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Fufa D, Mdoka C, Ayalew M, Khofi H, Amankwah E, Chokwenda N, Mezgebu E, Mavinkurve-Groothuis AMC, Kamiza S, Chikaphonya-Phiri B, Wassie M, Atwiine B, Branchard M, Gorostegui M, Parkes J, Kudowa E, Eklu B, Jator B, Renner LA, Borgstein E, Molyneux E, Kouya F, Pritchard-Jones K, Paintsil V, Chitsike I, Chagaluka G, Israels T. Effectiveness of a Wilms tumour treatment guideline adapted to local circumstances in sub-Saharan Africa: A report from Wilms Africa Phase II-CANCaRe Africa. Pediatr Blood Cancer 2024; 71:e31300. [PMID: 39198982 DOI: 10.1002/pbc.31300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/05/2024] [Accepted: 08/18/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Wilms tumour (WT) is one of the cancer types targeted by the Global Initiative for Childhood Cancer (GICC). The objective of this study was to describe the outcomes of Wilms Africa Phase II in sub-Saharan Africa. METHODS Wilms Africa Phase II used a comprehensive WT treatment protocol in a multi-centre, prospective study conducted in eight hospitals in Ethiopia (2), Ghana (2), Malawi, Cameroon, Zimbabwe and Uganda. Eligibility criteria were: age younger than 16 years, unilateral WT, diagnosed between 1 January 2021 and 31 December 2022. RESULTS We included 230 WT patients, median age 3 years, 53% male. Median maximum tumour diameter at diagnosis was 13.6 cm and 33% of patients had metastatic disease. Nephrectomy was performed in 71% of patients, of whom 21% had a tumour rupture. Two-year event-free survival (EFS) was 41.3% ± 3.9% after a median follow-up of 17 months (range: 1-33 months), with treatment abandonment considered an event. Treatment abandonment occurred in 26% and death during treatment in 14%. Disease relapse occurred in 10%. Two-year EFS of the 26 patients who received radiotherapy was 64.5% ± 9.7% with no reported disease relapse. CONCLUSION Patients continue to present late with advanced WT in sub-Saharan Africa, and their survival is below the 60% GICC target. Prevention of treatment abandonment and treatment-related mortality remain important. Earlier diagnosis and access to radiotherapy are expected to decrease disease-related mortality.
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Affiliation(s)
- Diriba Fufa
- Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Cecilia Mdoka
- CANCaRe Africa, The Collaborative African Network for Childhood Cancer Care and Research, Blantyre, Malawi
| | - Mulugeta Ayalew
- Unit of Pediatric Hematology Oncology, University of Gondar Specialized Hospital, Gondar, Ethiopia
| | - Harriet Khofi
- CANCaRe Africa, The Collaborative African Network for Childhood Cancer Care and Research, Blantyre, Malawi
- Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | | | - Nester Chokwenda
- College of Health Sciences, Child and Adolescent Health, University of Zimbabwe, Harare, Zimbabwe
| | | | | | - Steve Kamiza
- Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | | | - Mulugeta Wassie
- Unit of Pediatric Hematology Oncology, University of Gondar Specialized Hospital, Gondar, Ethiopia
| | | | | | - Maite Gorostegui
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - Evaristar Kudowa
- Department of Statistics, Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
| | - Bernice Eklu
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Brian Jator
- Paediatrics, Mbingo Baptist Hospital, Mbingo, Cameroon
| | | | - Eric Borgstein
- Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Elizabeth Molyneux
- Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | | | | | - Vivian Paintsil
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Inam Chitsike
- College of Health Sciences, Child and Adolescent Health, University of Zimbabwe, Harare, Zimbabwe
| | - George Chagaluka
- Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Trijn Israels
- CANCaRe Africa, The Collaborative African Network for Childhood Cancer Care and Research, Blantyre, Malawi
- Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
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Chen S, Wan Z, Hu S, Bu W, Lu Y, Zhao Z. Effect of radiation after surgery on the prognosis of children with Wilms tumor. PLoS One 2024; 19:e0308824. [PMID: 39298401 DOI: 10.1371/journal.pone.0308824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 07/31/2024] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND To explore the association between radiation after surgery and the 5-year overall survival (OS) and 5-year cancer-specific survival (CSS) in patients with Wilms tumor. METHODS In this cohort study, 1564 participants were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The univariate and multivariable COX proportional risk model as well as competitive risk model were used to explore the covariates associated with 5-year OS and 5-year CSS of patients with Wilms tumor and the correlation between radiation after surgery and 5-year OS or 5-year CSS of patients with Wilms tumor, respectively. The Kaplan-Meier curves of participants were plotted. RESULTS The median follow-up was 126.00 (84.00, 178.00) months. Patients receiving surgery had higher 5-year survival probability than those not receiving surgery, while participants receiving radiation after surgery showed poor 5-year survival than those not. After adjusting for covariates including age and SEER stage, increased risk of 5-year overall mortality in patients with Wilms tumor [hazard ratio (HR) = 1.62, 95% confidence interval (CI): 1.10-2.41). After the adjustment for confounding factors including age, SEER stage and ethnicity, increased risk of 5-year cancer-specific mortality of patients with Wilms tumor was observed in those receiving radiation after surgery (HR = 1.77, 95%CI: 1.13-2.79). CONCLUSION Radiation after surgery was associated with poor prognosis of patients with Wilms tumor, which indicated that the clinicians should assess whether the patient was suitable for using radiation after surgery.
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Affiliation(s)
- Songqiang Chen
- Department of Urology, Hainan Women and Children's Medical Center, Haikou, Hainan, China
| | - Zhisheng Wan
- Department of Urology, Hainan Women and Children's Medical Center, Haikou, Hainan, China
| | - Shaohua Hu
- Department of Urology, Hainan Women and Children's Medical Center, Haikou, Hainan, China
| | - Weizhen Bu
- Department of Urology, Hainan Women and Children's Medical Center, Haikou, Hainan, China
| | - Yiqun Lu
- Department of Urology, Children's Hospital of Fudan University, Shanghai, China
| | - Zhenli Zhao
- Department of Urology, Hainan Women and Children's Medical Center, Haikou, Hainan, China
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Uittenboogaard A, van de Velde M, van de Heijden L, Mukuhi L, de Vries N, Langat S, Olbara G, Huitema ADR, Vik T, Kaspers G, Njuguna F. Vincristine exposure in Kenyan children with cancer: CHAPATI feasibility study. Pediatr Blood Cancer 2024; 71:e31160. [PMID: 38956809 DOI: 10.1002/pbc.31160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 07/04/2024]
Abstract
The low incidence of vincristine-induced peripheral neuropathy (VIPN) in Kenyan children may result from low vincristine exposure. We studied vincristine exposure in Kenyan children and dose-escalated in case of low vincristine exposure (NCT05844670). Average vincristine exposure was high. Individual vincristine exposure was assessed with a previously developed nomogram. A 20% dose increase was recommended for participants with low exposure and no VIPN, hyperbilirubinemia, or malnutrition. None of the 15 participants developed VIPN. Low vincristine exposure was seen in one participant: a dose increase was implemented without side effects. In conclusion, the participants did not develop VIPN despite having high vincristine exposure.
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Affiliation(s)
- Aniek Uittenboogaard
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Mirjam van de Velde
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lisa van de Heijden
- Department of Pharmacy & Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Clinical Pharmacy, OLVG, Amsterdam, The Netherlands
| | - Leah Mukuhi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Niels de Vries
- Department of Pharmacy & Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sandra Langat
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Gilbert Olbara
- Department of Child Health and Paediatrics, Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Alwin D R Huitema
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pharmacy & Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Terry Vik
- Pediatric Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gertjan Kaspers
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Festus Njuguna
- Department of Child Health and Paediatrics, Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
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Atwiine B, Mdoka C, Branchard M, Chagaluka G, Fufa D, Ayalew M, Khofi H, Amankwah E, Chokwenda N, Birhane F, Mezgebu E, Eklu B, Jator B, Kudowa E, Mbah G, Wassie M, Dondo V, Paintsil V, Pritchard-Jones K, Renner LA, Sung L, Kouya F, Molyneux E, Chitsike I, Israels T. Prevention of treatment abandonment remains an important challenge to increase survival of Wilms tumor in sub-Saharan Africa: A report from Wilms Africa-CANCaRe Africa. Pediatr Blood Cancer 2024; 71:e31069. [PMID: 38773703 DOI: 10.1002/pbc.31069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/21/2024] [Accepted: 04/29/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND The Wilms Africa studies implemented an adapted Wilm's tumor (WT) treatment protocol in sub-Saharan Africa in two phases. Phase I began with four sites and provided out-of-pocket costs. Phase II expanded the number of sites, but lost funding provision. Objective is to describe the outcomes of Phase II and compare with Phase I. METHODS Wilms Africa Phase I (n = 4 sites; 2014-2018) and Phase II (n = 8 sites; 2021-2022) used adapted treatment protocols. Funding for families' out-of-pocket costs was provided during Phase I but not Phase II. Eligibility criteria were age less than 16 years and newly diagnosed unilateral WT. We documented patients' outcome at the end of planned first-line treatment categorized as treatment abandonment, death during treatment, and disease-related events (death before treatment, persistent disease, relapse, or progressive disease). Sensitivity analysis compared outcomes in the same four sites. RESULTS We included 431 patients in Phase I (n = 201) and Phase II (n = 230). The proportion alive without evidence of disease decreased from 69% in Phase I to 54% in Phase II at all sites (p = .002) and 58% at the original four sites (p = .04). Treatment abandonment increased overall from 12% to 26% (p < .001), and was 20% (p = .04) at the original four sites. Disease-related events (5% vs. 6% vs. 6%) and deaths during treatment (14% vs. 14% vs. 17%) were similar. CONCLUSION Provision of out-of-pocket costs was important to improve patient outcomes at the end of planned first-line treatment in WT. Prevention of treatment abandonment remains an important challenge.
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Affiliation(s)
| | - Cecilia Mdoka
- The Collaborative African Network for Childhood Cancer Care and Research, CANCaRe Africa, Blantyre, Malawi
| | | | - George Chagaluka
- Paediatrics and Child Health, Kamuzu University of Health sciences (KUHES), Blantyre, Malawi
| | - Diriba Fufa
- Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Mulugeta Ayalew
- Unit of Pediatric Hematology Oncology, University of Gondar Specialized Hospital, Gondar, Ethiopia
| | - Harriet Khofi
- The Collaborative African Network for Childhood Cancer Care and Research, CANCaRe Africa, Blantyre, Malawi
- Paediatrics and Child Health, Kamuzu University of Health sciences (KUHES), Blantyre, Malawi
| | | | | | - Feven Birhane
- Unit of Pediatric Hematology Oncology, University of Gondar Specialized Hospital, Gondar, Ethiopia
| | | | - Bernice Eklu
- Paediatric Oncology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Brian Jator
- Paediatrics, Mbingo Baptist Hospital, Mbingo, Cameroon
| | - Evaristar Kudowa
- Department of Statistics, Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
| | - Glenn Mbah
- Paediatrics, Mbingo Baptist Hospital, Mbingo, Cameroon
| | - Mulugeta Wassie
- Unit of Pediatric Hematology Oncology, University of Gondar Specialized Hospital, Gondar, Ethiopia
| | - Vongai Dondo
- Pediatrics, College of Health Sciences, Harare, Zimbabwe
| | - Vivian Paintsil
- Paediatric Oncology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | | | - Lillian Sung
- Sick Children's Hospital, Toronto, Ontario, Canada
| | | | - Elizabeth Molyneux
- Paediatrics and Child Health, Kamuzu University of Health sciences (KUHES), Blantyre, Malawi
| | - Inam Chitsike
- Pediatrics, College of Health Sciences, Harare, Zimbabwe
| | - Trijn Israels
- The Collaborative African Network for Childhood Cancer Care and Research, CANCaRe Africa, Blantyre, Malawi
- Paediatrics and Child Health, Kamuzu University of Health sciences (KUHES), Blantyre, Malawi
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Lemmen J, Mageto S, Njuguna F, Midiwo N, Vik TA, Kaspers G, Mostert S. A caregivers' perspective on social reintegration and stigma of childhood cancer survivors in Kenya. Psychooncology 2024; 33:e6345. [PMID: 38708858 DOI: 10.1002/pon.6345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 04/10/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES Childhood cancer survivors' social reintegration may be hampered in low and middle-income countries. The nature and extent of social challenges and prejudices that survivors encounter in such settings are largely unknown. This study explores caregivers' perspectives on social reintegration and stigmatization of Kenyan childhood cancer survivors. METHODS Caretakers of childhood cancer survivors (<18 years) were interviewed using mixed-methods questionnaires during home or clinic visits between 2021 and 2022. Stigma was assessed with an adjusted Social Impact Scale and risk factors were investigated. RESULTS Caretakers of 54 survivors (median age 11 years) were interviewed. Families' income (93%) decreased since start of treatment. Caretakers (44%) often lost their jobs. Financial struggles (88%) were a burden that provoked conflicts within communities (31%). School fees for siblings became unaffordable (52%). Families received negative responses (26%) and were left or avoided (13%) by community members after cancer disclosure. Survivors and families were discriminated against because the child was perceived fragile, and cancer was considered fatal, contagious, or witchcraft. Survivors repeated school levels (58%) and were excluded from school activities (19%) or bullied (13%). Performance limitations of daily activities (p = 0.019), male sex (p = 0.032), solid tumors (p = 0.056) and a short time since treatment completion (p = 0.047) were associated with increased stigma. Caretakers recommended educational programs in schools and communities to raise awareness about cancer treatment and curability. CONCLUSIONS Childhood cancer survivors and their families experienced difficulties with re-entry and stigmatization in society. Increasing cancer and survivorship awareness in schools and communities should facilitate social reintegration and prevent stigmatization.
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Affiliation(s)
- Jesse Lemmen
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Susan Mageto
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Pharmacology, School of Health Sciences, Kisii University, Kisii, Kenya
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi University, Eldoret, Kenya
| | - Nancy Midiwo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Terry A Vik
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gertjan Kaspers
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Saskia Mostert
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Holmes DM, Matatiyo A, Mpasa A, Huibers MHW, Manda G, Tomoka T, Mulenga M, Namazzi R, Mehta P, Zobeck M, Mzikamanda R, Chintagumpala M, Allen C, Nuchtern JG, Borgstein E, Aronson DC, Ozuah N, Nandi B, McAtee CL. Outcomes of Wilms tumor therapy in Lilongwe, Malawi, 2016-2021: Successes and ongoing research priorities. Pediatr Blood Cancer 2023; 70:e30242. [PMID: 36798020 PMCID: PMC10698850 DOI: 10.1002/pbc.30242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/07/2023] [Accepted: 01/18/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Wilms tumor therapy in low- and middle-income countries (LMICs) relies on treatment protocols adapted to resource limitations, but these protocols have rarely been evaluated in real-world settings. Such evaluations are necessary to identify high-impact research priorities for clinical and implementation trials in LMICs. The purpose of this study was to identify highest priority targets for future clinical and implementation trials in sub-Saharan Africa by assessing outcomes of a resource-adapted treatment protocol in Malawi. METHODS We conducted a retrospective cohort study of children treated for Wilms tumor with an adapted SIOP-backbone protocol in Lilongwe, Malawi between 2016 and 2021. Survival analysis assessed variables associated with poor outcome with high potential for future research and intervention. RESULTS We identified 136 patients, most commonly with stage III (n = 35; 25.7%) or IV disease (n = 35; 25.7%). Two-year event-free survival (EFS) was 54% for stage I/II, 51% for stage III, and 13% for stage IV. A single patient with stage V disease survived to 1 year. Treatment abandonment occurred in 36 (26.5%) patients. Radiotherapy was indicated for 55 (40.4%), among whom three received it. Of these 55 patients, 2-year EFS was 31%. Of 14 patients with persistent metastatic pulmonary disease at the time of nephrectomy, none survived to 2 years. Notable variables independently associated with survival were severe acute malnutrition (hazard ratio [HR]: 1.9), increasing tumor stage (HR: 1.5), and vena cava involvement (HR: 3.1). CONCLUSION High-impact targets for clinical and implementation trials in low-resource settings include treatment abandonment, late presentation, and approaches optimized for healthcare systems with persistently unavailable radiotherapy.
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Affiliation(s)
- David M Holmes
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Apatsa Matatiyo
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Atupele Mpasa
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
| | - Minke H W Huibers
- Department of Outreach, Princess Maxima Center, Utrecht, Netherlands
| | - Geoffrey Manda
- Global Health Institute, Department of Epidemiology and Social Medicine, University of Antwerp, Belgium
| | - Tamiwe Tomoka
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Maurice Mulenga
- Department of Pathology, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Ruth Namazzi
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Parth Mehta
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Mark Zobeck
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Rizine Mzikamanda
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Carl Allen
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Jed G Nuchtern
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Eric Borgstein
- Department of Surgery, University of Malawi College of Medicine, Zomba, Malawi
| | - Daniel C Aronson
- Department of Surgery, University Children's Hospital Zürich, Zürich, Switzerland
| | - Nmazuo Ozuah
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Bip Nandi
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Casey L McAtee
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Development of a Therapeutic Drug Monitoring Strategy for the Optimization of Vincristine Treatment in Pediatric Oncology Populations in Africa. Ther Drug Monit 2023; 45:354-363. [PMID: 36917736 DOI: 10.1097/ftd.0000000000001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Recent studies have reported ethnic differences in vincristine exposure and outcomes such as toxicity. This resulted in the hypothesis of subtherapeutic dosing in African children. To optimize individual treatment, a strategy to identify subtherapeutic exposure using therapeutic drug monitoring is essential. The aim of the current study was to develop a strategy for therapeutic drug monitoring of vincristine in African children to meet the following criteria: (1) identify patients with low vincristine exposure with sufficient sensitivity (>70%), (2) determine vincristine exposure with a limited sampling strategy design of 3 samples, and (3) allow all samples to be collected within 4 hours after administration. METHODS An in silico simulation study was performed using a previously described population pharmacokinetic model and real-life demographic dataset of Kenyan and Malawian pediatric oncology patients. Two different therapeutic drug monitoring strategies were evaluated: (1) Bayesian approach and (2) pharmacometric nomogram. The sampling design was optimized using the constraints described above. Sensitivity analysis was performed to investigate the influence of missing samples, erroneous sampling times, and different boundaries on the nomogram weight bands. RESULTS With the Bayesian approach, 43.3% of the estimated individual exposure values had a prediction error of ≥20% owing to extremely high shrinkage. The Bayesian approach did not improve with alternative sampling designs within sampling constraints. However, the pharmacometric nomogram could identify patients with low vincristine exposure with a sensitivity, specificity, and accuracy of 75.1%, 76.4%, and 75.9%, respectively. The pharmacometric nomogram performed similarly for different weight bands. CONCLUSIONS The pharmacometric nomogram was able to identify patients with low vincristine exposure with high sensitivity, with 3 blood samples collected at 1, 1.5, and 4 hours after administration. Missing samples should be avoided, and the 3 scheduled samples should be collected within 15, 5, and 15 minutes of 1, 1.5, and 4 hours after administration, respectively.
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Ekuk E, Odongo CN, Tibaijuka L, Oyania F, Egesa WI, Bongomin F, Atwiine R, Acan M, Situma M. One year overall survival of wilms tumor cases and its predictors, among children diagnosed at a teaching hospital in South Western Uganda: a retrospective cohort study. BMC Cancer 2023; 23:196. [PMID: 36864435 PMCID: PMC9979450 DOI: 10.1186/s12885-023-10601-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 02/01/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Wilms tumor (WT) is the second most common solid tumor in Africa with both low overall survival (OS) and event-free survival (EFS) rates. However, no known factors are predicting this poor overall survival. OBJECTIVE The study was to determine the one-year overall survival of WT cases and its predictors among children diagnosed in the pediatric oncology and surgical units of Mbarara regional referral hospital (MRRH), western Uganda. METHODOLOGY Children's treatment charts and files diagnosed and managed for WT were retrospectively followed up for the period between January 2017 to January 2021. Charts of children with histologically confirmed diagnoses were reviewed for demographics, clinical and histological characteristics, as well as treatment modalities. RESULTS One-year overall survival was found to be 59.3% (95% CI: 40.7-73.3), with tumor size greater than 15 cm (p 0.021) and unfavorable WT type (p 0.012) being the predominant predictors. CONCLUSION Overall survival (OS) of WT at MRRH was found to be 59.3%, and predictive factors noted were unfavorable histology and tumor size greater than 115 cm.
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Affiliation(s)
- Eddymond Ekuk
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda.
| | - Charles Newton Odongo
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda
- Department of Anatomy, Faculty of Medicine Soroti University, Soroti, Uganda
| | - Leevan Tibaijuka
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda
| | - Felix Oyania
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda
| | - Walufu Ivan Egesa
- Department of Pediatrics, Faculty of Clinical Medicine and Dentistry, Kampala International, Kampala, Uganda
| | - Felix Bongomin
- Department of Microbiology, Mycology, and Immunology, Internal Medicine Gulu University, Gulu, Uganda
| | - Raymond Atwiine
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda
| | - Moses Acan
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda
| | - Martin Situma
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda
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