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Ji W, Shen J, Wang B, Chen F, Meng D, Wang S, Dai D, Zhou Y, Wang C, Zhou Q. Effects of dacomitinib on the pharmacokinetics of poziotinib in vivo and in vitro. PHARMACEUTICAL BIOLOGY 2021; 59:457-464. [PMID: 33899675 PMCID: PMC8079061 DOI: 10.1080/13880209.2021.1914114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/02/2021] [Indexed: 06/12/2023]
Abstract
CONTEXT Dacomitinib and poziotinib, irreversible ErbB family blockers, are often used for treatment of non-small cell lung cancer (NSCLC) in the clinic. OBJECTIVE This study investigates the effect of dacomitinib on the pharmacokinetics of poziotinib in rats. MATERIALS AND METHODS Twelve Sprague-Dawley rats were randomly divided into two groups: the test group (20 mg/kg dacomitinib for 14 consecutive days) and the control group (equal amounts of vehicle). Each group was given an oral dose of 10 mg/kg poziotinib 30 min after administration of dacomitinib or vehicle at the end of the 14 day administration. The concentration of poziotinib in plasma was quantified by UPLC-MS/MS. Both in vitro effects of dacomitinib on poziotinib and the mechanism of the observed inhibition were studied in rat liver microsomes and human liver microsomes. RESULTS When orally administered, dacomitinib increased the AUC, Tmax and decreased CL of poziotinib (p < 0.05). The IC50 values of M1 in RLM, HLM and CYP3A4 were 11.36, 30.49 and 19.57 µM, respectively. The IC50 values of M2 in RLM, HLM and CYP2D6 were 43.69, 0.34 and 0.11 µM, respectively, and dacomitinib inhibited poziotinib by a mixed way in CYP3A4 and CYP2D6. The results of the in vivo experiments were consistent with those of the in vitro experiments. CONCLUSIONS This research demonstrates that a drug-drug interaction between poziotinib and dacomitinib possibly exists when readministered with poziotinib; thus, clinicians should pay attention to the resulting changes in pharmacokinetic parameters and accordingly, adjust the dose of poziotinib in clinical settings.
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Affiliation(s)
- Weiping Ji
- Department of Orthopaedics, The Sixth Affiliated Hospital of Wenzhou Medical University, The People’s Hospital of Lishui, Lishui, China
| | - Jiquan Shen
- Department of Orthopaedics, The Sixth Affiliated Hospital of Wenzhou Medical University, The People’s Hospital of Lishui, Lishui, China
| | - Bo Wang
- Department of Orthopaedics, The Sixth Affiliated Hospital of Wenzhou Medical University, The People’s Hospital of Lishui, Lishui, China
| | - Feifei Chen
- The Laboratory of Clinical Pharmacy, The Sixth Affiliated Hospital of Wenzhou Medical University, The People’s Hospital of Lishui, Lishui, China
| | - Deru Meng
- The Laboratory of Clinical Pharmacy, The Sixth Affiliated Hospital of Wenzhou Medical University, The People’s Hospital of Lishui, Lishui, China
| | - Shuanghu Wang
- The Laboratory of Clinical Pharmacy, The Sixth Affiliated Hospital of Wenzhou Medical University, The People’s Hospital of Lishui, Lishui, China
- School of Pharmaceutical Science, Guangdong Provincial Key Laboratory of New Drug Screening, Southern Medical University, Guangzhou, China
| | - Dapeng Dai
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yunfang Zhou
- The Laboratory of Clinical Pharmacy, The Sixth Affiliated Hospital of Wenzhou Medical University, The People’s Hospital of Lishui, Lishui, China
| | - Changxiong Wang
- Department of Gastroenterology, The Sixth Affiliated Hospital of Wenzhou Medical University, The People’s Hospital of Lishui, Lishui, China
| | - Quan Zhou
- The Laboratory of Clinical Pharmacy, The Sixth Affiliated Hospital of Wenzhou Medical University, The People’s Hospital of Lishui, Lishui, China
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Fan B, Tan X, Lou Y, Zheng Y, Zhang L, Wu X. Prognostic factors of patients with advanced lung cancer treated with anlotinib: a retrospective cohort study. J Int Med Res 2021; 49:3000605211046173. [PMID: 34758674 PMCID: PMC8591656 DOI: 10.1177/03000605211046173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective Our study aimed to evaluate the main factors affecting the efficacy of anlotinib to determine the therapeutically dominant populations. Methods The medical records of patients with lung cancer who were treated with anlotinib from July 2018 to February 2020 at Renji Hospital, School of Medicine, Shanghai Jiaotong University were retrospectively reviewed. The optimal cutoff prognostic nutritional index (PNI) value for predicting efficacy was determined according to receiver operating characteristic curves. Progression-free survival (PFS) and overall survival (OS) were calculated and compared using the Kaplan–Meier method and log‐rank test. The prognostic values of each variable were evaluated with univariate and multivariate Cox proportional hazard regression analyses. Results The overall disease control rate of 44 patients with lung cancer was 93.2% (41/44). The median PFS was 5.0 months (95% [confidence interval] CI: 2.2–7.8), and the median OS was 6.5 months (95% CI: 3.6–9.3). The multivariate analysis results indicated that hand–foot syndrome and high PNI values were independent protective factors of PFS and OS. Conclusions Anlotinib was effective in treating locally advanced or advanced lung cancer. High pretreatment PNI scores and the presence of hand–foot syndrome after treatment were independent prognostic markers for favorable OS and PFS.
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Affiliation(s)
- Bijun Fan
- Department of Respiratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiaoming Tan
- Department of Respiratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yueyan Lou
- Department of Respiratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yu Zheng
- Department of Respiratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Liyan Zhang
- Department of Respiratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xueling Wu
- Department of Respiratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Lancia C, Anninga JK, Sydes MR, Spitoni C, Whelan J, Hogendoorn PCW, Gelderblom H, Fiocco M. A novel method to address the association between received dose intensity and survival outcome: benefits of approaching treatment intensification at a more individualised level in a trial of the European Osteosarcoma Intergroup. Cancer Chemother Pharmacol 2019; 83:951-962. [PMID: 30879111 PMCID: PMC6458990 DOI: 10.1007/s00280-019-03797-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/08/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE There is lack of consensus on the prognostic value of received high dose intensity in osteosarcoma survivorship. Many studies have not shown a clear survival benefit when dose intensity is increased. The aim of this study is to go beyond chemotherapy intensification by arm-wide escalation of intended dose and/or compression of treatment schedule, while conversely addressing the relationship between treatment intensity and survival at the patient level. The study focusses on the difference in outcome results, based on a novel, progressively more individualised approach to dose intensity. METHODS A retrospective analysis of data from MRC BO06/EORTC 80931 randomised controlled trial for treatment of osteosarcoma was conducted. Three types of post hoc patient groups are formed using the intended regimen: the individually achieved cumulative dose and time on treatment, and the increase of individual cumulative dose over time. Event-free survival is investigated and compared in these three stratifications. RESULTS The strata of intended regimen and achieved treatment yields equivalent results. Received cumulative dose over time produces groups with evident different survivorship characteristics. In particular, it highlights a group of patients with an estimated 3-year event-free survival much larger (more than 10%) than other patient groups. This group mostly contains patients randomised to an intensified regimen. In addition, adverse events reported by that group show the presence of increased preoperative myelotoxicity. CONCLUSIONS The manuscript shows the benefits of analyzing studies by using longitudinal data, e.g. recorded per cycle. This has impact on the drafting of future trials by showing why such a level of detail is needed for both treatment and adverse event data. The novel method proposed, based on cumulative dose received over time, shows that longitudinal treatment data might be used to link survival outcome with drug metabolism. This is particularly valuable when pharmacogenetics data for metabolism of cytotoxic agents are not collected. TRIAL REGISTRATION ISRCTN86294690.
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Affiliation(s)
- Carlo Lancia
- Mathematical Institute Leiden University, Niels Bohrweg 1, 2333 CA Leiden, The Netherlands
| | - Jakob K. Anninga
- Department Paediatric Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Matthew R. Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL and MRC London Hub for Trials Methodology Research, 90 High Holborn, London, WC1V 6LJ UK
| | - Cristian Spitoni
- Mathematical Institute Utrecht University, Budapestlaan 6, 3584 CD Utrecht, The Netherlands
- Department of Epidemiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Jeremy Whelan
- Department of Oncology, University College London Hospital, 235 Euston Rd, Fitzrovia, London, NW1 2BU UK
| | - Pancras C. W. Hogendoorn
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Marta Fiocco
- Mathematical Institute Leiden University, Niels Bohrweg 1, 2333 CA Leiden, The Netherlands
- Department of Biomedical Data Science, Section Medical Statistics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Peng Y, Li Q, Zhang J, Shen W, Zhang X, Sun C, Cui H. Update review of skin adverse events during treatment of lung cancer and colorectal carcinoma with epidermal growth receptor factor inhibitors. Biosci Trends 2018; 12:537-552. [PMID: 30555112 DOI: 10.5582/bst.2018.01246] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The past decades have witnessed a rapid increase in the use of molecularly targeted therapies. One class of agents includes the epidermal growth factor receptor inhibitors (EGFRIs), which afford patients longer progression-free survival (PFS) times, especially among non-small cell lung cancer (NSCLC) and metastatic colorectal carcinoma (mCRC). Certain adverse effects, particularly skin toxicity, are mainly manifested as rash, xerosis, pruritus, nails changes, hair changes and mucositis. Previous studies reported the adverse events occurred based on the cutaneous inflammation reaction. Treatment recommended glucocorticoids and antibiotics. It is suggested that skin toxicity is an important issue because it usually affects patients' quality of life (QoL) and still causes dose reduction or discontinuation of targeted therapies. For these reasons, more and more oncologists and dermatologists recognize the importance of recognition and management of skin toxicities with the expansion in availability of EGFRIs. In this review, we conducted a systematic review of recent data to examine the types and frequencies of dermatologic toxicities associated with anti-epidermal growth factor receptor (EGFR) therapies in NSCLC and mCRC. In addition, we would like to explore the management and treatment options currently used by clinicians based on the possible mechanism.
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Affiliation(s)
- Yanmei Peng
- Beijing University of Chinese Medicine, China-Japan Friendship Hospital
| | - Qiang Li
- Beijing University of Chinese Medicine, China-Japan Friendship Hospital
| | - Jingyi Zhang
- Beijing University of Chinese Medicine, China-Japan Friendship Hospital
| | - Wen Shen
- Beijing University of Chinese Medicine, China-Japan Friendship Hospital
| | - Xu Zhang
- Beijing University of Chinese Medicine, China-Japan Friendship Hospital
| | - Chenyao Sun
- Beijing University of Chinese Medicine, China-Japan Friendship Hospital
| | - Huijuan Cui
- Department of Integrative Oncology, China-Japan Friendship Hospital
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Lu Y, Li A, Lai X, Jiang J, Zhang L, Zhong Z, Zhao W, Tang P, Zhao H, Ren X. Identification of differentially expressed genes and signaling pathways using bioinformatics in interstitial lung disease due to tyrosine kinase inhibitors targeting the epidermal growth factor receptor. Invest New Drugs 2018; 37:384-400. [PMID: 30203136 DOI: 10.1007/s10637-018-0664-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022]
Abstract
Interstitial lung disease (ILD) is a rare but lethal adverse effect of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) treatment. The specific mechanism of this disease is not fully understood. To systematically analyze genes associated with EGFR-TKI induced ILD, gene data of EGFR-TKI induced ILD were extracted initially using text mining, and then the intersection between genes from text mining and Gene Expression Omnibus (GEO) dataset was taken for further protein-protein interaction (PPI) analysis using String-bd database. Go ontology (GO) and pathway enrichment analysis was also conducted based on Database of Annotation, Visualization and Integrated Discovery (DAVID) platform. The PPI network generated by STRING was visualized by Cytoscape, and the topology scores, functional regions and gene annotations were analyzed using plugins of CytoNCA, molecular complex detection (MCODE) and ClueGo. 37 genes were identified as EGFR-TKI induced ILD related. Gene enrichment analysis yield 18 enriched GO terms and 12 associated pathways. A PPI network that included 199 interactions for a total of 35 genes was constructed. Ten genes were selected as hub genes using CytoNCA plugin, and four highly connected clusters were identified using MCODE plugin. GO and pathway annotation analysis for the cluster one revealed that five genes were associated with either response to dexamethasone or with lung fibrosis, including CTGF, CCL2, IGF1, EGFR and ICAM1. Our data might be useful to reveal the pathological mechanisms of EGFR-TKI induced ILD and provide evidence for the diagnosis and treatment in the future.
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Affiliation(s)
- Yuan Lu
- Department of Respiratory, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Xueyuan AVE 1098, Xili University Town, Shenzhen, 518055, Guangdong, People's Republic of China
| | - Ang Li
- The State Key Laboratory of Cancer Biology, Department of Immunology, Air Force Military Medical University (Fourth Military Medical University), 169 Changle West Road, Xi'an, 710032, People's Republic of China
| | - Xiaofeng Lai
- Department of Clinical Genetics and Experimental Medicine, Fuzhou General Hospital, Xiamen University School of Medicine, Fuzhou, Fujian, 350025, People's Republic of China
| | - Jun Jiang
- Department of Respiratory, Xijing Hospital, Air Force Military Medical University (Fourth Military Medical University), Changle, West Road 127, Xi'an, 710032, People's Republic of China
| | - Lihong Zhang
- Department of Respiratory, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Xueyuan AVE 1098, Xili University Town, Shenzhen, 518055, Guangdong, People's Republic of China
| | - Zhicheng Zhong
- Department of Respiratory, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Xueyuan AVE 1098, Xili University Town, Shenzhen, 518055, Guangdong, People's Republic of China
| | - Wen Zhao
- Department of Respiratory, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Xueyuan AVE 1098, Xili University Town, Shenzhen, 518055, Guangdong, People's Republic of China
| | - Ping Tang
- Department of Respiratory, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Xueyuan AVE 1098, Xili University Town, Shenzhen, 518055, Guangdong, People's Republic of China
| | - Hu Zhao
- Department of Urology, Fuzhou Dongfang Hospital, Xiamen University, Xierhuan Northern Road 156, Fuzhou, 350025, People's Republic of China.
| | - Xinling Ren
- Department of Respiratory, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Xueyuan AVE 1098, Xili University Town, Shenzhen, 518055, Guangdong, People's Republic of China.
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Wang J, Zhao Y, Wang Q, Zhang L, Shi J, Wang Z, Cheng Y, He J, Shi Y, Yu H, Zhao Y, Chen W, Luo Y, Wang X, Nan K, Jin F, Dong J, Li B, Liu Z, Han B, Li K. Prognostic factors of refractory NSCLC patients receiving anlotinib hydrochloride as the third- or further-line treatment. Cancer Biol Med 2018; 15:443-451. [PMID: 30766754 PMCID: PMC6372914 DOI: 10.20892/j.issn.2095-3941.2018.0158] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: Anlotinib hydrochloride is a multitarget tyrosine kinase inhibitor that targets vascular endothelial growth factor receptor, fibroblast growth factor receptor, platelet-derived growth factor receptor, c-Kit, and c-MET; therefore, it exhibits both antitumor and anti-angiogenetic activities. A phase III trial has shown that anlotinib improved progression-free survival (PFS) and overall survival (OS) in patients with advanced non-small cell lung cancer (NSCLC), who presented with progressive disease or intolerance after standard chemotherapy. This study aimed to analyze the characteristics of patients receiving anlotinib treatment to determine the dominant populations who are fit for the treatment. Methods: Data were collected from March 2015 to January 2017 from a randomized, double-blind, placebo-controlled, multicenter, phase III trial of anlotinib (ALTER0303). A total of 437 patients were enrolled and randomly allocated (2:1) to the anlotinib and placebo groups. Kaplan–Meier analysis and log-rank test were performed to compare PFS and OS. Cox proportional hazards model was adopted for multivariate prognostic analysis. Results: Multivariate analysis indicated that high post-therapeutic peripheral blood granulocyte/lymphocyte ratio and elevated alkaline phosphatase levels were independent risk factors for PFS. Meanwhile, elevated thyroid-stimulating hormone, blood glucose, and triglyceride levels; hypertension; and hand–foot syndrome were independent protective factors of PFS. High post-therapeutic peripheral blood granulocyte/lymphocyte ratio, an Eastern Cooperative Oncology Group (ECOG) score ≥ 2, and the sum of the maximal target lesion length at baseline were independent risk factors of OS, and hypertriglyceridemia was an independent protective factor of OS. Conclusions: This study preliminarily explored the possible factors that affected PFS and OS after anlotinib treatment in patients with advanced refractory NSCLC, and the baseline characteristics of the therapeutically dominant populations were then identified.
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Affiliation(s)
- Jing Wang
- Department of Pulmonary Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Yizhuo Zhao
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai 230030, China
| | - Qiming Wang
- Department of Medical Oncology, Henan Province Tumor Hospital, Zhengzhou 450008, China
| | - Li Zhang
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing 100730 China
| | - Jianhua Shi
- Department of Medical Oncology, Linyi Cancer Hospital, Linyi 276001, China
| | - Zhehai Wang
- Department of Internal Medicine, Shandong Cancer Hospital, Jinan 250117, China
| | - Ying Cheng
- Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun 130012, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Yuankai Shi
- Department of Medical Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Hao Yu
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 210029, China
| | - Yang Zhao
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 210029, China
| | - Weiqiang Chen
- Department of Respiratory Medicine, Lanzhou Military General Hospital, Lanzhou 730050, China
| | - Yi Luo
- Department of Head and Neck Oncology, Hunan Cancer Hospital, Changsha 220633, China
| | - Xiuwen Wang
- Department of Chemotherapy, Qilu Hospital of Shandong University, Jinan 250000, China
| | - Kejun Nan
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Faguang Jin
- Department of Respiratory and Critical Diseases, Tang Du Hospital, Xi'an 710038, China
| | - Jian Dong
- Department of Oncology, Yunnan Cancer Hospital, Kunming 650032, China
| | - Baolan Li
- General Department, Capital Medical University Beijing Chest Hospital, Beijing 101149, China
| | - Zhujun Liu
- Department of Pulmonary Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Baohui Han
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai 230030, China
| | - Kai Li
- Department of Pulmonary Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
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Zarogoulidis P, Huang H, Tsiouda T, Sardeli C, Trakada G, Veletza L, Kallianos A, Kosmidis C, Rapti A, Papaemmanouil L, Hatzibougias D, Drougas D, Bai C, Hohenforst-Schmidt W. Immunotherapy "Shock" with vitiligo due to nivolumab administration as third line therapy in lung adenocarcinoma. Respir Med Case Rep 2017; 22:283-286. [PMID: 29124007 PMCID: PMC5671388 DOI: 10.1016/j.rmcr.2017.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 10/17/2017] [Accepted: 10/25/2017] [Indexed: 12/28/2022] Open
Abstract
Non-small cell lung cancer is still diagnosed at late stage due to the lack of early symptoms and methods of diagnostic prevention. In the past ten years several targeted therapies have been introduced or explored. Tyrosine kinase inhibitors and immunotherapy are currently considered the most effective and safe therapies in comparison to the non-specific cytotoxic agents. Regarding tyrosine kinase inhibitors the adverse effects have been fully explored, however; on the other hand for immunotherapy there are still several issues to be clarified. We report a rare case of a patient with lung cancer adenocarcinoma who developed vitiligo throughout his body after nivolumab administration.
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Affiliation(s)
- Paul Zarogoulidis
- Pulmonary-Oncology Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Haidong Huang
- Department of Respiratory and Critical Care Medicine, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Theodora Tsiouda
- Pulmonary-Oncology Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece
| | - Chrysa Sardeli
- Department of Pharmacology & Clinical Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Trakada
- Division of Pulmonology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Alexandra Hospital, Athens, Greece
| | - Lemonia Veletza
- Division of Pulmonology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Alexandra Hospital, Athens, Greece
| | - Anastasios Kallianos
- Division of Pulmonology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Alexandra Hospital, Athens, Greece
| | | | - Aggeliki Rapti
- Second Pulmonary Clinic, "Sotiria" Chest Diseases Hospital, Athens, Greece
| | - Liana Papaemmanouil
- Pathology Department, "G. Papanikolaou" General Hospital, Thessaloniki, Greece
| | | | - Dimitrios Drougas
- Private Scientigraphy Department, "Bioiatriki", Thessaloniki, Greece
| | - Chong Bai
- Department of Respiratory and Critical Care Medicine, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wolfgang Hohenforst-Schmidt
- Sana Clinic Group Franken, Department of Cardiology/Pulmonology/Intensive Care/Nephrology, "Hof'' Clinics, University of Erlangen, Hof, Germany
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