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Lingaratnam S, Shah M, Nicolazzo J, Michael M, Seymour JF, James P, Lazarakis S, Loi S, Kirkpatrick CMJ. A systematic review and meta-analysis of the impacts of germline pharmacogenomics on severe toxicity and symptom burden in adult patients with cancer. Clin Transl Sci 2024; 17:e13781. [PMID: 38700261 PMCID: PMC11067509 DOI: 10.1111/cts.13781] [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: 12/08/2023] [Revised: 02/12/2024] [Accepted: 03/14/2024] [Indexed: 05/05/2024] Open
Abstract
The clinical application of Pharmacogenomics (PGx) has improved patient safety. However, comprehensive PGx testing has not been widely adopted in clinical practice, and significant opportunities exist to further optimize PGx in cancer care. This systematic review and meta-analysis aim to evaluate the safety outcomes of reported PGx-guided strategies (Analysis 1) and identify well-studied emerging pharmacogenomic variants that predict severe toxicity and symptom burden (Analysis 2) in patients with cancer. We searched MEDLINE, EMBASE, CENTRAL, clinicaltrials.gov, and International Clinical Trials Registry Platform from inception to January 2023 for clinical trials or comparative studies evaluating PGx strategies or unconfirmed pharmacogenomic variants. The primary outcomes were severe adverse events (SAE; ≥ grade 3) or symptom burden with pain and vomiting as defined by trial protocols and assessed by trial investigators. We calculated pooled overall relative risk (RR) and 95% confidence interval (95%CI) using random effects models. PROSPERO, registration number CRD42023421277. Of 6811 records screened, six studies were included for Analysis 1, 55 studies for Analysis 2. Meta-analysis 1 (five trials, 1892 participants) showed a lower absolute incidence of SAEs with PGx-guided strategies compared to usual therapy, 16.1% versus 34.0% (RR = 0.72, 95%CI 0.57-0.91, p = 0.006, I2 = 34%). Meta-analyses 2 identified nine medicine(class)-variant pairs of interest across the TYMS, ABCB1, UGT1A1, HLA-DRB1, and OPRM1 genes. Application of PGx significantly reduced rates of SAEs in patients with cancer. Emergent medicine-variant pairs herald further research into the expansion and optimization of PGx to improve systemic anti-cancer and supportive care medicine safety and efficacy.
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Affiliation(s)
- Senthil Lingaratnam
- Pharmacy DepartmentPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia
- Monash Institute of Pharmaceutical Sciences, Monash UniversityMelbourneVictoriaAustralia
| | - Mahek Shah
- Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Joseph Nicolazzo
- Monash Institute of Pharmaceutical Sciences, Monash UniversityMelbourneVictoriaAustralia
| | - Michael Michael
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Medical OncologyPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - John F. Seymour
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Clinical HaematologyPeter MacCallum Cancer Centre and Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Paul James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Smaro Lazarakis
- Health Sciences LibraryRoyal Melbourne HospitalMelbourneVictoriaAustralia
| | - Sherene Loi
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia
- Division of Cancer ResearchPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Carl M. J. Kirkpatrick
- Monash Institute of Pharmaceutical Sciences, Monash UniversityMelbourneVictoriaAustralia
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Jin Y, Li X, Jiang C, Zhao J, Liu G, Li H, Jin G, Li Q. An Update in Our Understanding of the Relationships Between Gene Polymorphisms and Chemotherapy-Induced Nausea and Vomiting. Int J Gen Med 2021; 14:5879-5892. [PMID: 34566427 PMCID: PMC8458022 DOI: 10.2147/ijgm.s329257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022] Open
Abstract
The occurrence and severity of chemotherapy-induced nausea and vomiting (CINV) are influenced by many factors; this includes therapeutic factors, such as the dose, administration mode, and chemotherapeutic agent emetogenicity, as well as patient-related risk factors, such as the gender, age, alcohol consumption history, and anxiety level. However, these factors cannot fully explain the individual CINV differences. In recent years, the correlation between gene polymorphism and CINV has been a hot research topic; the present paper reviews current research on CINV-related gene polymorphisms, and the results indicate that the use of gene polymorphism for the optimization of CINV efficacy is of important clinical significance.
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Affiliation(s)
- Yilan Jin
- Department of Medical Oncology, Ordos Central Hospital, Ordos, 017000, People's Republic of China
| | - Xiaorong Li
- Department of Medical Oncology, Ordos Central Hospital, Ordos, 017000, People's Republic of China
| | - Caihong Jiang
- Department of Medical Oncology, Ordos Central Hospital, Ordos, 017000, People's Republic of China
| | - Jun Zhao
- Department of Medical Oncology, Ordos Central Hospital, Ordos, 017000, People's Republic of China
| | - Guang Liu
- Department of Medical Oncology, Ordos Central Hospital, Ordos, 017000, People's Republic of China
| | - Hui Li
- Department of Medical Oncology, Ordos Central Hospital, Ordos, 017000, People's Republic of China
| | - Gaowa Jin
- Department of Medical Oncology, Ordos Central Hospital, Ordos, 017000, People's Republic of China
| | - Quanfu Li
- Department of Medical Oncology, Ordos Central Hospital, Ordos, 017000, People's Republic of China
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Qi L, Luo Q, Zhang Y, Jia F, Zhao Y, Wang F. Advances in Toxicological Research of the Anticancer Drug Cisplatin. Chem Res Toxicol 2019; 32:1469-1486. [PMID: 31353895 DOI: 10.1021/acs.chemrestox.9b00204] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cisplatin is one of the most widely used chemotherapeutic agents for various solid tumors in the clinic due to its high efficacy and broad spectrum. The antineoplastic activity of cisplatin is mainly due to its ability to cross-link with DNA, thus blocking transcription and replication. Unfortunately, the clinical use of cisplatin is limited by its severe, dose-dependent toxic side effects. There are approximately 40 specific toxicities of cisplatin, among which nephrotoxicity is the most common one. Other common side effects include ototoxicity, neurotoxicity, gastrointestinal toxicity, hematological toxicity, cardiotoxicity, and hepatotoxicity. These side effects together reduce the life quality of patients and require lowering the dosage of the drug, even stopping administration, thus weakening the treatment effect. Few effective measures exist clinically against these side effects because the exact mechanisms of various side effects from cisplatin remain still unclear. Therefore, substantial effort has been made to explore the complicated biochemical processes involved in the toxicology of cisplatin, aiming to identify effective ways to reduce or eradicate its toxicity. This review summarizes and reviews the updated advances in the toxicological research of cisplatin. We anticipate to provide insights into the understanding of the mechanisms underlying the side effects of cisplatin and designing comprehensive therapeutic strategies involving cisplatin.
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Affiliation(s)
- Luyu Qi
- Beijing National Laboratory for Molecular Sciences; National Centre for Mass Spectrometry in Beijing; CAS Key Laboratory of Analytical Chemistry for Living Biosystems , Institute of Chemistry, Chinese Academy of Sciences , Beijing 100190 , P.R. China.,University of Chinese Academy of Sciences , Beijing 100049 , P.R. China
| | - Qun Luo
- Beijing National Laboratory for Molecular Sciences; National Centre for Mass Spectrometry in Beijing; CAS Key Laboratory of Analytical Chemistry for Living Biosystems , Institute of Chemistry, Chinese Academy of Sciences , Beijing 100190 , P.R. China.,University of Chinese Academy of Sciences , Beijing 100049 , P.R. China
| | - Yanyan Zhang
- Beijing National Laboratory for Molecular Sciences; National Centre for Mass Spectrometry in Beijing; CAS Key Laboratory of Analytical Chemistry for Living Biosystems , Institute of Chemistry, Chinese Academy of Sciences , Beijing 100190 , P.R. China
| | - Feifei Jia
- Beijing National Laboratory for Molecular Sciences; National Centre for Mass Spectrometry in Beijing; CAS Key Laboratory of Analytical Chemistry for Living Biosystems , Institute of Chemistry, Chinese Academy of Sciences , Beijing 100190 , P.R. China
| | - Yao Zhao
- Beijing National Laboratory for Molecular Sciences; National Centre for Mass Spectrometry in Beijing; CAS Key Laboratory of Analytical Chemistry for Living Biosystems , Institute of Chemistry, Chinese Academy of Sciences , Beijing 100190 , P.R. China
| | - Fuyi Wang
- Beijing National Laboratory for Molecular Sciences; National Centre for Mass Spectrometry in Beijing; CAS Key Laboratory of Analytical Chemistry for Living Biosystems , Institute of Chemistry, Chinese Academy of Sciences , Beijing 100190 , P.R. China.,University of Chinese Academy of Sciences , Beijing 100049 , P.R. China.,Basic Medical College , Shandong University of Chinese Traditional Medicine , Jinan 250355 , P.R. China
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Shimizu H, Suzuki K, Uchikura T, Tsuji D, Yamanaka T, Hashimoto H, Goto K, Matsui R, Seki N, Shimada T, Ikeda S, Ikegami N, Hama T, Yamamoto N, Sasaki T. Economic analysis of palonosetron versus granisetron in the standard triplet regimen for preventing chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy in Japan (TRIPLE phase III trial). J Pharm Health Care Sci 2018; 4:31. [PMID: 30555710 PMCID: PMC6287343 DOI: 10.1186/s40780-018-0128-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/14/2018] [Indexed: 11/25/2022] Open
Abstract
Background We conducted an economic assessment using test data from the phase III TRIPLE study, which examined the efficacy of a 5-hydroxytryptamine 3 receptor antagonist as part of a standard triplet antiemetic regimen including aprepitant and dexamethasone in preventing chemotherapy-induced nausea and vomiting in patients receiving cisplatin-based highly emetogenic chemotherapy (HEC). Methods We retrospectively investigated all medicines prescribed for antiemetic purposes within 120 h after the initiation of cisplatin administration during hospitalization. In the TRIPLE study, patients were assigned to treatment with granisetron (GRA) 1 mg (n = 413) or palonosetron (PALO) 0.75 mg (n = 414). The evaluation measure was the cost-effectiveness ratio (CER) assessed as the cost per complete response (CR; no vomiting/retching and no rescue medication). The analysis was conducted from the public healthcare payer’s perspective. Results The CR rates were 59.1% in the GRA group and 65.7% in the PALO group (P = 0.0539), and the total frequencies of rescue medication use for these groups were 717 (153/413 patients) and 573 (123/414 patients), respectively. In both groups, drugs with antidopaminergic effects were chosen as rescue medication in 86% of patients. The costs of including GRA and PALO in the standard triplet antiemetic regimen were 15,342.8 and 27,863.8 Japanese yen (JPY), respectively. In addition, the total costs of rescue medication use were 73,883.8 (range, 71,106.4–79,017.1) JPY for the GRA group and 59,292.7 (range, 57,707.5–60,972.8) JPY for the PALO group. The CERs (JPY/CR) were 26,263.4 and 42,628.6 for the GRA and PALO groups, respectively, and the incremental cost-effectiveness ratio (ICER) between the groups was 189,171.6 (189,044.8–189,215.5) JPY/CR. Conclusions We found that PALO was more expensive than GRA in patients who received a cisplatin-based HEC regimen. Electronic supplementary material The online version of this article (10.1186/s40780-018-0128-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hisanori Shimizu
- 1Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan.,13Department of Pharmacy Services, Showa University Hospital, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Kenichi Suzuki
- 2Department of Pharmacy, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Takeshi Uchikura
- 1Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan
| | - Daiki Tsuji
- 3Department of Clinical Pharmacology & Genetics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Takeharu Yamanaka
- 4Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | | | - Koichi Goto
- 6Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Reiko Matsui
- 7Departments of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Nobuhiko Seki
- 8Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Toshikazu Shimada
- 9Center for Clinical Reseach&Trial, Teikyo University Hospital, Tokyo, Japan
| | - Shunya Ikeda
- 10Department of Public Health, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Naoki Ikegami
- 11Graduate School of Public Health, St Lukes International University, Tokyo, Japan
| | - Toshihiro Hama
- 2Department of Pharmacy, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Nobuyuki Yamamoto
- 12Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Tadanori Sasaki
- 1Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan
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