1
|
Ribeiro AHS, Braga ELC, Ferreira NDAG, Olej B, Verçosa N, Antunes LDS, Cavalcanti IL. CYP2D6 isoenzyme and ABCB1 gene polymorphisms associated with postoperative nausea and vomiting in women undergoing laparoscopic cholecystectomy: a randomized trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:744423. [PMID: 36841429 PMCID: PMC11148501 DOI: 10.1016/j.bjane.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Postoperative nausea and vomiting is still a common complication. Serotonin receptor antagonists are commonly used in clinical practice for antiemetic prophylaxis. Interindividual variations in drug response, including single nucleotide polymorphisms, are related to pharmacokinetic and pharmacodynamic changes in these drugs and may lead to a poor therapeutic response. This study aimed to evaluate the influence of CYP2D6 isoenzyme and ABCB1 gene polymorphisms on the frequency of postoperative nausea and vomiting with the use of ondansetron or palonosetron. METHODS A randomized, double-blind clinical trial including 82 women aged 60 years or over undergoing laparoscopic cholecystectomy was conducted. Patients were randomized to receive either ondansetron or palonosetron for postoperative nausea and vomiting prophylaxis. DNA was extracted from saliva. Genetic polymorphisms were analyzed by real-time polymerase chain reaction. The following polymorphisms were analyzed: rs3892097 C/T, rs1128503 A/G, rs16947 A/G, rs1065852 A/G, rs1045642 A/G, rs2032582 C/A, and rs20325821 C/A. RESULTS Overall, vomiting, and severe nausea occurred in 22.5% and 57.5% of patients, respectively. In the palonosetron group, patients with the GG genotype (rs16947 A/G) experienced more severe nausea (p = 0.043). In the ondansetron group, patients with the AA genotype (rs16947 A/G) presented mild nausea (p = 0.034), and those with the AA genotype (rs1065852 A/G) experienced more vomiting (p = 0.034). CONCLUSION A low antiemetic response was observed with ondansetron in the presence of the AA genotype (rs16947 A/G) and the AA genotype (rs1065852 A/G), and a low therapeutic response was found with palonosetron in the presence of the GG genotype (rs16947 A/G) in laparoscopic cholecystectomy. REGISTER ClinicalTrials.gov.
Collapse
Affiliation(s)
| | | | | | - Beni Olej
- Universidade Federal Fluminense (UFF), Niterói, Rio de Janeiro, RJ, Brazil
| | - Nubia Verçosa
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | |
Collapse
|
2
|
Ghorbani M, Namazi S, Dehghani M, Razi F, Khalvati B, Dehshahri A. Gene polymorphisms of TACR1 serve as the potential pharmacogenetic predictors of response to the neurokinin-1 receptor antagonist-based antiemetic regimens: a candidate-gene association study in breast cancer patients. Cancer Chemother Pharmacol 2024:10.1007/s00280-024-04661-9. [PMID: 38678150 DOI: 10.1007/s00280-024-04661-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/20/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE The current candidate gene association study aims to investigate tag SNPs from the TACR1 gene as pharmacogenetic predictors of response to the antiemetic guidelines-recommended, NK-1 receptor antagonist-based, triple antiemetic regimens. METHODS A set of eighteen tag SNPs of TACR1 were genotyped in breast cancer patients receiving anthracycline and cyclophosphamide (with/without docetaxel) applying real-time PCR-HRMA. Data analysis for 121 ultimately enrolled patients was initiated by defining haplotype blocks using PHASE v.2.1. The association of each tag SNP and haplotype alleles with failure to achieve the defined antiemetic regimen efficacy endpoints was tested using PLINK (v.1.9 and v.1.07, respectively) based on the logistic regression, adjusting for the previously known chemotherapy-induced nausea and vomiting (CINV) prognostic factors. All reported p-values were corrected using the permutation test (n = 100,000). RESULTS Four variants of rs881, rs17010730, rs727156, and rs3755462, as well as haplotypes containing the mentioned variants, were significantly associated with failure to achieve at least one of the defined efficacy endpoints. Variant annotation via in-silico studies revealed that the non-seed sequence variant, rs881, is located in the miRNA (hsa-miR-613) binding site. The other three variants or a variant in complete linkage disequilibrium with them overlap a region of high H3K9ac-promoter-like signature or regions of high enhancer-like signature in the brain or gastrointestinal tissue. CONCLUSION Playing an essential role in regulating TACR1 expression, gene polymorphisms of TACR1 serve as the potential pharmacogenetic predictors of response to the NK-1 receptor antagonist-based, triple antiemetic regimens. If clinically approved, modifying the NK-1 receptor antagonist dose leads to better management of CINV in risk-allele carriers.
Collapse
Affiliation(s)
- Marziyeh Ghorbani
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soha Namazi
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mehdi Dehghani
- Department of Hematology and Medical Oncology, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farideh Razi
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahman Khalvati
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
- Biological Mass Spectrometry Center, Stony Brook Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Ali Dehshahri
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
3
|
Yeo W, Ngai NTY, Yip CCH, Mo FKF, Yeo VA, Ko JWH, Li LV, Lau TKH, Lai KT, Pang E, Yip CHW, Yeo HL, Kwok CCH, Ko SWY, Molassiotis A. Risk Factors Associated with Chemotherapy-Induced Nausea and Vomiting Among Women with Breast Cancer Receiving Highly Emetogenic Chemotherapy: Individual Patient-Based Analysis of Three Prospective Antiemetic Trials. Cancer Manag Res 2024; 16:283-297. [PMID: 38617187 PMCID: PMC11012748 DOI: 10.2147/cmar.s447546] [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: 11/22/2023] [Accepted: 03/22/2024] [Indexed: 04/16/2024] Open
Abstract
Purpose Although risk factors related to chemotherapy-induced nausea and vomiting (CINV) have been identified in previous studies, only a few studies have evaluated the risk factors associated with contemporary antiemetic prophylaxis, including olanzapine/aprepitant- or NEPA-containing regimens. This study aimed to identify the risk factors associated with CINV development in Chinese breast cancer patients receiving doxorubicin and cyclophosphamide chemotherapy. Methods Data from 304 patients enrolled in 3 previously reported prospective antiemetic studies were included. Multivariate logistic regression models were used to predict risk factors associated with CINV occurrence. Additionally, the likelihood of treatment failure in relation to the number of risk factors in individual patients was evaluated. Results Multivariate analysis of the entire study group revealed that obesity status (defined as body mass index/= 25.0 kg/m2) and the use of olanzapine/aprepitant- or NEPA-containing anti-emetic regimens were associated with a high likelihood, while a history of motion sickness was associated with a lower likelihood, complete response (CR), and "no nausea" in the overall phase. A history of vomiting during pregnancy was also associated with a lower likelihood of an overall CR. Patients with an increasing number of risk factors had a higher likelihood of treatment failure and shorter time to first vomiting. Those who did not achieve CR and "no nausea" in the first cycle were less likely to achieve these parameters in the subsequent cycle of chemotherapy. Conclusion The present study confirmed previously reported risk factors for CINV in Chinese breast cancer patients receiving doxorubicin and cyclophosphamide. Further optimization of CINV control is required for patients with identifiable risk factors; olanzapine/aprepitant- or NEPA- containing prophylaxis are the preferred contemporary anti-emetics regimens for Chinese breast cancer patients undergoing doxorubicin and cyclophosphamide chemotherapy.
Collapse
Affiliation(s)
- Winnie Yeo
- Department of Clinical Oncology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People’s Republic of China
| | - Nicole T Y Ngai
- Department of Clinical Oncology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People’s Republic of China
| | - Christopher C H Yip
- Department of Clinical Oncology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People’s Republic of China
| | - Frankie K F Mo
- Department of Clinical Oncology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People’s Republic of China
| | - Victoria A Yeo
- Department of Clinical Oncology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People’s Republic of China
| | - Jonathan W H Ko
- Department of Clinical Oncology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People’s Republic of China
| | - Leung V Li
- Department of Clinical Oncology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People’s Republic of China
| | - Thomas K H Lau
- Department of Clinical Oncology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People’s Republic of China
| | - Kwai Tung Lai
- Department of Clinical Oncology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People’s Republic of China
| | - Elizabeth Pang
- Department of Clinical Oncology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People’s Republic of China
| | - Claudia H W Yip
- Department of Clinical Oncology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People’s Republic of China
| | - Horatio L Yeo
- Department of Clinical Oncology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People’s Republic of China
| | - Carol Chi Hei Kwok
- Department of Clinical Oncology, Princess Margaret Hospital, Kowloon, Hong Kong, People’s Republic of China
| | - Stephanie W Y Ko
- Department of Clinical Oncology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People’s Republic of China
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| |
Collapse
|
4
|
Singh K, Pituch K, Zhu Q, Gu H, Ernst B, Tofthagen C, Brewer M, Kober KM, Cooper BA, Paul SM, Conley YP, Hammer M, Levine JD, Miaskowski C. Distinct Nausea Profiles Are Associated With Gastrointestinal Symptoms in Oncology Patients Receiving Chemotherapy. Cancer Nurs 2023; 46:92-102. [PMID: 35671438 PMCID: PMC9437145 DOI: 10.1097/ncc.0000000000001076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unrelieved chemotherapy-induced nausea (CIN) occurs 48% of patients undergoing chemotherapy and is one of the most debilitating symptoms that patients report. OBJECTIVE The aims of this study were to identify subgroups of patients with distinct CIN profiles and determine how these subgroups differed on demographic and clinical characteristics; severity, frequency, and distress of CIN; and the co-occurrence of common gastrointestinal symptoms. METHODS Patients (n = 1343) completed demographic questionnaire and Memorial Symptom Assessment Scale 6 times over 2 cycles of chemotherapy. Latent class analysis was used to identify subgroups of patients with distinct CIN profiles. Differences among these subgroups were evaluated using parametric and nonparametric statistics. RESULTS Four distinct CIN profiles were identified: none (40.8%), increasing-decreasing (21.5%), decreasing (8.9%), and high (28.8%). Compared with the none class, patients in the high class were younger, had a lower annual household income, had child care responsibilities, had a lower Karnofsky Performance Status score and a higher Self-administered Comorbidity Questionnaire score, and were more likely to have received chemotherapy on a 14-day cycle and a highly emetogenic chemotherapy regimen. In addition, patients in the high class reported high occurrence rates for dry mouth, feeling bloated, diarrhea, lack of appetite, abdominal cramps, difficulty swallowing, mouth sores, weight loss, and change in the way food tastes. CONCLUSIONS That 60% of the patients reported moderate to high CIN occurrence rates confirms that this unrelieved symptom is a significant clinical problem. IMPLICATIONS FOR PRACTICE Nurses need to evaluate patients' level of adherence to their antiemetic regimen and make appropriate referrals for physical therapy, psychological services, and dietary counseling.
Collapse
Affiliation(s)
- Komal Singh
- Author Affiliations: Edson College of Nursing and Health Innovation, Arizona State University, Phoenix (Drs Singh, Pituch, and Brewer); Biodesign Center for Fundamental and Applied Microbiomics, Arizona State University, Tempe (Dr Zhu); Department of Environmental Health Sciences, Florida International University, Port Saint Lucie (Dr Gu); Cancer Center, Mayo Clinic, Phoenix, Arizona (Drs Singh and Ernst); Department of Nursing, Mayo Clinic, Jacksonville, Florida (Dr Tofthagen), HonorHealth Research Institute, Scottsdale, Arizona (Dr Brewer); School of Nursing, University of California, San Francisco (Drs Kober, Cooper, Paul, and Miaskowski); School of Nursing, University of Pittsburgh, Pennsylvania (Dr Conley); The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, Boston, Massachusetts (Dr Hammer); School of Medicine, University of California, San Francisco (Drs Levine and Miaskowski)
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Crowder SL, Hoogland AI, Welniak TL, LaFranchise EA, Carpenter KM, Li D, Rotroff DM, Mariam A, Pierce CM, Extermann M, Kim RD, Tometich DB, Figueiredo JC, Muzaffar J, Bari S, Turner K, Weinstock GM, Jim HS. Metagenomics and chemotherapy-induced nausea: A roadmap for future research. Cancer 2022; 128:461-470. [PMID: 34643945 PMCID: PMC8776572 DOI: 10.1002/cncr.33892] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/06/2021] [Accepted: 08/13/2021] [Indexed: 02/03/2023]
Abstract
Uncontrolled chemotherapy-induced nausea and vomiting can reduce patients' quality of life and may result in premature discontinuation of chemotherapy. Although nausea and vomiting are commonly grouped together, research has shown that antiemetics are clinically effective against chemotherapy-induced vomiting (CIV) but less so against chemotherapy-induced nausea (CIN). Nausea remains a problem for up to 68% of patients who are prescribed guideline-consistent antiemetics. Despite the high prevalence of CIN, relatively little is known regarding its etiology independent of CIV. This review summarizes a metagenomics approach to the study and treatment of CIN with the goal of encouraging future research. Metagenomics focuses on genetic risk factors and encompasses both human (ie, host) and gut microbial genetic variation. Little work to date has focused on metagenomics as a putative biological mechanism of CIN. Metagenomics has the potential to be a powerful tool in advancing scientific understanding of CIN by identifying new biological pathways and intervention targets. The investigation of metagenomics in the context of well-established demographic, clinical, and patient-reported risk factors may help to identify patients at risk and facilitate the prevention and management of CIN.
Collapse
Affiliation(s)
| | | | | | | | | | - Daneng Li
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center
| | - Daniel M. Rotroff
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Arshiya Mariam
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Richard D. Kim
- Department of Hematology Oncology, Moffitt Cancer Center
| | | | | | - Jameel Muzaffar
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center
| | - Shahla Bari
- Department of Hematology Oncology, Moffitt Cancer Center
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center
| | | | - Heather S.L. Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center
| |
Collapse
|
6
|
Multiple Gastrointestinal Symptoms Are Associated With Chemotherapy-Induced Nausea in Patients With Breast Cancer. Cancer Nurs 2022; 45:181-189. [PMID: 34183520 PMCID: PMC8712622 DOI: 10.1097/ncc.0000000000000976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Unrelieved chemotherapy-induced nausea (CIN) is a significant problem for patients with breast cancer (BC). OBJECTIVE In a sample of patients with BC who were assessed before their second or third cycle of chemotherapy, study purposes were to evaluate for the occurrence, severity, frequency, and distress associated with CIN; evaluate for differences in demographic and clinical characteristics and gastrointestinal (GI) symptom occurrence rates between patients who did and did not report CIN; and determine which demographic, clinical, and symptom characteristics were associated with the occurrence of CIN. METHODS Patients completed demographic and clinical questionnaires and the Memorial Symptom Assessment Scale for nausea and common GI symptom assessments. Univariate analyses evaluated for differences in demographic and clinical characteristics and GI symptom occurrence between patients who did and did not report CIN. Multiple logistic regression analysis evaluated for characteristics associated with CIN. RESULTS Of the 532 patients with BC, 47.2% reported CIN occurrence. Characteristics associated with CIN group membership were poorer functional status, receipt of chemotherapy on a 14-day cycle, and higher occurrence rates of 5 GI symptoms (ie, dry mouth, vomiting, constipation, change in the way food tastes, and lack of appetite; all P < .001). CONCLUSIONS Unrelieved CIN is a common symptom in patients with BC. This study is the first to demonstrate that 5 co-occurring GI symptoms were associated with CIN occurrence. IMPLICATIONS FOR PRACTICE This study identified new risk factors for CIN occurrence in patients with BC. Clinicians may be able to initiate additional interventions to alleviate CIN.
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Gupta K, Walton R, Kataria SP. Chemotherapy-Induced Nausea and Vomiting: Pathogenesis, Recommendations, and New Trends. Cancer Treat Res Commun 2020; 26:100278. [PMID: 33360668 DOI: 10.1016/j.ctarc.2020.100278] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/23/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
The significant physical and emotional effects of chemotherapy-induced nausea and vomiting (CINV) are experienced by cancer patients. Severe symptoms decrease the patient's quality of life and potentially deters further treatment. The five main forms of CINV (i.e., acute, delayed, anticipatory, breakthrough, and refractory) require different treatment regimens, which often include 5-HT3 receptor antagonists, NK1 receptor antagonists, and corticosteroids. Despite a significant amount of research and development of antiemetic agents, management of CINV remains a great challenge with many needs waiting to be adequately addressed, such as controlling non-acute CINV, developing appropriate CINV treatment protocols for multiple-day chemotherapy patients, and providing options for those prone to CINV despite treatment. Further research is required to optimize CINV management for these patients.
Collapse
Affiliation(s)
- Kush Gupta
- Kasturba Medical College, Mangalore, Karnataka 575001, India.
| | | | - S P Kataria
- Vardhaman Mahavir Medical College and Safdurjung Hospital, New Delhi 110029, India
| |
Collapse
|
9
|
Analysis of pharmacogenomic factors for chemotherapy-induced nausea and vomiting in patients with breast cancer receiving doxorubicin and cyclophosphamide chemotherapy. Cancer Chemother Pharmacol 2020; 87:73-83. [PMID: 33099677 DOI: 10.1007/s00280-020-04177-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/09/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Chemotherapy-induced nausea and vomiting (CINV) can lead to a significant deterioration in the quality of life of cancer patients receiving chemotherapy. This study aimed to determine whether ABCB1 2677G > T/A was associated with complete response (CR; defined as no vomiting and no rescue medication) in acute phase (CR0-24), as well as to explore the genetic factors affecting delayed phase (CR24-120) CINV in cancer patients treated with a standard triple antiemetic regimen that included aprepitant. METHODS This prospective single-center study included a total of 166 chemotherapy-naïve patients with breast cancer who received a standard dose of doxorubicin and cyclophosphamide combination chemotherapy; granisetron, dexamethasone, and aprepitant were administered prior to chemotherapy. CR0-24 was compared between minor allele homozygous (TT, AA, and TA) and major allele homozygous plus heterozygous (GG, GA, and GT) groups of ABCB1 2677G > T/A. In addition, 14 genetic polymorphisms were genotyped and their associations with CRs were investigated. RESULTS The proportion of patients who achieved CR0-24, which was the primary endpoint of this study, was 59% in the minor allele homozygous and 61% in the major allele homozygous plus heterozygous groups of ABCB1 2677G > T/A. Although this difference was not statistically significant, multivariate logistic regression analysis adjusted for potential risk factors showed that TACR1 1323TT (OR, 2.57; P = 0.014) was a significant determinant of CR24-120. CONCLUSION No significant association was found between ABCB1 2677G > T/A and CR0-24. However, it was observed that the polymorphism of TACR1, which encodes the neurokinin 1 receptor, might be a potential genetic risk factor for the development of delayed phase CINV.
Collapse
|
10
|
Saragiotto L, Leandro-Merhi VA, Aquino JLBD, MendonÇa JA. GASTROINTESTINAL CHANGES DURING NUTRITIONAL FOLLOW-UP OF CANCER PATIENTS UNDERGOING OUTPATIENT CHEMOTHERAPY. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:354-360. [PMID: 33237213 DOI: 10.1590/s0004-2803.202000000-68] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 08/07/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cancer patients may have gastrointestinal changes that influence nutritional status. OBJECTIVE To investigate the occurrence of gastrointestinal changes resulting from outpatient chemotherapy treatment in cancer patients. METHODS In a retrospective longitudinal study, the nutritional status and chemotherapy gastrointestinal changes (nausea, vomit, diarrhea, constipation, mucositis, dysphagia, xerostomia, inappetence, dysgeusia and heartburn) in cancer patients (n=187) were investigated in an outpatient follow-up. For the study of the parameters over time, the generalized estimating equation (GEE) method was used. Kruskal-Wallis, Mann-Whitney tests and Spearman coefficient, at a significance level of 5% were also used. RESULTS The majority of the patients were female (63.64%) and the mean age was 57.5±12.1 years. The most frequent symptoms were nausea (18.54%); inappetence (18.31%); intestinal constipation (11.58%); diarrhea (7.98%); xerostomia (7.59%) and vomiting (7.43%). The nutritional status did not exhibit any relevant changes (P=0.7594). However, a higher prevalence of eutrophy was observed, followed by overweight; vomiting exhibited a significant difference (P=0.0211). The nausea symptom exhibited a significant difference with a higher prevalence of colorectal neoplasia when compared to breast neoplasia (P=0.0062); as well as vomiting in lung and colorectal neoplasias (P=0.0022), and dysphagia, in head and neck neoplasia, when compared to other neoplasms (P<0.001). There was a statistically significant difference between the number of medical appointments and gender (P=0.0102) and between dysphagia and gender (P<0.0001). CONCLUSION The study findings enhance the need for signs and symptoms follow up, as well as nutritional status follow up of patients undergoing outpatient chemotherapy.
Collapse
Affiliation(s)
- Laiz Saragiotto
- Programa de Pós-Graduação em Ciências da Saúde, PUC-Campinas, SP, Brasil
| | | | | | | |
Collapse
|
11
|
Singh KP, Dhruva A, Flowers E, Paul SM, Hammer MJ, Wright F, Cartwright F, Conley YP, Melisko M, Levine JD, Miaskowski C, Kober KM. Alterations in Patterns of Gene Expression and Perturbed Pathways in the Gut-Brain Axis Are Associated With Chemotherapy-Induced Nausea. J Pain Symptom Manage 2020; 59:1248-1259.e5. [PMID: 31923555 PMCID: PMC7239734 DOI: 10.1016/j.jpainsymman.2019.12.352] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 12/12/2022]
Abstract
CONTEXT Despite current advances in antiemetic treatments, approximately 50% of oncology patients experience chemotherapy-induced nausea (CIN). OBJECTIVES The purpose of this study was to evaluate for differentially expressed genes and perturbed pathways associated with the gut-brain axis (GBA) across two independent samples of oncology patients who did and did not experience CIN. METHODS Oncology patients (n = 735) completed study questionnaires in the week before their second or third cycle of chemotherapy. CIN occurrence was assessed using the Memorial Symptom Assessment Scale. Gene expression analyses were performed in two independent samples using ribonucleic acid sequencing (Sample 1, n = 357) and microarray (Sample 2, n = 352) methodologies. Fisher's combined probability method was used to determine genes that were differentially expressed and pathways that were perturbed between the two nausea groups across both samples. RESULTS CIN was reported by 63.6% of the patients in Sample 1 and 48.9% of the patients in Sample 2. Across the two samples, 703 genes were differentially expressed, and 37 pathways were found to be perturbed between the two CIN groups. We identified nine perturbed pathways that are involved in mechanisms associated with alterations in the GBA (i.e., mucosal inflammation, disruption of gut microbiome). CONCLUSION Persistent CIN remains a significant clinical problem. Our study is the first to identify novel GBA-related pathways associated with the occurrence of CIN. Our findings warrant confirmation and suggest directions for future clinical studies to decrease CIN occurrence.
Collapse
Affiliation(s)
- Komal P Singh
- School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Anand Dhruva
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Elena Flowers
- School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Marilyn J Hammer
- The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Frances Cartwright
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michelle Melisko
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, San Francisco, California, USA.
| |
Collapse
|
12
|
Eliasen A, Dalhoff K, Mathiasen R, Schmiegelow K, Rechnitzer C, Schelde AB, Perwitasari DA, Tsuji D, Brok J. Pharmacogenetics of antiemetics for chemotherapy-induced nausea and vomiting: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2020; 149:102939. [PMID: 32259776 DOI: 10.1016/j.critrevonc.2020.102939] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 03/09/2020] [Indexed: 01/21/2023] Open
Abstract
A substantial proportion of cancer patients experience chemotherapy-induced nausea and vomiting (CINV) despite the use of antiemetic drugs. Prevalent genetic polymorphisms involved in antiemetic drug metabolism, drug transport and receptor pathways likely affect the effectiveness of antiemetics. Knowledge on which polymorphisms to integrate into individualised clinical care is needed. We did a systematic review evaluating the association between polymorphisms and effectiveness of antiemetics in cancer patients receiving moderately to highly emetogenic chemotherapy. Twenty studies n = 2331 evaluated eight polymorphisms in five candidate genes involved in 5-HT3 antagonist pathways. HTR3C C1214G increased the risk of acute chemotherapy-induced vomiting in the dominant model (odds ratio (OR) = 2.67, 95 % confidence interval (CI): 1.08-6.63). ABCB1 C3435T reduced the risk of acute CINV in the recessive model (OR = 0.60, 95 % CI: 0.44-0.81). Future studies should evaluate candidate genes that affect pharmacogenetics of other antiemetics beside 5-HT3 antagonists.
Collapse
Affiliation(s)
- Astrid Eliasen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Denmark; Department of Paediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Denmark; Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - René Mathiasen
- Department of Paediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Catherine Rechnitzer
- Department of Paediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Astrid Blicher Schelde
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Denmark; Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Daiki Tsuji
- Department of Clinical Pharmacology & Genetics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Jesper Brok
- Department of Paediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.
| |
Collapse
|
13
|
Singh K, Paul SM, Kober KM, Conley YP, Wright F, Levine JD, Joseph PV, Miaskowski C. Neuropsychological Symptoms and Intrusive Thoughts Are Associated With Worse Trajectories of Chemotherapy-Induced Nausea. J Pain Symptom Manage 2020; 59:668-678. [PMID: 31689477 PMCID: PMC7024637 DOI: 10.1016/j.jpainsymman.2019.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/20/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022]
Abstract
CONTEXT Although chemotherapy-induced vomiting is well controlled with evidence-based antiemetic regimens, chemotherapy-induced nausea (CIN) remains a significant clinical problem. OBJECTIVES Study purposes, in a sample of outpatients with breast, gastrointestinal, gynecological, or lung cancer who received two cycles of chemotherapy (CTX, n = 1251), were to evaluate for interindividual differences in the severity of CIN and to determine which demographic, clinical, symptom, and stress characteristics are associated with higher initial levels as well as with the trajectories of CIN. METHODS Patients were recruited during their first or second cycle of CTX. Patients completed self-report questionnaires a total of six times over two cycles of CTX. Hierarchical linear modeling was used to evaluate for interindividual differences in and characteristics associated with the severity of CIN. RESULTS Across the two cycles of CTX, higher levels of sleep disturbance, depression, and morning fatigue, as well as higher levels of intrusive thoughts, were associated with higher initial levels of CIN. In addition, lower functional status scores and shorter cycle lengths were associated with higher initial levels of CIN, and younger age and higher emetogenicity of the CTX regimen were associated with both higher initial levels as well as worse trajectories of CIN severity. CONCLUSION These findings suggest that common symptoms associated with cancer and its treatment are associated with increased severity of CIN. Targeted interventions for these symptoms may reduce the burden of unrelieved CIN.
Collapse
Affiliation(s)
- Komal Singh
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
| | - Paule V Joseph
- Sensory Science & Metabolism Unit, Biobehavioral Branch, Division of Intramural Research, Department of Health and Human Services, National Institutes of Health, Bethesda, Maryland, USA
| | | |
Collapse
|
14
|
Singh K, Kober KM, Paul SM, Hammer M, Wright F, Conley YP, Levine JD, Miaskowski C. Gastrointestinal symptoms are associated with trajectories of chemotherapy-induced nausea. Support Care Cancer 2019; 28:2205-2215. [PMID: 31428931 DOI: 10.1007/s00520-019-05031-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/06/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Between 19 and 58% of oncology patients experience chemotherapy-induced nausea (CIN). In a sample of outpatients with breast, gastrointestinal (GI), gynecological, and lung cancer, the study purposes were to evaluate for inter-individual differences in the severity of CIN over two cycles of chemotherapy (CTX) and to determine which demographic and clinical characteristics and GI symptoms were associated with higher initial levels as well as with the trajectories of CIN severity. METHODS Patients completed study questionnaires at six time points over two cycles of CTX. These questionnaires provided information on demographic and clinical characteristics, as well as the occurrence of twelve GI symptoms. Hierarchical linear modeling based on full maximum likelihood estimation was performed. RESULTS Of the 1251 patients, 47.2% reported CIN. Across two cycles of CTX, lower functional status scores and higher levels of comorbidity were associated with higher initial levels of CIN. Younger age and emetogenicity of the CTX regimen were associated with higher initial levels as well as worse trajectories of CIN. The occurrence of five GI symptoms (i.e., vomiting, lack of appetite, constipation, feeling bloated, and difficulty swallowing) was associated with higher initial levels of CIN. The occurrence of mouth sores was associated with higher initial levels as well as with worst trajectories of CIN. CONCLUSIONS This study is the first to identify distinct demographic, clinical, and GI symptom characteristics associated with CIN severity. These findings suggest that the etiology of CIN is complex and may warrant interventions beyond standard antiemetics.
Collapse
Affiliation(s)
- Komal Singh
- School of Nursing, Department of Physiological Nursing, University of California, 2 Koret Way-N631Y, San Francisco, CA, 94143-0610, USA
| | - Kord M Kober
- School of Nursing, Department of Physiological Nursing, University of California, 2 Koret Way-N631Y, San Francisco, CA, 94143-0610, USA
| | - Steven M Paul
- School of Nursing, Department of Physiological Nursing, University of California, 2 Koret Way-N631Y, San Francisco, CA, 94143-0610, USA
| | | | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, Department of Physiological Nursing, University of California, 2 Koret Way-N631Y, San Francisco, CA, 94143-0610, USA.
| |
Collapse
|
15
|
Guo WC, Wang F. Effect of nerve electrical stimulation for treating chemotherapy-induced nausea and vomiting in patients with advanced gastric cancer: A randomized controlled trial. Medicine (Baltimore) 2018; 97:e13620. [PMID: 30572473 PMCID: PMC6319986 DOI: 10.1097/md.0000000000013620] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND This randomized controlled trial evaluated the effectiveness of nerve electrical stimulation (NES) for the treatment of chemotherapy-induced nausea and vomiting (CINV) in patients with advanced gastric cancer (AGC). METHODS One hundred twenty-four eligible patients with AGC were included in this randomized controlled trial. They were equally divided the NES group and the sham group. The patients in the NES group received NES intervention, while the subjects in the sham group underwent sham NES. The primary outcome included symptoms severity and appetite. The secondary outcomes included quality of life, as measured by the MD Anderson Symptom Inventory (MDASI) score, and functional impairment, as evaluated by the Karnofsky score. Additionally, adverse events were also documented during the period of the treatment. RESULTS After treatment, NES showed greater effectiveness in reducing the severity of nausea (P = .02), and vomiting (P = .04), as well as the appetite improvement (P = .02), compared with the sham NES. Furthermore, no adverse events related to NES treatment were detected. CONCLUSION The results of this study demonstrated that NES may help to relieve CINV in patients with AGC. Future studies are still needed to warrant these results.
Collapse
|
16
|
Singh KP, Kober KM, Dhruva AA, Flowers E, Paul SM, Hammer MJ, Cartwright F, Wright F, Conley YP, Levine JD, Miaskowski C. Risk Factors Associated With Chemotherapy-Induced Nausea in the Week Before the Next Cycle and Impact of Nausea on Quality of Life Outcomes. J Pain Symptom Manage 2018; 56:352-362. [PMID: 29857180 PMCID: PMC10919143 DOI: 10.1016/j.jpainsymman.2018.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 12/18/2022]
Abstract
CONTEXT Despite current advances in antiemetic treatments, between 19% and 58% of oncology patients experience chemotherapy-induced nausea (CIN). OBJECTIVES Aims of this post hoc exploratory analysis were to determine occurrence, severity, and distress of CIN and evaluate for differences in demographic and clinical characteristics, symptom severity, stress; and quality of life (QOL) outcomes between oncology patients who did and did not report CIN in the week before chemotherapy (CTX). Demographic, clinical, symptom, and stress characteristics associated with CIN occurrence were determined. METHODS Patients (n = 1296) completed questionnaires that provided information on demographic and clinical characteristics, symptom severity, stress, and QOL. Univariate analyses evaluated for differences in demographic and clinical characteristics, symptom severity, stress, and QOL scores between the two patient groups. Multiple logistic regression analysis was used to evaluate for factors associated with nausea group membership. RESULTS Of the 1296 patients, 47.5% reported CIN. In the CIN group, 15% rated CIN as severe and 23% reported high distress. Factors associated with CIN included less education; having childcare responsibilities; poorer functional status; higher levels of depression, sleep disturbance, evening fatigue, and intrusive thoughts; as well as receipt of CTX on a 14-day CTX cycle and receipt of an antiemetic regimen that contained serotonin receptor antagonist and steroid. Patients in the CIN group experienced clinically meaningful decrements in QOL. CONCLUSION This study identified new factors (e.g., poorer functional status, stress) associated with CIN occurrence. CIN negatively impacted patients' QOL. Pre-emptive and ongoing interventions may alleviate CIN occurrence in high-risk patients.
Collapse
Affiliation(s)
- Komal P Singh
- School of Nursing, University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Anand A Dhruva
- School of Medicine, University of California, San Francisco, California, USA
| | - Elena Flowers
- School of Nursing, University of California, San Francisco, California, USA
| | - Steve M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Marilyn J Hammer
- Department of Nursing, Mount Sinai Hospital, New York, New York, USA
| | | | - Fay Wright
- School of Nursing, New York University, New York, New York, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
| | | |
Collapse
|