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Dote S, Shiwaku E, Kohno E, Fujii R, Mashimo K, Morimoto N, Yoshino M, Odaira N, Ikesue H, Hirabatake M, Takahashi K, Takahashi M, Takagi M, Nishiuma S, Ito K, Shimato A, Itakura S, Takahashi Y, Negoro Y, Shigemori M, Watanabe H, Hayasaka D, Nakao M, Tasaka M, Goto E, Kataoka N, Yokomizo A, Kobayashi A, Nakata Y, Miyake M, Hayashi Y, Yamamoto Y, Hirata T, Azuma K, Makihara K, Fukui R, Tokutome A, Yagisawa K, Honda S, Meguro Y, Suzuki S, Yamaguchi D, Miyata H, Kobayashi Y. Impact of prior bevacizumab therapy on the incidence of ramucirumab-induced proteinuria in colorectal cancer: a multi-institutional cohort study. Int J Clin Oncol 2023:10.1007/s10147-023-02357-3. [PMID: 37261583 PMCID: PMC10233195 DOI: 10.1007/s10147-023-02357-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/18/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND The association between prior bevacizumab (BEV) therapy and ramucirumab (RAM)-induced proteinuria is not known. We aimed to investigate this association in patients with metastatic colorectal cancer (mCRC). METHODS mCRC patients who received folinic acid, fluorouracil, and irinotecan (FOLFIRI) plus RAM were divided into with and without prior BEV treatment groups. The cumulative incidence of grade 2-3 proteinuria and rate of RAM discontinuation within 6 months (6M) after RAM initiation were compared between the two groups. RESULTS We evaluated 245 patients. In the Fine-Gray subdistribution hazard model including prior BEV, age, sex, comorbidities, eGFR, proteinuria ≥ 2 + at baseline, and later line of RAM, prior BEV treatment contributed to proteinuria onset (P < 0.01). A shorter interval between final BEV and initial RAM increased the proteinuria risk; the adjusted odds ratios (95% confidence intervals) for the intervals of < 28 days, 28-55 days, and > 55 days (referring to prior BEV absence) were 2.60 (1.23-5.51), 1.51 (1.01-2.27), and 1.04 (0.76-1.44), respectively. The rate of RAM discontinuation for ≤ 6M due to anti-VEGF toxicities was significantly higher in the prior BEV treatment group compared with that in the no prior BEV treatment group (18% vs. 6%, P = 0.02). Second-line RAM discontinuation for ≤ 6M without progression resulted in shorter overall survival of 132 patients with prior BEV treatment (P < 0.01). CONCLUSION Sequential FOLFIRI plus RAM after BEV failure, especially within 55 days, may exacerbate proteinuria. Its escalated anti-VEGF toxicity may negatively impact the overall survival.
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Affiliation(s)
- Satoshi Dote
- Department of Pharmacy, Kyoto-Katsura Hospital, Kyoto, Japan.
| | - Eiji Shiwaku
- Department of Pharmacy, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Emiko Kohno
- Department of Pharmacy, Kansai Medical University Hospital, Osaka, Japan
| | - Ryohei Fujii
- Department of Pharmacy, Kansai Medical University Hospital, Osaka, Japan
| | - Keiji Mashimo
- Department of Pharmacy, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Naomi Morimoto
- Department of Pharmacy, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Masaki Yoshino
- Department of Pharmacy, Niigata Cancer Center Hospital, Niigata, Japan
| | - Naoki Odaira
- Department of Pharmacy, Niigata Cancer Center Hospital, Niigata, Japan
| | - Hiroaki Ikesue
- Department of Pharmacy, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masaki Hirabatake
- Department of Pharmacy, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Masaya Takahashi
- Department of Pharmacy, Osaka City University Hospital, Osaka, Japan
| | - Mari Takagi
- Department of Pharmacy, Osaka International Cancer Institute, Osaka, Japan
| | - Satoshi Nishiuma
- Department of Pharmacy, Osaka International Cancer Institute, Osaka, Japan
| | - Kaori Ito
- Department of Clinical Pharmacy, School of Medicine, Fujita Health University, Aichi, Japan
| | - Akane Shimato
- Department of Clinical Pharmacy, School of Medicine, Fujita Health University, Aichi, Japan
| | - Shoji Itakura
- Department of Pharmacy, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Yoshitaka Takahashi
- Department of Pharmacy, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Yutaka Negoro
- Department of Pharmacy, University of Fukui Hospital, Fukui, Japan
| | - Mina Shigemori
- Department of Pharmacy, University of Fukui Hospital, Fukui, Japan
| | | | - Dai Hayasaka
- Department of Pharmacy, Matsushita Memorial Hospital, Osaka, Japan
| | - Masahiko Nakao
- Department of Pharmacy, Osaka City General Hospital, Osaka, Japan
| | - Misaki Tasaka
- Department of Pharmacy, Osaka City General Hospital, Osaka, Japan
| | - Emi Goto
- Department of Pharmacy, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Noriaki Kataoka
- Department of Pharmacy, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Ayako Yokomizo
- Department of Pharmacy, St. Marianna University Hospital, Kanagawa, Japan
| | - Ayako Kobayashi
- Department of Pharmacy, St. Marianna University Hospital, Kanagawa, Japan
| | - Yoko Nakata
- Department of Pharmacy, Medical Research Institute KITANO HOSPITAL, Osaka, Japan
| | - Mafumi Miyake
- Department of Pharmacy, Medical Research Institute KITANO HOSPITAL, Osaka, Japan
| | - Yaeko Hayashi
- Department of Pharmacy, Omihachiman Community Medical Center, Shiga, Japan
| | - Yoshie Yamamoto
- Department of Pharmacy, Omihachiman Community Medical Center, Shiga, Japan
| | - Taiki Hirata
- Department of Pharmacy, Tokyo Medical University Hospital, Tokyo, Japan
| | - Kanako Azuma
- Department of Pharmacy, Tokyo Medical University Hospital, Tokyo, Japan
| | - Katsuya Makihara
- Department of Pharmacy, Yodogawa Christian Hospital, Osaka, Japan
| | - Rino Fukui
- Department of Pharmacy, Yodogawa Christian Hospital, Osaka, Japan
| | - Akira Tokutome
- Department of Pharmacy, Sapporo-Higashi Tokushukai General Hospital/Institute of Biomedical Research, Hokkaido, Japan
| | - Keiji Yagisawa
- Department of Pharmacy, Sapporo-Higashi Tokushukai General Hospital/Institute of Biomedical Research, Hokkaido, Japan
| | - Shinji Honda
- Department of Pharmacy, Kyoto City Hospital, Kyoto, Japan
| | - Yuji Meguro
- Department of Pharmacy, Kyoto City Hospital, Kyoto, Japan
| | - Shota Suzuki
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Nara, Japan
| | - Daisuke Yamaguchi
- Department of Medical Oncology, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Hitomi Miyata
- Department of Nephrology, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Yuka Kobayashi
- Department of Pharmacy, Kyoto-Katsura Hospital, Kyoto, Japan
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Yoshimura Y, Sawa N, Matsuoka S, Ikuma D, Oba Y, Sekine A, Hasegawa E, Mizuno H, Yamanouchi M, Suwabe T, Hoshino J, Kono K, Kinowaki K, Ohashi K, Toda S, Matoba S, Wakui H, Ubara Y. Glomerular Microangiopathy with Cellular Crescent-like Formation and Endotheliopathy Due to Ramucirumab Treatment for Metastatic Sigmoid Colon Cancer. Intern Med 2022; 61:3547-3552. [PMID: 35569979 PMCID: PMC9790787 DOI: 10.2169/internalmedicine.9185-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/14/2022] [Indexed: 01/07/2023] Open
Abstract
We encountered a 77-year-old Japanese man who presented with nephrotic-range proteinuria 20 days after receiving ramucirumab treatment for metastatic sigmoid colon cancer. A kidney biopsy showed two characteristic histological findings. The first finding was podocyte injury with cellular crescent-like formation, although focal segmental glomerulosclerosis (FSGS) (collapsing variant) according to the Columbia classification may have been a more appropriate name for this injury, as hypertrophy and hyperplasia of epithelial cells, presumably resulting from podocyte injury, were seen between Bowman's capsule and the glomerular basement membrane (GBM); these changes appeared to be due to the collapse of the GBM rather than to GBM destruction with fibrinoid necrosis. The second finding was endotheliopathy characterized by prominent mesangial interposition via enlargement of the mesangial matrix with mesangiolysis. Proteinuria and renal dysfunction subsided after discontinuation of ramucirumab. Bevacizumab has been reported to induce glomerular microangiopathy with endothelial damage and swelling six months after treatment, but in this case, ramucirumab may have induced focal segmental glomerulosclerosis (FSGS) collapsing variant and glomerular microangiopathy with endotheliopathy via mesangial damage within 1 month. We believe that the damage to the glomerular podocyte and endothelial cells via mesangial damage secondary to ramucirumab in our patient was a different type of glomerular microangiopathy than the endothelial cell damage with enlargement of the subendothelial space caused by bevacizumab.
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Affiliation(s)
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | | | - Daisuke Ikuma
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
| | - Yuki Oba
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
| | | | | | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
| | | | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Japan
- Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Shigeo Toda
- Department of Gastroenterological Surgery, Toranomon Hospital, Japan
| | - Shuichiro Matoba
- Department of Gastroenterological Surgery, Toranomon Hospital, Japan
| | - Hideki Wakui
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
- Department of Life Science, Graduate School of Engineering Science, Akita University, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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Miao C, Zhu X, Wei X, Long M, Jiang L, Li C, Jin D, Du Y. Pro- and anti-fibrotic effects of vascular endothelial growth factor in chronic kidney diseases. Ren Fail 2022; 44:881-892. [PMID: 35618410 PMCID: PMC9154791 DOI: 10.1080/0886022x.2022.2079528] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Renal fibrosis is the inevitable common end-point of all progressive chronic kidney diseases. The underlying mechanisms of renal fibrosis are complex, and currently there is no effective therapy against renal fibrosis. Renal microvascular rarefaction contributes to the progression of renal fibrosis; however, an imbalance between proangiogenic and antiangiogenic factors leads to the loss of renal microvasculature. Vascular endothelial growth factor (VEGF) is the most important pro-angiogenic factor. Recent studies have unraveled the involvement of VEGF in the regulation of renal microvascular rarefaction and fibrosis via various mechanisms; however, it is not clear whether it has anti-fibrotic or pro-fibrotic effect. This paper reviews the available evidence pertaining to the function of VEGF in the fibrotic process and explores the associated underlying mechanisms. Our synthesis will help identify the future research priorities for developing specialized treatments for alleviating or preventing renal fibrosis. Abbreviation: VEGF: vascular endothelial growth factor; CKD: chronic kidney disease; ESKD: end-stage kidney disease; ER: endoplasmic reticulum; VEGFR: vascular endothelial growth factor receptor; AKI: acute kidney injury; EMT: epithelial-to-mesenchymal transition; HIF: hypoxia-inducible factor; α-SMA: α smooth muscle actin; UUO: unilateral ureteral obstruction; TGF-β: transforming growth factor-β; PMT: pericyte-myofibroblast transition; NO: nitric oxide; NOS: nitric oxide synthase; nNOS: neuronal nitric oxide synthase; iNOS: inducible nitric oxide synthase; eNOS: endothelial nitric oxide synthase; sGC: soluble guanylate cyclase; PKG: soluble guanylate cyclase dependent protein kinases; UP R: unfolded protein response
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Affiliation(s)
- Changxiu Miao
- Department of Nephrology, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Xiaoyu Zhu
- Department of Nephrology, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Xuejiao Wei
- Department of Nephrology, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Mengtuan Long
- Department of Nephrology, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Lili Jiang
- Physical Examination Center, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Chenhao Li
- Department of Nephrology, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Die Jin
- Department of Nephrology, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Yujun Du
- Department of Nephrology, The First Hospital of Jilin University, Changchun, People's Republic of China
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