Guideline sheets on the side effects of anticancer drugs are useful for general practitioners

Evaluating the simultaneous electrochemical determination of antineoplastic drugs using LaNiO3/g-C3N4@RGH nanocomposite material

A novel electrochemical sensor based on LaNiO3/g-C3N4@RGH nanocomposite material was developed to simultaneously determine Ribociclib (RIBO) and Alpelisib (ALPE). Ribociclib and Alpelisib are vital anticancer medications used in the treatment of advanced breast cancer. The sensor exhibited excellent electrocatalytic activity towards the oxidation of RIBO and ALPE, enabling their simultaneous detection. The fabricated sensor was characterized using various techniques, including energy dispersive X-ray (EDX), Fourier-transform infrared spectroscopy (FTIR), X-ray diffraction (XR), scanning electron microscopy (SEM), and X-ray photoelectron spectroscopy (XPS), which confirmed the successful synthesis of the LaNiO3/g-C3N4@RGH composite material. Electrochemical characterization revealed enhanced conductivity and lower resistance of the modified electrode compared to the bare electrode. The developed sensor exhibited high repeatability, reproducibility, stability, and selectivity toward RIBO detection. Furthermore, the sensor displayed high sensitivity with low detection limits of 0.88 nM for RIBO and 6.1 nM for ALPE, and linear ranges of 0.05-6.2 μM and 0.5-6.5 μM, respectively. The proposed electrochemical sensor offers a promising approach for simultaneously determining RIBO and ALPE in pharmaceutical formulations and biological samples with recovery data of 98.7-102.0 %, providing a valuable tool for anticancer drug analysis and clinical research.

Discovery of diverse sesquiterpenoids from Magnolia grandiflora with cytotoxic activities by inducing cell apoptosis

Phytochemical study of Magnolia grandiflora led to the isolation of 39 sesquiterpenoids, including 15 new compounds (1-15). Compounds 1 and 2 are discovered to be the first 13-norgermacrane type sesquiterpenoids in natural products. Compound 15 is a rare 5,6-seco-guaiane type sesquiterpene and its possible biogenic precursor is presumed to be compound 20. Subsequent structural modification for compound 28 led to 21 derivatives, among which 15 derivatives were new compounds. All compounds were tested for the inhibitory effects on three tumor cell lines, and 17 compounds were active with the IC50 values ranging from 1.91 ± 0.39 μM to 12.29 ± 1.68 μM. The structure-activity relationships implied that an α, β-unsaturated lactone group was an important active group for the cytotoxicity. Two most active compounds (19 and 29) with low toxicity on normal human liver cell line were selected for further mechanism study. Compound 29 could induce apoptosis on Colo320DM cells through influencing the key apoptotic related proteins, such as PARP, Cleaved PARP, cleaved Caspase-3, and pro-Caspase 3. In addition, compound 19 with the best cytotoxic activity on HEL cells also could induce the apoptosis in dose- and time-dependent manners. In summary, our investigation implied that compounds 19 and 29 are two new potential anti-cancer candidates for ongoing study in the future.

Study protocol of the CREDO randomised controlled trial: evaluation of a structured return home consultation for patients suffering from metastaticcancer

INTRODUCTION

Patients suffering from cancer are often managed by multiple health professionals. General practitioners with specific skills in oncology could facilitate care coordination between hospital and general practice in the management of these patients. To explore this hypothesis, we run a randomised clinical trial, called 'Concertation de REtour à DOmicile, CREDO'. The main objective is to explore the effectiveness of a 'return home' consultation compared with standard care. The number of unscheduled visits to care centres is used to evaluate the effectiveness of the treatment.

METHODS AND ANALYSIS

CREDO is a multicentre, randomised, open-label, prospective trial. It takes place in two specialised cancer care centres in southern France (Occitania region). Patient inclusion criteria are: be over 18 years old; be treated with a first cycle of metastatic chemotherapy in a specialised cancer care centre; have a metastatic solid cancer and be returning home after treatment. Patients are randomised in two arms: standard-arm (conventional management) or intervention-arm (CREDO management). In the intervention arm, a 'return home' consultation is carried out in three steps. First, the investigating GP (GP with specific skills in oncology) from the specialised care centre collects information about the patient and patient's management choices. Then, the investigating GP conducts an interview with the patient's referring GP to quickly communicate and discuss information about the patient. Finally, the investigating GP summarises these exchanges and transmits this information to the care centres chosen by the patient.All the patients are followed for 1 year.Statistical and medicoeconomic analysis are planned.

ETHICS AND DISSEMINATION

This clinical trial is registered under ClinicalTrials.gov identifier and was approved by the ethics committee of South-Western French Committee for the Protection of Persons (number: 2016-A01587-44) and from the French National Drug Safety Agency (ANSM, number: 2016111500034).An international publication of the final results and conference presentations will be planned.

TRIAL REGISTRATION NUMBER

NCT02857400.

Experimental system of care coordination for the home return of patients with metastatic cancer: a survey of general practitioners

BACKGROUND

To promote improved coordination between general practice and hospital, the French clinical trial CREDO ("Concertation de REtour à DOmicile") is testing an innovative experimental consultation for patients with metastatic cancer who are returning home. This consultation involves the patient, the patient's referring GP (GP_ref) and a GP with specific skills in oncology (GP_onc) in a specialized care center. The objective of our study is to explore the satisfaction of GPs_ref about this consultation, in the phase of interaction between GP_onc and GP_ref.

METHODS

This observational, cross-sectional, multicenter study explored the satisfaction of GPs_ref who had participated in this type of consultation, via a telephone survey.

RESULTS

One Hundred GPs_ref responded to the questionnaire between April and September 2019 (overall response rate: 55%). 84.5% were satisfied with the consultation, and the majority were satisfied with its methods. Half of the GPs_ref learned new information during the consultation, three-quarters noted an impact on their practice, and 94.4% thought that this type of coordination between the GP_ref and the oncology specialist could improve general practice - hospital coordination.

CONCLUSIONS

For GPs, the CREDO consultation seems to be practical and effective in improving the coordination between general medicine and hospital. GPs would benefit from such coordination for all patients with cancer, several times during follow-up and at each occurrence of a medically significant event.

Novel CMC-CdTe / ZnS QDs Nanosensor for the Detection of Anticancer Drug Epirubicin

Epirubicin (EPI) is one of the standard anticancer drugs that apply for various cancers treatment. However, the accumulation of EPI in the human body can be highly toxic, and it causes inevitable harm to organs. As a result, the evaluation of low concentrations of this drug in body samples requires sensitive, rapid, and accurate analysis methods. The fluorescence method is an efficient way in comparison of the traditional methods such as liquid chromatography, capillary electrophoresis, and electrochemical methods. Herein, we synthesized a novel fluorescence nanosensor named CMC-CdTe/ZnS based on using quantum dots (QDs). The structure of the prepared nanosensor is confirmed by different analysis methods such as FT-IR, TGA, and TEM. Besides that, the fluorescence intensity response of CMC-CdTe/ZnS QDs in the presence of Epirubicin drug is investigated. Based on obtained results, not only this nanosensor developed, but also the fluorescence quenching was explained by the typical Stern-Volmer equation. The best linear quenching equation for entitled nanosensor in the presence of Epirubicin is F0/F = 0.0346Q + 1.08 (R2 = 0.99), and the detection limit of Epirubicin is around 0.04 × 10-6 mol/L at 25 °C. All of the results display that this method could be reliable and suitable approach for determination of Epirubicin in commercial samples as well.

Small Private Online Course in Teaching Oncology-Feedback After 1 Year: What Lessons?

In response to the complexity of medical care in oncology, 2 years ago, we designed a new teaching method (SPOC, Small Private Online Course) to improve cancer treatment and its management by emphasizing the community-hospital interface. The educational objective of this study was to evaluate after 1 year if the interest for this teaching remained constant over the long term to meet both educational and financial requirements. We designed a questionnaire including 18 questions grouped in 3 main parts describing the profile of the participants, his/her own experience, and the current utilization of the SPOC. Of 1574 participants of the 2 first sessions, 182 (11.5%) completed the questionnaire after 1 year. The majority of respondents were between the ages of 31 and 60 and belonged to a paramedical group (47.81%). After 1 year, 84.6% participants were satisfied or very satisfied with the content of the SPOC, 83.6% would recommended it, and 67% would be interested in using an updated SPOC again. Only 4.9% kept some contacts with other participants and 4.9% with teachers. 31.3% considered that the SPOC had a medium impact on their professional activity, 33.5% a lot, and 2.7% completely whereas 24.7% considered that it had little impact. The evaluation at 1 year showed that this digital learning method had a global positive impact on the professional practice of the participants. This study highlighted the empowerment of participants after this kind of teaching, but the network between participants was not enhanced.

Adverse events of targeted therapies reported by patients with cancer treated in primary care

Background

Targeted Therapies (TT) are among the therapeutic innovations for cancer treatment in outpatient settings. TT-related Adverse Events (AEs) are a source of loss of opportunity for patients if their management is inappropriate.

Objectives

The objective of this study was to describe the AE frequency and severity as reported by patients with cancer who received TT in ambulatory settings. A second objective was to describe the role of the general practitioner (GP) in the management of AEs.

Methods

All patients who started TT at a French Regional Cancer Centre in 2017–2018 were eligible for this 12-month prospective study. A self-administered questionnaire was distributed at inclusion and returned after three months. In the questionnaire, patients listed all AEs that occurred during this period and rated their severity. Occurrence and severity were compared with the rating by a specialised nurse. Patients also indicated the health professional they contacted first for the reported AE.

Results

Among the 247 eligible patients, 15 were excluded and 144 responded to the questionnaire. Fourteen different TTs have been prescribed. Asthenia (92.4%) and anorexia (64.6%) were the most frequent AE. Patients’ AE severity rating was more severe than the nurse’s rating for all drugs (p < 0.001). Patients first contacted their GP for 15.6% of AEs, whereas 20.7% of AEs were not reported to any health professional.

Conclusion

Patients experienced an average of 4 AEs. AE severity rating was significantly different between patients and nurses. Patients do not always communicate AEs to health care professionals.

Inventory of tools for care coordination between general practice and hospital system for patients suffering from cancer in active phase of treatment: A scoping review

INTRODUCTION

During the active phase of treatment, major difficulties appear in the transmission and quality of the information communicated to the General Practitioner (GP). Our objective was to carry out an inventory of the coordination tools used to improve exchanges between the hospital and the GP in the management of the patient suffering from cancer during this phase.

MATERIAL AND METHOD

A scoping review was conducted using MEDLINE databases via PubMed, The Cochrane Library, Web of Science. Articles published between 1998 and 2018, in English and French, were analysed.

RESULTS

Over 4,863 articles were extracted, and 11 studies were included. They highlight an increase in the quality of patient care after the introduction of information sheets or training by video vignettes with GPs. They demonstrate the importance of using standardised letters between health professionals. The role of a "leader physician" is discussed, and its first evaluations are positive. An increase in information transmitted to GPs leads to a better satisfaction of patients and GPs.

CONCLUSION

Communication tools are essential for the transmission of information, but direct and oral communication between all health professionals seems to be a point to be further developed.

[Specificity of the management of metastatic renal cancer in the older patient]

AIM

To define the necessary arrangements of medical treatment with anti-angiogenics, mTOR inhibitor or systemic immunotherapies in the management of metastatic renal cell carcinoma in elderly patients.

METHOD

Bibliographical search was performed from the Medline bibliographic database (NLM Pubmed tool) and Embase focused on: metastatic renal cell carcinoma, elderly, treatment.

RESULTS

The selection criteria for the medical treatment of metastatic renal cell carcinoma in elderly patients are the IMDC score, necessarily complemented by performance status, the tolerability profile of treatments, more frequent drug interactions, treatment adherence, management capacity of side effects, and patient preference. Each of these criteria is detailed in critical ways.

CONCLUSION

The efficacy and tolerability of medical treatments for metastatic renal cancer have not been reported as different depending on age. No dosage adjustment is recommended in principle. However, prevention and early treatment of side effects of treatment should be strengthened in elderly patients.

Febrile neutropenia in adjuvant and neoadjuvant chemotherapy for breast cancer: a retrospective study in routine clinical practice from a single institution

BACKGROUND

Febrile neutropenia (FN) is one of the most common and most critical adverse effects of chemotherapy. Despite many existing guidelines based on the use of granulocyte-colony stimulating factor (G-CSF), FN continues to impair the quality of life and interfere with the treatment of many patients. The purpose of this study was to assess the incidence and management of FN associated with chemotherapy for early breast cancer in routine clinical practice.

METHODS

All patients with early-stage breast cancer (ESBC) treated by chemotherapy at Institut Curie, Hôpital René Huguenin, in 2014 were retrospectively included. The incidence and management of FN were reported. Risk factors associated with FN were studied by robust-error-variance Poisson regression.

RESULTS

A total of 524 patients received either neoadjuvant (N = 130) or adjuvant chemotherapy (N = 394). Most patients (80%) were treated with a combination of 5-fluorouracil, epirubicin, and cyclophosphamide (FEC100; 3 cycles) followed by docetaxel 100 mg/m² (D; 3 cycles). The overall incidence of FN was 17%. Eighteen percent of patients received primary prophylaxis (PP) for FN with G-CSF, using pegfilgrastim in 64% of cases and 74% of patients over the age of 70 received PP. Less than 5% of patients who received PP experienced FN. Recurrent FN after secondary prophylaxis was observed in 9% of patients. Forty-seven percent of cases of FN occurred after the first cycle and 30% occurred after the fourth cycle, corresponding to D ± trastuzumab (T). The FEC100 regimen was associated with a relative risk of FN of 1.98 (p = 0.09). Autoimmune (AI) and inflammatory diseases were associated with a higher risk of FN (RR 3.08; p < 0.01). No significant difference in the incidence of FN was observed between adjuvant and neoadjuvant chemotherapy. FN was managed on an outpatient basis in 72% of cases. Outpatients with FN were mainly treated by a combination of amoxicillin-clavulanic acid and ciprofloxacin. Dose reduction or chemotherapy regimen modification were necessary in 25% of patients after FN. No toxic death was reported.

CONCLUSION

The incidence of FN induced by adjuvant/neoadjuvant chemotherapy in ESBC is higher in routine clinical practice than in clinical trials. AI or inflammatory diseases were significant independent risk factors for FN. Primary prophylaxis in patients at risk (elderly, comorbid patients), especially treated with the FEC regimen, is the keystone of management of this adverse effect. Prevention and management of FN to ensure the patient's safety and quality of life are a major issue for both medical oncologists and supportive care physicians.

The Impact of a Small Private Online Course as a New Approach to Teaching Oncology: Development and Evaluation

BACKGROUND

Oncology involves complex care and multidisciplinary management of patients; however, misinformation and ineffective communication remain problematic.

OBJECTIVE

The educational objective of our study was to develop a new teaching method to improve cancer treatment and management by emphasizing the link between hospitals (inpatients) and their surrounding communities (outpatients).

METHODS

A team of 22 professionals from public and private institutions developed a small private online course (SPOC). Each offering of the course lasted 6 weeks and covered 6 topics: individual health care plans, cancer surgery, ionizing radiation, cancer medicines, clinical research, and oncological supportive care. For participants in the course, we targeted people working in the cancer field. The SPOC used an active teaching method with collaborative and multidisciplinary learning. A final examination was offered in each session. We evaluated participants' satisfaction rate through a questionnaire and the success of the SPOC by participants' completion, success, and commitment rates.

RESULTS

Of the total participants (N=1574), 446 completed the evaluation form. Most participants were aged 31 to 45 years. Participants included 56 nurses, 131 pharmacists, 80 from the medical field (including 26 physicians), 53 from patients' associations, 28 health teachers, and 13 students (medical and paramedical). Among the participants, 24.7% (90/446) had an independent medical practice, 38.5% (140/446) worked in a public institution, and 36.8% (134/446) worked in a private institution. After completing the SPOC sessions, 85.9% (384/446) thought they had learned new information, 90.8% (405/446) felt their expectations were met, and 90.4% (403/446) considered that the information had a positive impact on their professional practice. The completion rate was 35.51% (559/1574), the success rate was 71.47% (1025/1574), and the commitment rate was 64.67% (1018/1574). Concerning the cost effectiveness of SPOC compared with a traditional classroom of 25 students, online education became more effective when there were more than 950 participants.

CONCLUSIONS

SPOCs improved the management of oncology patients. This new digital learning technique is an attractive concept to integrate into teaching practice. It offered optimal propagation of information and met the students' expectations.