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Kobuchi S, Matsui M, Ito Y. Predictive marker for exposure-driven haematological toxicity of tegafur-uracil and proposed modified-dosage regimen by pharmacometric approach in rats. Xenobiotica 2022; 52:697-706. [PMID: 36412205 DOI: 10.1080/00498254.2022.2142696] [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: 11/24/2022]
Abstract
Myelosuppression is a dose-limiting toxicity of uracil-tegafur (UFT), which contains uracil and the 5‑fluorouracil prodrug tegafur, and inhibits the continuation of chemotherapy, causing treatment failure. A proper dosing strategy to avoid severe myelosuppression-induced discontinuation of chemotherapy is required.Plasma drug concentrations were determined in rats after single oral UFT administration of 15, 30, or 60 mg/kg. Blood cell counts were also measured after oral UFT administration for 5 days. Pharmacokinetic-toxicodynamic (PK-TD) modelling and simulation were performed to describe the time-course alterations in the blood cell counts.Severe neutropenia was observed in rats treated with 60 mg/kg UFT on day 7. A significant decrease in neutrophil counts from baseline levels prior to UFT administration was observed on day 3, whereas leukocyte and lymphocyte counts decreased on day 7. The semi-physiological PK-TD model successfully captured alterations in neutrophil counts after UFT administration, whereas the model could not well describe the platelet, leukocyte, and lymphocyte counts, possibly due to the absence of severe thrombocytopenia, leukocytopenia, and lymphocytopenia, respectively.Neutrophils are sensitive markers for estimating the grade of haematological toxicity of UFT, and a PK-TD model might be an attractive tool for quantitatively evaluating the onset and degree of myelosuppression.
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Affiliation(s)
| | | | - Yukako Ito
- Kyoto Pharmaceutical University, Kyoto, Japan
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Liao CK, Kuo YT, Chern YJ, Hsu YJ, Lin YC, Yu YL, Hsieh PS, Chiang JM, Yeh CY, You JF. Tegafur-Uracil/Leucovorin Plus Oxaliplatin (TEGAFOX) as Consolidation Regimen after Short-Course Radiotherapy Is Effective for Locally Advanced Rectal Cancer. J Clin Med 2022; 11:jcm11102920. [PMID: 35629045 PMCID: PMC9146085 DOI: 10.3390/jcm11102920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/26/2022] [Accepted: 05/20/2022] [Indexed: 11/25/2022] Open
Abstract
This study aimed to explore the safety and efficacy of neoadjuvant SCRT and tegafur−uracil/leucovorin plus oxaliplatin (TEGAFOX) for LARC in comparison to those of the modified 5-fluorouracil, leucovorin, and oxaliplatin (mFOLFOX-6) regimen. We retrospectively evaluated 15 and 22 patients with LARC who underwent SCRT, followed by consolidation chemotherapy with TEGAFOX and mFOLFOX-6 before surgery, respectively, between January 2015 and December 2019. The primary endpoint was the tumor response rate. The secondary endpoints were compliance, toxicity, complications, overall survival (OS), and disease-free survival (DFS). The dose reduction rate was lower in the TEGAFOX group (0 vs. 9.1% (n = 2)). No grade III-IV toxicities occurred in the TEGAFOX group. Two and four patients in the TEGAFOX and mFOLFOX-6 groups, respectively, achieved clinical complete responses. The pathologic complete response rate was lower in the TEGAFOX group (7.7% vs. 17.6%). Overall, 11 (73.3%) and 17 (81.0%) patients had a neoadjuvant rectal (NAR) score of <16 in the TEGAFOX and mFOLFOX-6 groups, respectively. All patients in this study received sphincter-preservation surgery. One patient in each group developed Clavien−Dindo grade III complications. There were no significant between-group differences in the 3-year OS (81.8% vs. 84.8%, p = 0.884) and 3-year DFS (72% vs. 71.6%, p = 0.824) rates. TEGAFOX, as consolidation chemotherapy after SCRT, achieves good tumor downstaging and patient compliance in LARC. The toxicity, complications, and surgical outcomes are similar to those of mFOLFOX-6. Thus, TEGAFOX can be considered a chemotherapy option for rectal cancer treatment.
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Affiliation(s)
- Chun-Kai Liao
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan 333423, Taiwan; (C.-K.L.); (Y.-T.K.); (Y.-J.C.); (Y.-J.H.); (Y.-C.L.); (P.-S.H.); (J.-M.C.); (C.-Y.Y.)
| | - Ya-Ting Kuo
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan 333423, Taiwan; (C.-K.L.); (Y.-T.K.); (Y.-J.C.); (Y.-J.H.); (Y.-C.L.); (P.-S.H.); (J.-M.C.); (C.-Y.Y.)
| | - Yih-Jong Chern
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan 333423, Taiwan; (C.-K.L.); (Y.-T.K.); (Y.-J.C.); (Y.-J.H.); (Y.-C.L.); (P.-S.H.); (J.-M.C.); (C.-Y.Y.)
| | - Yu-Jen Hsu
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan 333423, Taiwan; (C.-K.L.); (Y.-T.K.); (Y.-J.C.); (Y.-J.H.); (Y.-C.L.); (P.-S.H.); (J.-M.C.); (C.-Y.Y.)
| | - Yueh-Chen Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan 333423, Taiwan; (C.-K.L.); (Y.-T.K.); (Y.-J.C.); (Y.-J.H.); (Y.-C.L.); (P.-S.H.); (J.-M.C.); (C.-Y.Y.)
| | - Yen-Lin Yu
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Road, Anle District, Keelung City 204201, Taiwan;
| | - Pao-Shiu Hsieh
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan 333423, Taiwan; (C.-K.L.); (Y.-T.K.); (Y.-J.C.); (Y.-J.H.); (Y.-C.L.); (P.-S.H.); (J.-M.C.); (C.-Y.Y.)
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan District, Taoyuan 333323, Taiwan
| | - Jy-Ming Chiang
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan 333423, Taiwan; (C.-K.L.); (Y.-T.K.); (Y.-J.C.); (Y.-J.H.); (Y.-C.L.); (P.-S.H.); (J.-M.C.); (C.-Y.Y.)
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan District, Taoyuan 333323, Taiwan
| | - Chien-Yuh Yeh
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan 333423, Taiwan; (C.-K.L.); (Y.-T.K.); (Y.-J.C.); (Y.-J.H.); (Y.-C.L.); (P.-S.H.); (J.-M.C.); (C.-Y.Y.)
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan District, Taoyuan 333323, Taiwan
| | - Jeng-Fu You
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan 333423, Taiwan; (C.-K.L.); (Y.-T.K.); (Y.-J.C.); (Y.-J.H.); (Y.-C.L.); (P.-S.H.); (J.-M.C.); (C.-Y.Y.)
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan District, Taoyuan 333323, Taiwan
- Correspondence: ; Tel.: +886-975365617
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