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Imai C, Saeki H, Yamamoto K, Ichikawa A, Arai M, Tawada A, Suzuki T, Takiguchi Y, Hanazawa T, Ishii I. Radiotherapy plus cetuximab for locally advanced squamous cell head and neck cancer in patients with cisplatin‑ineligible renal dysfunction: A retrospective study. Oncol Lett 2022; 23:152. [PMID: 35836484 PMCID: PMC9258593 DOI: 10.3892/ol.2022.13271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/22/2022] [Indexed: 11/05/2022] Open
Abstract
Clinical trials have not fully demonstrated the efficacy and safety of radiotherapy plus cetuximab for locally advanced squamous cell head and neck cancer (LA-SCCHN) in patients with cisplatin-ineligible renal dysfunction. Patients who received radiotherapy plus cetuximab for LA-SCCHN at Chiba University Hospital (Chiba, Japan) between July 2013 and October 2018 were retrospectively reviewed. Background characteristics and locoregional control and overall survival rates were compared between patients with and without renal dysfunction. Survival was examined using Kaplan-Meier analysis and an adjusted Cox proportional hazards model. Kaplan-Meier analysis demonstrated that overall survival was shorter in patients with creatinine clearance of <45 ml/min (P=0.041; log-rank test). However, there was no difference in the locoregional control rate (P=0.477; log-rank test). Adjusted Cox analysis revealed that the risk of death was increased by 2.52-fold (hazard ratio, 2.52; 95% confidence interval, 1.01-6.30; P=0.048) if creatinine clearance was <45 ml/min. Moderate to severe renal dysfunction did not affect the locoregional control rate in patients with LA-SCCHN treated with radiotherapy plus cetuximab but was an adverse prognostic factor.
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Affiliation(s)
- Chiaki Imai
- Division of Pharmacy, Chiba University Hospital, Chiba, Chiba 260‑8677, Japan
| | - Hiromi Saeki
- Division of Pharmacy, Chiba University Hospital, Chiba, Chiba 260‑8677, Japan
| | - Kohei Yamamoto
- Division of Pharmacy, Chiba University Hospital, Chiba, Chiba 260‑8677, Japan
| | - Ayano Ichikawa
- Division of Pharmacy, Chiba University Hospital, Chiba, Chiba 260‑8677, Japan
| | - Makoto Arai
- Department of Gastroenterology, Tokyo Women's Medical University, Yachiyo Medical Center, Yachiyo, Chiba 276‑8524, Japan
| | - Akinobu Tawada
- Department of Nursing, Faculty of Health Care Sciences, Chiba Prefectural University of Health Sciences, Chiba, Chiba 261‑0014, Japan
| | - Takaaki Suzuki
- Division of Pharmacy, Chiba University Hospital, Chiba, Chiba 260‑8677, Japan
| | - Yuichi Takiguchi
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Chiba 260‑8670, Japan
| | - Toyoyuki Hanazawa
- Department of Otorhinolaryngology/Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba 260‑8670, Japan
| | - Itsuko Ishii
- Division of Pharmacy, Chiba University Hospital, Chiba, Chiba 260‑8677, Japan
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Safety of radiotherapy for hemodialysis patients with cancer. Int J Clin Oncol 2020; 25:978-983. [PMID: 31965416 DOI: 10.1007/s10147-020-01621-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The number of hemodialysis (HD) patients is increasing worldwide, and they are at a higher risk of cancer than the general population. Because HD patients are more likely to have inflammation, radiotherapy (RT)-induced adverse effects (AEs) are theoretically expected to be worse for HD patients. Since only a few reports have been published on this subject, we aimed to evaluate the tolerability of RT in HD patients. METHODS We retrospectively analyzed AEs related to RT for HD patients. Our study included patients from three institutions treated between January 2007 and July 2017. The patient eligibility criteria were (i) receipt of maintenance HD 2-3 times per week for end-stage renal disease prior to the start of RT and (ii) pathologically confirmed malignancies. The endpoints were acute and late non-hematologic AEs. RESULTS The study included 56 patients. The most common histology was head and neck cancer (23%), followed by lung cancer (14%) and prostate cancer (11%). The median radiation dose was 60 (range, 12-93.8) Gy at an equivalent dose in 2-Gy fractions (EQD2). The RT completion rate was 96%. Patients had a median follow-up period after RT of 9.1 (range 0.5-98.1) months. Grade 3 or worse acute and late AEs were noted in 6 (11%) and 3 (7%) patients, respectively. In the acute phase, 2 patients had grade 5 AEs, both of which were infections. CONCLUSION Our results suggest that RT for HD patients is clinically tolerable. However, some patients can experience severe infections related to treatment.
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Management of targeted therapies in cancer patients with chronic kidney disease, or on haemodialysis: An Associazione Italiana di Oncologia Medica (AIOM)/Societa’ Italiana di Nefrologia (SIN) multidisciplinary consensus position paper. Crit Rev Oncol Hematol 2019; 140:39-51. [DOI: 10.1016/j.critrevonc.2019.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 01/06/2023] Open
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Lucas AT, Robinson R, Schorzman AN, Piscitelli JA, Razo JF, Zamboni WC. Pharmacologic Considerations in the Disposition of Antibodies and Antibody-Drug Conjugates in Preclinical Models and in Patients. Antibodies (Basel) 2019; 8:E3. [PMID: 31544809 PMCID: PMC6640706 DOI: 10.3390/antib8010003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 12/11/2022] Open
Abstract
The rapid advancement in the development of therapeutic proteins, including monoclonal antibodies (mAbs) and antibody-drug conjugates (ADCs), has created a novel mechanism to selectively deliver highly potent cytotoxic agents in the treatment of cancer. These agents provide numerous benefits compared to traditional small molecule drugs, though their clinical use still requires optimization. The pharmacology of mAbs/ADCs is complex and because ADCs are comprised of multiple components, individual agent characteristics and patient variables can affect their disposition. To further improve the clinical use and rational development of these agents, it is imperative to comprehend the complex mechanisms employed by antibody-based agents in traversing numerous biological barriers and how agent/patient factors affect tumor delivery, toxicities, efficacy, and ultimately, biodistribution. This review provides an updated summary of factors known to affect the disposition of mAbs/ADCs in development and in clinical use, as well as how these factors should be considered in the selection and design of preclinical studies of ADC agents in development.
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Affiliation(s)
- Andrew T Lucas
- University of North Carolina (UNC), Eshelman School of Pharmacy, Chapel Hill, NC 27599, USA.
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Ryan Robinson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Allison N Schorzman
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Joseph A Piscitelli
- University of North Carolina (UNC), Eshelman School of Pharmacy, Chapel Hill, NC 27599, USA.
| | - Juan F Razo
- University of North Carolina (UNC), Eshelman School of Pharmacy, Chapel Hill, NC 27599, USA.
| | - William C Zamboni
- University of North Carolina (UNC), Eshelman School of Pharmacy, Chapel Hill, NC 27599, USA.
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Lucas AT, Price LSL, Schorzman AN, Storrie M, Piscitelli JA, Razo J, Zamboni WC. Factors Affecting the Pharmacology of Antibody-Drug Conjugates. Antibodies (Basel) 2018; 7:antib7010010. [PMID: 31544862 PMCID: PMC6698819 DOI: 10.3390/antib7010010] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 12/12/2022] Open
Abstract
Major advances in therapeutic proteins, including antibody–drug conjugates (ADCs), have created revolutionary drug delivery systems in cancer over the past decade. While these immunoconjugate agents provide several advantages compared to their small-molecule counterparts, their clinical use is still in its infancy. The considerations in their development and clinical use are complex, and consist of multiple components and variables that can affect the pharmacologic characteristics. It is critical to understand the mechanisms employed by ADCs in navigating biological barriers and how these factors affect their biodistribution, delivery to tumors, efficacy, and toxicity. Thus, future studies are warranted to better understand the complex pharmacology and interaction between ADC carriers and biological systems, such as the mononuclear phagocyte system (MPS) and tumor microenvironment. This review provides an overview of factors that affect the pharmacologic profiles of ADC therapies that are currently in clinical use and development.
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Affiliation(s)
- Andrew T Lucas
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- UNC Eshelman School of Pharmacy, Chapel Hill, NC 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Lauren S L Price
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Allison N Schorzman
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Mallory Storrie
- UNC Eshelman School of Pharmacy, Chapel Hill, NC 27599, USA.
| | | | - Juan Razo
- UNC Eshelman School of Pharmacy, Chapel Hill, NC 27599, USA.
| | - William C Zamboni
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- UNC Eshelman School of Pharmacy, Chapel Hill, NC 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Ebisumoto K, Okami K, Hamada M, Maki D, Sakai A, Saito K, Shimizu F, Kaneda S, Iida M. Cetuximab with radiotherapy as an alternative treatment for advanced squamous cell carcinoma of the temporal bone. Auris Nasus Larynx 2017; 45:637-639. [PMID: 28867454 DOI: 10.1016/j.anl.2017.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/19/2017] [Accepted: 08/09/2017] [Indexed: 12/24/2022]
Abstract
The prognosis of advanced temporal bone cancer is poor, because complete surgical resection is difficult to achieve. Chemoradiotherapy is one of the available curative treatment options; however, its systemic effects on the patient restrict the use of this treatment. A 69-year-old female (who needed peritoneal dialysis) presented at our clinic with T4 left external auditory canal cancer and was treated with cetuximab plus radiotherapy (RT). The primary lesion showed complete response. The patient is currently alive with no evidence of disease two years after completion of the treatment and does not show any late toxicity. This is the first advanced temporal bone cancer patient treated with RT plus cetuximab. Cetuximab plus RT might be a treatment alternative for patients with advanced temporal bone cancer.
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Affiliation(s)
- Koji Ebisumoto
- Department of Otolaryngology-Head Neck Surgery, Tokai University, Isehara, Kanagawa, 259-1193, Japan.
| | - Kenji Okami
- Department of Otolaryngology-Head Neck Surgery, Tokai University, Isehara, Kanagawa, 259-1193, Japan
| | - Masashi Hamada
- Department of Otolaryngology-Head Neck Surgery, Tokai University, Isehara, Kanagawa, 259-1193, Japan
| | - Daisuke Maki
- Department of Otolaryngology-Head Neck Surgery, Tokai University, Isehara, Kanagawa, 259-1193, Japan
| | - Akihiro Sakai
- Department of Otolaryngology-Head Neck Surgery, Tokai University, Isehara, Kanagawa, 259-1193, Japan
| | - Kosuke Saito
- Department of Otolaryngology-Head Neck Surgery, Tokai University, Isehara, Kanagawa, 259-1193, Japan
| | - Fukuko Shimizu
- Department of Otolaryngology-Head Neck Surgery, Tokai University, Isehara, Kanagawa, 259-1193, Japan
| | - Shoji Kaneda
- Department of Otolaryngology-Head Neck Surgery, Tokai University, Isehara, Kanagawa, 259-1193, Japan
| | - Masahiro Iida
- Department of Otolaryngology-Head Neck Surgery, Tokai University, Isehara, Kanagawa, 259-1193, Japan
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Kobayashi M, Endo S, Hamano Y, Imanishi M, Akutsu D, Sugaya A, Ochi D, Moriwaki T, Hyodo I. Successful Treatment with Modified FOLFOX6 and Panitumumab in a Cecal Cancer Patient Undergoing Hemodialysis. Intern Med 2016; 55:127-30. [PMID: 26781010 DOI: 10.2169/internalmedicine.55.5113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Combination chemotherapy of mFOLFOX6 (5-fluorouracil, leucovorin, and oxaliplatin) plus panitumumab, a fully human monoclonal antibody against epidermal growth factor receptor (EGFR), is one of the standard treatments for metastatic colorectal cancer (mCRC) without KRAS mutation. A few reports suggested no need of dose adjustment of cetuximab, a similar chimeric anti-EGFR antibody, in patients with renal impairment. However, panitumumab combined with cytotoxic drugs for hemodialysis patients has not been reported. We herein report a case of a hemodialysis mCRC patient successfully treated with mFOLFOX6 and panitumumab combination therapy.
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Affiliation(s)
- Mariko Kobayashi
- Division of Gastroenterology, University of Tsukuba Hospital, Japan
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Renal toxicity of anticancer agents targeting HER2 and EGFR. J Nephrol 2015; 28:647-57. [DOI: 10.1007/s40620-015-0226-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/08/2015] [Indexed: 01/29/2023]
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Abstract
The use of novel targeted anticancer agents has led to overall improvement in the prognosis of many patients affected by various malignancies, but has also been associated with an increased risk of poorly characterized toxic effects to different organs, including the kidneys. The high prevalence of kidney impairment in the general population complicates the issue further. Nephrologists most frequently work with patients with cancer when they are asked to investigate kidney function to assess the need for dose adjustments in anticancer therapy. A thorough knowledge of the renal safety profile of novel life-prolonging anticancer therapies, specific features of their metabolism, and pharmacokinetic and pharmacodynamic properties (under normal circumstances as well as in the setting of renal replacement therapy) is, therefore, necessary to preserve kidney function as far as possible and to ensure optimum treatment. In this Review we summarize the present knowledge of renal toxic effects from novel targeted anticancer agents and discuss whether the management of patients' treatment needs to be modified. We also advocate the development of a new onconephrology subspeciality.
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Krens LL, Baas JM, Verboom MC, Paintaud G, Desvignes C, Guchelaar HJ, Gelderblom H. Pharmacokinetics and safety of cetuximab in a patient with renal dysfunction. Cancer Chemother Pharmacol 2014; 73:1303-6. [DOI: 10.1007/s00280-014-2462-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/25/2014] [Indexed: 11/27/2022]
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Colorectal cancer patient on maintenance dialysis successfully treated with cetuximab. Anticancer Drugs 2014; 25:120-2. [DOI: 10.1097/cad.0000000000000025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Meibohm B, Zhou H. Characterizing the impact of renal impairment on the clinical pharmacology of biologics. J Clin Pharmacol 2012; 52:54S-62S. [PMID: 22232754 DOI: 10.1177/0091270011413894] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Similar to small-molecule drugs, there is also concern for protein-based therapeutics about their clinical use in patients with renal impairment including renal insufficiency and end-stage renal disease, which may modulate the efficacy and/or safety profile of these compounds. Theoretical considerations and clinical evidence suggest that the kidneys play a relevant role in the catabolism and thus elimination of only those protein therapeutics that have a size below the cutoff for glomerular filtration of approximately 60 kDa. Thus, the effect of renal impairment on protein therapeutics seems to be predictable and only relevant for compounds below this molecular weight cutoff. This is supported by clinical evidence that shows a lack of effect of renal impairment on large proteins such as monoclonal antibodies, whereas smaller proteins below the cutoff such as interleukin-10, growth hormone, erythropoietin, and anakinra experience a gradual decrease of their clearance and increase of their systemic exposure with increasing severity of renal impairment. Thus, dedicated renal impairment studies are warranted in the clinical development program of protein therapeutics that undergo glomerular filtration to establish the scientific rationale for their safe and efficacious use in patients with renal insufficiency.
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Affiliation(s)
- Bernd Meibohm
- College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Memphis, TN 38163, USA.
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Abstract
INTRODUCTION The increased incidence of cancer in dialysis patients has been discussed since the mid 1970s. Furthermore, the emergence of targeted therapies (TT) requires oncologists, nephrologists and pharmacists to question themselves about the handling of these new classes of drugs in dialysis patients. While the cytotoxic drugs have been used in oncology for a long time, these new molecules are recent and clinical studies on their management in dialysis patients are missing. METHODS We reviewed the international literature on the pharmacokinetics, efficacy, tolerance and dosage adjustment of TT used in hemodialysis cancer patients, using the following keywords: kidney; renal; dialysis; hemodialysis; end-stage renal disease and the name of each drug. RESULTS As described for cytotoxic drugs, there are only case reports or series published in the international literature. However, it is possible to propose some recommendations on TT handling in dialysis patients. It is not necessary to adapt the dose of monoclonal antibodies in dialysis patients. But it is important to considerer that this "class effect" is not true for all the other classes of drugs. In fact, the pharmacokinetic of tyrosine kinase inhibitors varies from drug to drug. CONCLUSION The use of TT is possible in dialysis patients. However, many drugs require special attention in dialysis. In addition, because these drugs are new, it is important that oncologists, nephrologists, and pharmacists remain up to date about the management of TT in dialysis patients.
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