a Black Patient. Cureus 2022; 14:e26891. [PMID: 35978746 PMCID: PMC9375837 DOI: 10.7759/cureus.26891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/30/2022] Open
Abstract
Palmar-plantar erythrodysesthesia, commonly known as hand-foot syndrome (HFS), is a side-effect of cancer chemotherapeutic agents such as capecitabine. Patients with HFS oftentimes present with palmoplantar numbness, tingling, burning pain, and/or hyperpigmentation; in advanced grades, blistering and ulceration may occur. In this article, we present the case of a Black patient with grade 1 HFS post-capecitabine treatment for metastasized breast cancer. Prompt recognition for atypical HFS symptom presentation in people of color and discontinuation of capecitabine with supportive treatment can prevent progression to grade 2+ HFS that limits activities of daily living (ADLs).
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Zaiem A, Hammamia SB, Aouinti I, Charfi O, Ladhari W, Kastalli S, Aidli SE, Lakhoua G. Hand-foot syndrome induced by chemotherapy drug: Case series study and literature review. Indian J Pharmacol 2022; 54:208-215. [PMID: 35848692 PMCID: PMC9396690 DOI: 10.4103/ijp.ijp_175_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Chemotherapy drugs can be responsible of several side effects such as hand-foot syndrome (HFS). This syndrome is also called "palmar-plantar erythrodysesthesia" and "acral erythema." Without proper management, it can deteriorate the quality of life of a patient, leading to temporary or definitive stop of chemotherapy. AIM OF THIS STUDY To identify the epidemiological and clinical characteristics of patients, the risk factors for occurrence and worsening of this syndrome, and the drugs most likely to be responsible of HFS. METHODS Our study was retrospective, including 42 patients with HFS secondary to a chemotherapy drug. These cases were notified to the National Center of Pharmacovigilance over 7 years. The severity of HFS has been classified according to the NCI-CTCAE v4.0 classification. RESULTS Our population was composed of 40 women and 2 men. The mean age was 51 years. Docetaxel was the main drug associated with this adverse effect. Hands were involved in all cases and were sometimes associated with other skin surfaces apart from feet. Erythema of the hands and/or feet was present in all patients; it was associated with edema in more than half of the cases. The distribution of different grades according to the NCI-CTCAE classification among the patients was almost equal: 28% Grade 1, 36% Grade 2, and 36% Grade 3. HFS occurred mainly after the first course of chemotherapy with a mean period of 3-4 days. The regression of HFS occurred more rapidly for Grade 1 and Grade 2 compared with Grade 3, especially when assisted by symptomatic treatment. The recurrence rate of HFS for those patients with decreased doses, spacing of cures, and/or symptomatic and prophylaxis treatment was 25%. CONCLUSION An early detection of HFS, associated with preventive measures, enables patients to continue the chemotherapy.
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Affiliation(s)
- Ahmed Zaiem
- Department of Collection and Analysis of Adverse Drug Events, National Center Chalbi Belkahia of Pharmacovigilance, Tunis, Tunisia,Research Unit UR17ES12, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia,Address for correspondence: Dr. Ahmed Zaiem, National Center of Pharmacovigilance, 9 Avenue du Dr Zouhaier Essafi 1006, Tunis, Tunisia. E-mail:
| | - Syrine Ben Hammamia
- Department of Collection and Analysis of Adverse Drug Events, National Center Chalbi Belkahia of Pharmacovigilance, Tunis, Tunisia,Research Unit UR17ES12, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Imen Aouinti
- Department of Collection and Analysis of Adverse Drug Events, National Center Chalbi Belkahia of Pharmacovigilance, Tunis, Tunisia,Research Unit UR17ES12, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Ons Charfi
- Department of Collection and Analysis of Adverse Drug Events, National Center Chalbi Belkahia of Pharmacovigilance, Tunis, Tunisia,Research Unit UR17ES12, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Walid Ladhari
- Research Unit UR17ES12, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Sarrah Kastalli
- Department of Collection and Analysis of Adverse Drug Events, National Center Chalbi Belkahia of Pharmacovigilance, Tunis, Tunisia,Research Unit UR17ES12, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Sihem El Aidli
- Department of Collection and Analysis of Adverse Drug Events, National Center Chalbi Belkahia of Pharmacovigilance, Tunis, Tunisia,Research Unit UR17ES12, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Ghozlane Lakhoua
- Department of Collection and Analysis of Adverse Drug Events, National Center Chalbi Belkahia of Pharmacovigilance, Tunis, Tunisia,Research Unit UR17ES12, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
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Kuo DJ, Spies JM, Le Floch N, Wong V. Ultraviolet recall due to cytarabine chemotherapy for acute myeloid leukaemia. BMJ Case Rep 2021; 14:e246596. [PMID: 34848424 PMCID: PMC8634239 DOI: 10.1136/bcr-2021-246596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Dennis John Kuo
- Pediatric Hematology-Oncology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Jeanie Marie Spies
- Pediatric Hematology-Oncology, Rady Children's Hospital San Diego, San Diego, California, USA
| | - Nathalie Le Floch
- Pediatric Hematology-Oncology, Rady Children's Hospital San Diego, San Diego, California, USA
| | - Victor Wong
- Pediatric Hematology-Oncology, University of California San Diego School of Medicine, La Jolla, California, USA
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Sous D, Armstrong AE, Huang JT, Shah S, Carlberg VM, Coughlin CC. Cutaneous reactions to pediatric cancer treatment: Part I. Conventional chemotherapy. Pediatr Dermatol 2021; 38:8-17. [PMID: 33170534 DOI: 10.1111/pde.14418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Chemotherapies often cause side effects of the skin, nails, and mucosal surfaces. These mucocutaneous toxicities contribute to morbidity and affect quality of life. Identification and management of these drug-induced eruptions is vital to allow for continuation of essential therapies. This review demonstrates the wide range of chemotherapy-induced cutaneous toxicities in children and includes clues for diagnosis as well as tips for counseling and management.
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Affiliation(s)
- Dana Sous
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Amy E Armstrong
- Division of Pediatric Oncology, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.,St. Louis Children's Hospital, St. Louis, MO, USA
| | - Jennifer T Huang
- Dermatology Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sonal Shah
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Valerie M Carlberg
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Carrie C Coughlin
- St. Louis Children's Hospital, St. Louis, MO, USA.,Division of Dermatology, Departments of Medicine and Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Chauhan P, Gupta A, Kumar S, Bishnu A, Nityanand S. Palmar‐plantar erythrodysesthesia associated with high‐dose methotrexate: Case report. Cancer Rep (Hoboken) 2020; 3:e1270. [DOI: 10.1002/cnr2.1270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Priyanka Chauhan
- Department of Hematology Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow India
| | - Anshul Gupta
- Department of Hematology Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow India
| | - Sujeet Kumar
- Department of Hematology Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow India
| | - Arijit Bishnu
- Department of Hematology Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow India
| | - Soniya Nityanand
- Department of Hematology Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow India
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Wang J, Ying YY, Chen ZH, Shao KD, Zhang WP, Lin SY. Guilu Erxian Glue () Inhibits Chemotherapy-Induced Bone Marrow Hematopoietic Stem Cell Senescence in Mice May via p16 INK4a-Rb Signaling Pathway. Chin J Integr Med 2020; 26:819-824. [PMID: 32915425 DOI: 10.1007/s11655-020-3098-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the effect of Guilu Erxian Glue (, GEG) on cyclophosphamide (CTX)-induced bone marrow hematopoietic stem cells (HSCs) senescence in mice and explore the underlying mechanism. METHODS The H22 liver cancer ascites lump model was established in male Kunming mice by injecting intraperitoneally (i.p.) with 5 × 106/mL H22 cells per mouse. Fifty tumor-bearing mice were divided into the control, model, pifithrin-α, GEG, and GEG+pifithrin-α groups using a random number table, 10 mice in each group. CTX (100 mg/kg i.p.) was administrated to mice from day 1 to day 3 (d1-d3) continuously except for the control group. The mice in the pifithrin-α, GEG and GEG+pifithrin-α groups were treated with pifithrin-α (2.2 mg/(kg·d) i.p.) for 6 consecutive days (d4-d9), GEG (9.5 g/(kg·d) i.p.) for 9 consecutive days (d1-d9), and GEG plus pifithrin-α, respectively. HSCs were collected after 9-d drug treatment. The anti-aging effect of GEG was studied by cell viability, cell cycle, and β -galactosidase (β -gal) assays. The mRNA and protein expressions of cyclin-dependent kinase 2 (CDK2), CDK4, inhibitor of cyclin-dependent kinase 4a encoding the tumor suppressor protein p16 (p16INK4a), p21Cip1/Waf1, p53, and phosphorylated retinoblastoma (pRb) were evaluated by quantitative real-time reverse transcription-polymerase chain reaction and semi-quantitative Western blot, respectively. RESULTS Compared with the model group, GEG increased cell viability as well as proliferation (P<0.05 or P<0.01) and reduced β -gal expression. Furthermore, GEG significantly decreased the expressions of p16INK4a, p53 and p21Cip1/Waf1 proteins, and increased the expressions of CDK2, CDK4 and pRb proteins compared with the model group (P<0.05 or P<0.01). CONCLUSION GEG can alleviate CTX-induced HSCs senescence in mice, and the p16INK4a-Rb signaling pathway might be the underlying mechanism.
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Affiliation(s)
- Jue Wang
- Department of Oncology, the Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, China
| | - Yin-Yin Ying
- Department of Oncology, the Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, China
| | - Zhao-Hui Chen
- Department of Oncology, Ningbo Forth Hospital, Ningbo, Zhejiang Province, 315700, China
| | - Ke-Ding Shao
- Science Research Department, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Wei-Ping Zhang
- Department of Oncology, the Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, China
| | - Sheng-You Lin
- Department of Oncology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, 310007, China.
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Liu R, Jiang Y, Hu X, Wu J, Jiang W, Jin G, Luan Y. A preclinical evaluation of cytarabine prodrug nanofibers assembled from cytarabine-lauric acid conjugate toward solid tumors. Int J Pharm 2018; 552:111-118. [PMID: 30268848 DOI: 10.1016/j.ijpharm.2018.09.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/30/2018] [Accepted: 09/17/2018] [Indexed: 12/20/2022]
Abstract
Cytarabine (Ara-C) has become cornerstones for the treatment of hatmatological malignancies for several decades; however, it still faces serious challenges in clinical applications due to its side effects such as hand foot syndrome (HFS) and stomatitis. Therefore, considerable researchers have devoted to looking for the new derivative with desirable activity and low toxicity. A new prodrug based on the conjugation of cytarabine with lauric acid (LA-Ara) was synthesized in our group, and it could self-assemble into nanofibers (NFs) in aqueous solution with high drug loading (57 wt%). The lauric acid moiety protects NH2 group of from the enzymatic attachment and simultaneously raises the lipophilicity of Ara-C, thus obviously prolongs its plasma half-life. The oil/water partition coefficient (lg P) and the permeability of cell membrane of LA-Ara were obviously increased compared with Ara-C. Furthermore, the in vitro gastrointestinal stability results indicated the prodrug was suitable to be administrated orally. In the current study, the in vitro cytotoxicity and in vivo anti breast cancer experimental results indicate LA-Ara markedly improved antitumor activity compared with free Ara-C. The favorable safety evaluations elucidated its potentiality for oral alternative treatment to Ara-C. Importantly, LA-Ara can effectively decrease the incidence of toxic effects (HFS and stomatitis) of Ara-C, thereby exhibiting favorable skin safety profile. Overall, these results indicated the LA-Ara would be an excellent candidate for further clinical investigation and simultaneously highlight the prospects of Ara-C prodrug strategies in solid tumors therapy.
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Affiliation(s)
- Ruiling Liu
- School of Pharmaceutical Science, Key Laboratory of Chemical Biology, Ministry of Education, Shandong University, 44 West Wenhua Road, Jinan 250012, PR China
| | - Yue Jiang
- School of Pharmaceutical Science, Key Laboratory of Chemical Biology, Ministry of Education, Shandong University, 44 West Wenhua Road, Jinan 250012, PR China
| | - Xu Hu
- School of Pharmaceutical Science, Key Laboratory of Chemical Biology, Ministry of Education, Shandong University, 44 West Wenhua Road, Jinan 250012, PR China
| | - Jilian Wu
- School of Pharmaceutical Science, Key Laboratory of Chemical Biology, Ministry of Education, Shandong University, 44 West Wenhua Road, Jinan 250012, PR China
| | - Wei Jiang
- School of Pharmaceutical Science, Key Laboratory of Chemical Biology, Ministry of Education, Shandong University, 44 West Wenhua Road, Jinan 250012, PR China
| | - Guoxia Jin
- College of Chemistry, Chemical Engineering and Materials Science, Shandong Normal University, Jinan 250014, PR China
| | - Yuxia Luan
- School of Pharmaceutical Science, Key Laboratory of Chemical Biology, Ministry of Education, Shandong University, 44 West Wenhua Road, Jinan 250012, PR China.
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