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Bowen J, Braga S, Zotto VD, Finnie J, DiPrimeo D, Cooke B, Bischof GF, Wong A, Di Palma JA. Preclinical and clinical evaluation through serial colonoscopic evaluation of neratinib-induced diarrhea in HER2-positive breast cancer-A pilot study. Physiol Rep 2024; 12:e70008. [PMID: 39187401 PMCID: PMC11347019 DOI: 10.14814/phy2.70008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 08/07/2024] [Accepted: 08/07/2024] [Indexed: 08/28/2024] Open
Abstract
The irreversible pan-HER tyrosine kinase inhibitor neratinib is approved for patients with HER2-positive, early-stage and metastatic breast cancer (BC). Neratinib-associated diarrhea is the most common reason for early discontinuation. Preclinical studies identified mechanisms of neratinib-induced diarrhea and rationale for prophylactic and preventive measures. We studied effects of neratinib on rat intestines and conducted a phase 2 study of colon pathogenesis in patients with HER2-positive BC treated with neratinib (NCT04366713). Colon samples from female albino Wistar rats receiving neratinib or vehicle were examined for histopathological changes. Patients with HER2-positive BC received neratinib 240 mg once daily for up to 1 year. Colonoscopy biopsies were collected at baseline and at Day 28 to identify changes consistent with rat pathologies. Rat colons were markedly altered in appearance, with similar short circuit currents (Isc) and responses to carbachol and forskolin. Mucosal barrier loss and/or significant increase in secretory propensity in neratinib- versus control-treated animals were not seen. Two of four endpoint-evaluable patients presented with mild pathological changes, largely comparable with the rat model. Preclinical evidence supports an inflammatory component of neratinib-induced diarrhea without mucosal barrier function loss. Colonoscopy findings in patients with BC indicate mild or no pathological changes in the colon due to neratinib treatment.
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Affiliation(s)
- Joanne Bowen
- School of BiomedicineThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Sofia Braga
- Medical OncologyHospital Prof. Doutor Fernando Fonseca, EPEAmadoraPortugal
| | - Valeria Dal Zotto
- Department of PathologyThe University of Alabama at BirminghamBirminghamAlabamaUSA
| | - John Finnie
- Division of Research and InnovationUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | | | - Blaire Cooke
- Puma Biotechnology, Inc.Los AngelesCaliforniaUSA
| | | | - Alvin Wong
- Puma Biotechnology, Inc.Los AngelesCaliforniaUSA
| | - Jack A. Di Palma
- Division of GastroenterologyUniversity of South Alabama, College of MedicineMobileAlabamaUSA
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Liu J, Yan S, Du J, Teng L, Yang R, Xu P, Tao W. Mechanism and treatment of diarrhea associated with tyrosine kinase inhibitors. Heliyon 2024; 10:e27531. [PMID: 38501021 PMCID: PMC10945189 DOI: 10.1016/j.heliyon.2024.e27531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/20/2024] Open
Abstract
Tyrosine kinase inhibitors (TKIs) have become first-line drugs for cancer treatment. However, their clinical use is seriously hindered since many patients experience diarrhea after receiving TKIs. The mechanisms of TKI-associated diarrhea remain unclear. Most existing therapies are symptomatic treatments based on experience and their effects are unsatisfactory. Therefore, clarification of the mechanisms underlying diarrhea is critical to develop effective anti-diarrhea drugs. This article summarizes several potential mechanisms of TKI-associated diarrhea and reviews current treatment progress.
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Affiliation(s)
- Jiangnan Liu
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical University, Heilongjiang, 150001, PR China
- Key Laboratory of Acoustic, Optical and Electromagnetic Diagnosis and Treatment of Cardiovascular Diseases, Heilongjiang, 150001, PR China
- The Cell Transplantation Key Laboratory of National Health Commission, Heilongjiang, 150001, PR China
| | - Shuai Yan
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical University, Heilongjiang, 150001, PR China
- Key Laboratory of Acoustic, Optical and Electromagnetic Diagnosis and Treatment of Cardiovascular Diseases, Heilongjiang, 150001, PR China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, Heilongjiang, 150001, PR China
- The Cell Transplantation Key Laboratory of National Health Commission, Heilongjiang, 150001, PR China
| | - Juntong Du
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical University, Heilongjiang, 150001, PR China
- Key Laboratory of Acoustic, Optical and Electromagnetic Diagnosis and Treatment of Cardiovascular Diseases, Heilongjiang, 150001, PR China
- The Cell Transplantation Key Laboratory of National Health Commission, Heilongjiang, 150001, PR China
| | - Lizhi Teng
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical University, Heilongjiang, 150001, PR China
- Key Laboratory of Acoustic, Optical and Electromagnetic Diagnosis and Treatment of Cardiovascular Diseases, Heilongjiang, 150001, PR China
- The Cell Transplantation Key Laboratory of National Health Commission, Heilongjiang, 150001, PR China
| | - Ru Yang
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical University, Heilongjiang, 150001, PR China
- Key Laboratory of Acoustic, Optical and Electromagnetic Diagnosis and Treatment of Cardiovascular Diseases, Heilongjiang, 150001, PR China
- The Cell Transplantation Key Laboratory of National Health Commission, Heilongjiang, 150001, PR China
| | - Peng Xu
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical University, Heilongjiang, 150001, PR China
- Key Laboratory of Acoustic, Optical and Electromagnetic Diagnosis and Treatment of Cardiovascular Diseases, Heilongjiang, 150001, PR China
- The Cell Transplantation Key Laboratory of National Health Commission, Heilongjiang, 150001, PR China
| | - Weiyang Tao
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical University, Heilongjiang, 150001, PR China
- Key Laboratory of Acoustic, Optical and Electromagnetic Diagnosis and Treatment of Cardiovascular Diseases, Heilongjiang, 150001, PR China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, Heilongjiang, 150001, PR China
- The Cell Transplantation Key Laboratory of National Health Commission, Heilongjiang, 150001, PR China
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Ma F, Yan M, Li W, Ouyang Q, Tong Z, Teng Y, Wang Y, Wang S, Geng C, Luo T, Zhong J, Zhang Q, Liu Q, Zeng X, Sun T, Mo Q, Liu H, Cheng Y, Cheng J, Wang X, Nie J, Yang J, Wu X, Wang X, Li H, Ye C, Dong F, Wu S, Zhu X, Xu B. Pyrotinib versus placebo in combination with trastuzumab and docetaxel as first line treatment in patients with HER2 positive metastatic breast cancer (PHILA): randomised, double blind, multicentre, phase 3 trial. BMJ 2023; 383:e076065. [PMID: 37907210 PMCID: PMC10616786 DOI: 10.1136/bmj-2023-076065] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of pyrotinib (an irreversible pan-HER (human epidermal growth factor receptor) inhibitor), trastuzumab, and docetaxel compared with placebo, trastuzumab, and docetaxel for untreated HER2 positive metastatic breast cancer. DESIGN Randomised, double blind, placebo controlled, multicentre, phase 3 trial. SETTING 40 centres in China between 6 May 2019 and 17 January 2022. PARTICIPANTS 590 female patients (median age 52 (interquartile range 46-58) years) with untreated HER2 positive metastatic breast cancer. INTERVENTIONS Eligible patients were randomised 1:1 to receive either oral pyrotinib (400 mg once daily) or placebo, both combined with intravenous trastuzumab (8 mg/kg in cycle 1 and 6 mg/kg in subsequent cycles) and docetaxel (75 mg/m2) on day 1 of each 21 day cycle. Randomisation was stratified by treatment history of trastuzumab in the (neo)adjuvant setting and hormone receptor status. Patients, investigators, and the sponsor's study team were masked to treatment assignment. MAIN OUTCOME MEASURES The primary endpoint was progression-free survival as assessed by the investigator. RESULTS Of the 590 randomised patients, 297 received pyrotinib, trastuzumab, and docetaxel treatment (pyrotinib group), and 293 received placebo, trastuzumab, and docetaxel treatment (placebo group). At data cut-off on 25 May 2022, the median follow-up was 15.5 months. The median progression-free survival according to the investigator was significantly longer in the pyrotinib group than in the placebo group (24.3 (95% confidence interval 19.1 to 33.0) months versus 10.4 (9.3 to 12.3) months; hazard ratio 0.41 (95% confidence interval 0.32 to 0.53); one sided P<0.001). Treatment related adverse events of grade 3 or higher were reported in 267 (90%) of the 297 patients in the pyrotinib group and 224 (76%) of the 293 patients in the placebo group. No treatment related deaths occurred in the pyrotinib group, and one (<1%; diabetic hyperosmolar coma) treatment related death occurred in the placebo group. Survival and toxicities are still under assessment with longer follow-up. CONCLUSIONS Pyrotinib, trastuzumab, and docetaxel showed superiority by significantly improving progression-free survival compared with placebo, trastuzumab, and docetaxel in patients with untreated HER2 positive metastatic breast cancer. The toxicity was manageable. The findings support this dual anti-HER2 regimen as an alternative first line treatment option in this patient population. TRIAL REGISTRATION ClinicalTrials.gov NCT03863223.
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Affiliation(s)
- Fei Ma
- Department of Medical Oncology, Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Yan
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Wei Li
- Department of Oncology, The First Hospital of Jilin University, Changchun, China
| | - Quchang Ouyang
- Breast Internal Medicine Department, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Zhongsheng Tong
- Department of Breast Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Yuee Teng
- Department of Breast Internal Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Yongsheng Wang
- Breast Surgery, Shandong Cancer Hospital and Institute, Jinan, China
| | - Shusen Wang
- Department of Internal Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Cuizhi Geng
- Breast Center, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, Shijiazhuang, China
| | - Ting Luo
- Department of Medical Oncology of Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jincai Zhong
- Medical Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qingyuan Zhang
- Ward One of Mammary Department, Harbin Medical University Cancer Hospital, Harbin, China
| | - Qiang Liu
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaohua Zeng
- Breast Cancer Center, Affiliated Cancer Hospital of Chongqing University, Chongqing, China
| | - Tao Sun
- Breast Internal Medicine Department, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Qinguo Mo
- Breast Surgery, Guangxi Medical University Affiliated Tumor Hospital, Nanning, China
| | - Hu Liu
- Department of Medical Oncology, The First Affiliated Hospital of USTC West District, Hefei, China
| | - Ying Cheng
- Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun, China
| | - Jing Cheng
- Oncology Center Breast Department, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Xiaojia Wang
- Breast Medicine, Zhejiang Cancer Hospital, Hangzhou, China
| | - Jianyun Nie
- Breast Surgery, Yunnan Cancer Hospital, Kunming, China
| | - Jin Yang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xinhong Wu
- Department of Breast Oncology, Hubei Cancer Hospital, Wuhan, China
| | - Xinshuai Wang
- Department of Medical Oncology, Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang, China
| | - Huiping Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Changsheng Ye
- Department of Breast, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Fangli Dong
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Shuchao Wu
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Xiaoyu Zhu
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Binghe Xu
- Department of Medical Oncology, Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Efficacy of the Whole-Course Case Management Model on Compliance and Satisfaction of Breast Cancer Patients with Whole-Course Standardized Treatment. JOURNAL OF ONCOLOGY 2022; 2022:2003324. [PMID: 35783153 PMCID: PMC9249505 DOI: 10.1155/2022/2003324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/18/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Abstract
Objective To explore the influence of the whole-course case management model on the compliance and satisfaction of breast cancer patients with the whole-course standardized treatment. Methods Eighty breast cancer patients admitted to our hospital between April 2020 and June 2021 were assigned to receive either conventional nursing (routine group, n = 40) or whole-process case management (experimental group, n = 40) according to different nursing methods. Outcome measures included self-rating anxiety scale (SAS) scores, self-rating depression scale (SDS) scores, adverse reactions, treatment compliance, and nursing satisfaction. Results After nursing, the SAS and SDS scores of the experimental group were significantly lower than those of the routine group (P < 0.05). The whole case management mode was associated with a significantly lower incidence of adverse reactions versus routine nursing (P < 0.05). The whole case management resulted in higher compliance of patients versus routine nursing (P < 0.05). The experimental group had a significantly higher nursing satisfaction versus the routine group (P < 0.05). Conclusion The whole-process case management mitigates patients' negative emotions, strengthens their treatment compliance, lowers the incidence of postoperative adverse reactions, and improves nursing satisfaction, which may provide a viable nursing alternative for patients with breast cancer.
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