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Pach J, Valido K, Belzer A, Leventhal JS. The Use of Biologic Agents for the Treatment of Cutaneous Immune-Related Adverse Events from Immune Checkpoint Inhibitors: A Review of Reported Cases. Am J Clin Dermatol 2024; 25:595-607. [PMID: 38767827 DOI: 10.1007/s40257-024-00866-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/22/2024]
Abstract
Cutaneous immune-related adverse events encompass a spectrum of dermatological manifestations, including lichenoid reactions, psoriasiform eruptions, eczematous dermatitis, immunobullous disorders, granulomatous reactions, pruritus, vitiligo, and severe cutaneous adverse reactions such as Stevens-Johnson syndrome. The conventional approach to treating high-grade or refractory cutaneous immune-related adverse events has involved high-dose systemic corticosteroids. However, their use is limited owing to the potential disruption of antitumor responses and associated complications. To address this, corticosteroid-sparing targeted immunomodulators have been explored as therapeutic alternatives. Biologic agents, commonly employed for non-cutaneous immune-related adverse events such as colitis, are increasingly recognized for their efficacy in treating various patterns of cutaneous immune-related adverse events, including psoriasiform, immunobullous, and Stevens-Johnson syndrome-like reactions. This review consolidates findings from the English-language literature, highlighting the use of biologic agents in managing diverse cutaneous immune-related adverse event patterns, also encompassing maculopapular, eczematous, and lichenoid eruptions, pruritus, and transient acantholytic dermatosis (Grover disease). Despite the established efficacy of these agents, further research is necessary to explore their long-term effects on antitumor responses.
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Affiliation(s)
- Jolanta Pach
- Yale University School of Medicine, New Haven, CT, USA
| | - Kailyn Valido
- Yale University School of Medicine, New Haven, CT, USA
| | - Annika Belzer
- Yale University School of Medicine, New Haven, CT, USA
| | - Jonathan S Leventhal
- Department of Dermatology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
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Minta A, Rose L, Shareef SJ, Adame S, Dulmage B. Availability of Cranial Prostheses for Black Patients at Comprehensive Cancer Centers. JCO Oncol Pract 2024:OP2300750. [PMID: 38917378 DOI: 10.1200/op.23.00750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/04/2024] [Accepted: 05/17/2024] [Indexed: 06/27/2024] Open
Abstract
PURPOSE For patients who seek to camouflage cancer-related hair loss, cranial prostheses such as wigs and hair pieces exist. We sought to determine the availability of yaki-textured, type IV curls, and afro wigs at boutiques in Comprehensive Cancer Centers (CCCs). METHODS The 56 CCCs in the United States were surveyed to see whether they had an affiliated wig boutique for patients experiencing hair loss. Boutique workers were then asked a series of seven questions regarding cranial prostheses options for patients seeking yaki-textured, type IV curls, and afro wigs. The availability of wigs was compared with US Census data on population size and density of Black residents. RESULTS Of the 56 CCCs, 27 (46%) institutions had active affiliated hair boutiques. We were able to reach 19 (70%) of the 27 boutiques, of which 53% (n = 10) offered yaki-textured wigs, 37% (n = 7) offered type IV curls or afro wigs, and 47% (n = 9) offered neither. Two additional boutiques offered in-store catalogs for Black patients who were interested in naturally appearing wigs. Although two institutions offered a wig bank that was free to all patients, neither had yaki-textured or afro wigs in stock. There was no significant relationship between population size or density of Black residents and availability of these wigs. CONCLUSION Many Black patients undergoing cancer treatment interested in cranial prosthesis do not have consistent access to wigs with textures comparable with type IV hair at CCCs. With increased inventory of racially inclusive wigs, partnerships with third-party vendors, and support for the previous authorization process, we can better support Black patients experiencing cancer-related hair loss.
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Affiliation(s)
- Abena Minta
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Lucy Rose
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Sarah J Shareef
- Michigan State University College of Human Medicine, East Lansing, MI
| | - Stephanie Adame
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Brittany Dulmage
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH
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3
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Pach JJ, Nelson CA, Leventhal JS. Characterizing skin and soft tissue infections in patients with cancer on systemic oncologic therapy: A single institution retrospective analysis from the outpatient and inpatient oncodermatology service. JAAD Int 2024; 15:21-23. [PMID: 38371669 PMCID: PMC10869938 DOI: 10.1016/j.jdin.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Affiliation(s)
- Jolanta J Pach
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Caroline A Nelson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
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Demir B, Demirci B, Tataroglu C, Barutca S, Barutca D. The efficacy of HDDPiW-jSB solution on docetaxel-induced alopecia of rats. Cutan Ocul Toxicol 2024; 43:113-119. [PMID: 38179974 DOI: 10.1080/15569527.2023.2300790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Chemotherapy induced alopecia (CIA) is one of the most common side effects in cancer patients, however; it doesn't have an effective pharmacological treatment yet. In this study we aimed to research the protective effect of newly developed HDDPiW-jSB solution on docetaxel (DTX) -induced rat alopecia model. MATERIAL AND METHODS Docetaxel (10 mg/kg/week) was administered to the 6-8 months old rats for three weeks. HDDPiW-jSB solution was applied once or twice a week for 4 weeks beginning prior to one week before DTX. Rat hair follicles were evaluated with hematoxylin-eosin and immune-histochemical staining. RESULTS In the first stage of this study, alopecia was successfully developed by DTX (10 mg/kg/three times) application. In the second stage of the study, application of HDDPiW-jSB solution, did not change the study parameters significantly on control group. The solution improved the anagen hair follicle count and Bcl-2 levels in the skin samples of DTX-induced alopecic rat groups, especially when applied twice weekly. Additionally, level of Caspase 3 was decreased. HDDPiW-jSB solution was safe when applied on the skin. CONCLUSION Topical HDDPiW-jSB solution could be effective and safe for the protection of DTX-induced alopecia in rat models.
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Affiliation(s)
- Bilgin Demir
- Departments of Internal Medicine, Division of Medical Oncology, Medical Faculty, Aydın Adnan Menderes University, Aydın, Turkey
| | - Buket Demirci
- Departments of Medical Pharmacology, Medical Faculty, Aydın Adnan Menderes University, Aydın, Turkey
| | - Canten Tataroglu
- Departments of Medical Pathology, Medical Faculty, Aydın Adnan Menderes University, Aydın, Turkey
| | - Sabri Barutca
- Departments of Internal Medicine, Division of Medical Oncology, Medical Faculty, Aydın Adnan Menderes University, Aydın, Turkey
| | - Duygu Barutca
- Industrial Engineering, Faculty of Engineering, Izmir University of Economics, Izmir, Turkey
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5
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Kim M, Carter J, Tadros AB, Abuhdra N, Nelson JA, Stern CS. A guide for addressing sexual health in breast cancer patients. J Surg Oncol 2024; 129:1034-1040. [PMID: 38385690 DOI: 10.1002/jso.27602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Sexual health concerns are common in breast cancer surgery but often overlooked. Yet, breast cancer patients want more sexual health information from their providers. We aimed to share ways for providers to address sexual health concerns with their breast cancer patients at different stages of the treatment process. METHODS Experts in breast cancer treatments, surgeries, and sexual health at Memorial Sloan Kettering Cancer Center assembled to review the literature and to develop the recommendations. RESULTS Providers should provide sexual health information for their breast cancer patients throughout the continuum of care. Conversations should be initiated by the providers and can be brief and informative. Whenever appropriate, patients should be referred to Sexual Medicine experts and/or psychosocial support. There are various recommendations and tools that can be utilized at diagnosis, endocrine and chemotherapy, and breast surgery to identify patients with sexual health concerns and to improve their sexual functioning. CONCLUSION In this paper, we sought to provide providers with some insights, suggestions, and tools to address sexual health concerns. We encourage healthcare providers to initiate the conversation throughout the continuum of care beginning as early as diagnosis and refer patients to additional services if available.
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Affiliation(s)
- Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jeanne Carter
- Gynecology Service, Department of Psychiatry, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Audree B Tadros
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nour Abuhdra
- Breast Oncology, Department of MedicineMemorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Carrie S Stern
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Belzer A, Pach JJ, Valido K, Leventhal JS. The Impact of Dermatologic Adverse Events on the Quality of Life of Oncology Patients: A Review of the Literature. Am J Clin Dermatol 2024; 25:435-445. [PMID: 38366030 DOI: 10.1007/s40257-024-00847-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/18/2024]
Abstract
Dermatologic adverse events resulting from oncologic therapy are common and negatively impact patients' quality of life. Dermatologic adverse events include toxicity of the skin, oral mucosa, nails, and hair and are seen with cytotoxic chemotherapy, targeted therapy, immunotherapy, and radiation therapy, with distinct patterns of dermatologic adverse events by drug class. Here, we review the literature on the impact of dermatologic adverse events on quality of life. Studies on quality of life in patients with cancer have relied on scales such as the Dermatologic Life Quality Index and Skindex to demonstrate the association between dermatologic adverse events and declining quality of life. This relationship is likely due to a variety of factors, including physical discomfort, changes to body image, decreased self-esteem, and an effect on social interactions. Addressing such quality-of-life concerns for patients with cancer is critical, not only for patients' well-being but also because decreased satisfaction with treatment can lead to discontinuation of treatment or dose reduction. Prophylactic treatment and early management of dermatologic adverse events by experienced dermatologists can alleviate the negative effects on quality of life and allow continuation of life-prolonging treatment.
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Affiliation(s)
- Annika Belzer
- Yale University School of Medicine, New Haven, CT, USA
| | | | - Kailyn Valido
- Yale University School of Medicine, New Haven, CT, USA
| | - Jonathan S Leventhal
- Department of Dermatology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
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Belmontesi M, Noberasco C. Using 3% retinol peeling and cosmeceuticals for the aesthetic wellness of the oncological patient after precautionary endocrine treatment: A case series. J Cosmet Dermatol 2024; 23:141-144. [PMID: 37464906 DOI: 10.1111/jocd.15908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/31/2023] [Accepted: 06/22/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Roughness, sagging, and skin rash are common in patients with breast cancer treated with LH-RH analog plus tamoxifen or aromatase inhibitors as adjuvant postsurgical endocrine therapy. The use of topical retinol (vitamin A) has shown to be an efficacious cosmetic treatment. AIMS Peeling with an advanced retinol peel formulation based on 3% retinol, 4% triethyl citrate, 0.1% aminophil, bisabolol, and 1% vitamin E acetate, in a vehicle in an alcoholic solution has been successfully used to ameliorate skin appearance on subjects with photodamage and in the aged population. We aimed to verify its use during adjuvant chemotherapy. PATIENTS Four subjects experiencing skin issues during postsurgical adjuvant therapy for their breast cancer received retinol peel at least 6 weeks after stopping their postsurgery therapy as a low invasive aesthetic medical treatment to be used both at the dermatology desk and at home. RESULTS Retinol peel was effective, safe, and well-tolerated, improving skin brightness and firmness in all the patients, since 4 weeks after the beginning of the treatment. Patients declared to be satisfied with the treatment and their skin appearance letting them feel better for cancer recovery, too. CONCLUSION These preliminary observations suggest that the use of an advanced retinol peel formulation might improve skin appearance in women experiencing skin damages caused by adjuvant therapy after breast cancer surgery.
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Affiliation(s)
| | - C Noberasco
- Chemioterapia e Oncologia Medica USL Nord Ovest Toscana Ospedale Campo di Marte Cittadella della Salute, Lucca, Italy
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Cucciniello L, Garufi G, Di Rienzo R, Martinelli C, Pavone G, Giuliano M, Arpino G, Montemurro F, Del Mastro L, De Laurentiis M, Puglisi F. Estrogen deprivation effects of endocrine therapy in breast cancer patients: Incidence, management and outcome. Cancer Treat Rev 2023; 120:102624. [PMID: 37751658 DOI: 10.1016/j.ctrv.2023.102624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/28/2023]
Abstract
Endocrine therapy is one of the standard adjuvant treatments to reduce the risk of recurrence and mortality in patients with hormone receptor positive early breast cancer. Despite its proven efficacy, ET side effects, which persist over time even if low grade, may deteriorate quality of life. During follow-up visits, emphasis is generally placed on the risk of disease recurrence, while the topic of ET side effects is commonly neglected and discussed only briefly. This could lead to poor adherence to therapy and early treatment discontinuation, resulting in worse survival outcomes. The aim of this review is to provide an overview of the available evidence on the incidence and reporting of ET-related side effects (including vasomotor symptoms, musculoskeletal disorders and genitourinary syndrome of menopause, as well as fatigue, psychological and ocular disorders, dysmetabolic effects and loss of bone density) and of the pharmacological and non-pharmacological strategies available to mitigate symptom burden.
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Affiliation(s)
- Linda Cucciniello
- Department of Medicine, University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy.
| | - Giovanna Garufi
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy; Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.
| | - Rossana Di Rienzo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Claudia Martinelli
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Giuliana Pavone
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Center of Experimental Oncology and Hematology, A.O.U. Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | | | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy; Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | | | - Fabio Puglisi
- Department of Medicine, University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy.
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Sollena P, Vasiliki N, Kotteas E, Stratigos AJ, Fattore D, Orlandi A, Mannino M, Di Pumpo M, Fida M, Starace M, Apalla Z, Romano MC, Riganti J, Segura S, Martinez AF, Fabbrocini G, Sibaud V, Peris K, On Behalf Of The Eadv Task Force Dermatology For Cancer Patients. Cyclin-Dependent Kinase 4/6 Inhibitors and Dermatologic Adverse Events: Results from the EADV Task Force "Dermatology for Cancer Patients" International Study. Cancers (Basel) 2023; 15:3658. [PMID: 37509319 PMCID: PMC10377938 DOI: 10.3390/cancers15143658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/29/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The introduction of cyclin-dependent kinase inhibitors (CDK4/6i) was a great advance in therapeutics for patients with estrogen receptor+/human epidermal growth factor receptor (HER2) locally advanced and metastatic breast cancer. Despite the increasing use of these agents, their adverse drug-related events have not yet been fully characterized. We describe the spectrum of cutaneous adverse reactions occurring in advanced breast cancer patients treated with cyclin-dependent kinase inhibitors, analyzing types, severity, time to onset, and possible treatment outcomes. METHODS We performed a multicentric retrospective study including patients with advanced breast cancer who developed cutaneous lesions during treatment with CDK4/6i in the period from June 2020 to June 2021. Patients > 18 years were recruited at eleven onco-dermatology units located in Albania (1), Argentina (1), France (1), Greece (3), Italy (3), and Spain (2). We evaluated patients' epidemiological and clinical characteristics, types of cutaneous adverse events, their time to onset, and treatment outcomes. The severity of the skin reactions was assessed using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 score. RESULTS Seventy-nine patients (median age: 62.3 years; range 39-83 years) were included in the study, and, collectively, we recorded a total of 165 cutaneous adverse events during follow-up visits. The most frequent cutaneous reactions were pruritus (49/79 patients), alopecia (25/79), and eczematous lesions (24/79). Cutaneous toxicities were usually mild in severity (>65%) and occurred after a median of 6.5 months. Only four patients (5%) required treatment discontinuation due to the severity of the skin lesions. The majority of the skin reactions were managed with topical treatments. CONCLUSIONS To the best of our knowledge, we present the largest case series of cutaneous adverse events developing in advanced breast cancer patients treated with CDK4/6i. We showed that cutaneous toxicities are usually mild in severity, and manageable with standard supportive care; however, in selected cases, they can lead to treatment discontinuation with possible implications for patients' clinical outcomes.
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Affiliation(s)
- Pietro Sollena
- UOC Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Nikolaou Vasiliki
- Dermato-Oncology Department, Cutaneous Toxicities Clinic, Andreas Sygros Hospital, National and Kapodistrian University of Athens, 16121 Athens, Greece
| | - Elias Kotteas
- Oncology Unit, 3rd Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, "Sotiria" General Hospital, 16121 Athens, Greece
| | - Alexander J Stratigos
- Dermato-Oncology Department, Cutaneous Toxicities Clinic, Andreas Sygros Hospital, National and Kapodistrian University of Athens, 16121 Athens, Greece
| | - Davide Fattore
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80126 Naples, Italy
| | - Armando Orlandi
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
| | - Maria Mannino
- Dermatologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marcello Di Pumpo
- Department of Scienza della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Monika Fida
- Dermatology Service, University Hospital Center "Mother Theressa", 1005 Tirana, Albania
| | - Michela Starace
- Dermatology-IRCCS, Policlinico Sant'Orsola, Department of Specialized, Experimental and Diagnostic Medicine, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Zoe Apalla
- Second Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | | | - Julia Riganti
- Dermatology Department, Hospital Italiano de Buenos Aires, 1199 Buenos Aires, Argentina
| | - Sonia Segura
- Department of Dermatology, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), 08003 Barcelona, Spain
| | - Azael Freites Martinez
- Oncodermatology Clinic at Hospital Ruber Juan Bravo and Universidad Europea, 28006 Madrid, Spain
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80126 Naples, Italy
| | - Vincent Sibaud
- Oncodermatology Department, Institut Universitaire du Cancer, Toulouse Oncopole, 31500 Toulouse, France
| | - Ketty Peris
- UOC Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Dermatologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Robijns J, Lodewijckx J, Claes M, Tuts L, Lenaerts M, Wessels T, Requilé A, Luyten D, Verheezen J, Joosens E, Mebis J. Evaluation of a novel skin care product for the management of chemotherapy-related dermatologic toxicities: A quasi-experimental study. Eur J Oncol Nurs 2023; 63:102278. [PMID: 36898268 DOI: 10.1016/j.ejon.2023.102278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/24/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE Evaluate the efficacy of a novel skincare product for the management of chemotherapy-related dermatological toxicities. METHODS A monocentric, prospective, interventional, open-label, pretest-posttest, single-group study with cancer patients receiving chemotherapy (n = 100) was set up. All enrolled patients applied the emollient daily to their face and body for three weeks. The severity of the skin reactions was evaluated by a researcher using the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 at baseline and end of the trial. Patient-reported outcomes (PROs) included the frequency and severity of skin symptoms (Numerical rating scale, NRS), quality of life (QoL; Skindex-16 and Dermatology Life Quality Index), Patient Benefit Index (PBI), and treatment satisfaction. PROs were collected at baseline, weekly, and at the end of the trial. RESULTS According to the CTCAE and NRS, the novel emollient significantly improved the severity and frequency of xerosis and pruritus (Ps ≤ .001). A significant reduction in the NRS score for frequency of erythema was measured (p < .001). The frequency and severity of burning and pain did not change. Regarding the patients' QoL, no beneficial effect of the skin care product was measurable. 44% of the patients experienced at least one patient-relevant treatment benefit. 87% of the patients were satisfied with the emollient and would recommend it. CONCLUSIONS This study shows that the novel emollient significantly reduced chemotherapy-induced skin toxicity, more specifically xerosis and pruritus without hampering patient's QoL. Future research is needed to make definite conclusions using a study design including a control group and a long-term follow-up.
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Affiliation(s)
- Jolien Robijns
- Faculty of Medicine and Life Sciences, Limburg Clinical Research Center, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium.
| | - Joy Lodewijckx
- Faculty of Medicine and Life Sciences, Limburg Clinical Research Center, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Marithé Claes
- Faculty of Medicine and Life Sciences, Limburg Clinical Research Center, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Laura Tuts
- Faculty of Medicine and Life Sciences, Limburg Clinical Research Center, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Melissa Lenaerts
- Faculty of Health, Medicine and Life Sciences, Department of Surgery, GROW School for Oncology & Reproduction, Maastricht University, Universiteitssingel 50, 6229ER, Maastricht, Netherlands
| | - Tim Wessels
- Limburg Oncology Center, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Annelies Requilé
- Limburg Oncology Center, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Daisy Luyten
- Limburg Oncology Center, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Jolanda Verheezen
- Limburg Oncology Center, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Eric Joosens
- Limburg Oncology Center, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Jeroen Mebis
- Faculty of Medicine and Life Sciences, Limburg Clinical Research Center, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium; Limburg Oncology Center, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
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Alos HC, Billones JB, Castillo AL, Vasquez RD. Alpinumisoflavone against cancer pro-angiogenic targets: In silico, In vitro, and In ovo evaluation. Daru 2022; 30:273-288. [PMID: 35925539 PMCID: PMC9715906 DOI: 10.1007/s40199-022-00445-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/16/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Breast cancer is currently the world's most predominant malignancy. In cancer progression, angiogenesis is a requirement for tumor growth and metastasis.Alpinumisoflavone (AIF), a bioactive isoflavonoid, exhibited good binding affinity with the angiogenesis pathway's druggable target through molecular docking. OBJECTIVES To confirm AIF's angiogenesis inhibitory activity, cytotoxic potential toward breast cancer cells, and druggability. METHODS Antiangiogenic activity was evaluated in six pro-angiogenic proteins in vitro, duck chorioallantoic membrane (CAM) in ovo, molecular docking and druggability in silico. RESULTS Findings showed that AIF significantly inhibited (p = < 0.001) the HER2(IC50 = 2.96 µM), VEGFR-2(IC50 = 4.80 µM), MMP-9(IC50 = 23.00 µM), FGFR4(IC50 = 57.65 µM), EGFR(IC50 = 92.06 µM) and RET(IC50 = > 200 µM) activity in vitro.AIF at 25 µM-200 µM significantly inhibited (p = < 0.001) the total number of branch points (IC50 = 14.25 μM) and mean length of tubule complexes (IC50 = 3.52 μM) of duck CAM comparable (p = > 0.001) with the positive control 200 µM celecoxib on both parameters.AIF inhibited the growth of the estrogen-receptor-positive (ER +) human breast cancer cells (MCF-7) by 44.92 ± 1.79% at 100 µM while presenting less toxicity to human dermal fibroblast neonatal (HDFn) normal cells.The positive control 100 µM doxorubicin showed 86.66 ± 0.93% and 92.97 ± 1.27% inhibition with MCF-7 (IC50 = 3.62 μM) and HDFn, (IC50 = 27.16 μM) respectively.In docking, AIF has the greatest in silico binding affinity on HER2 (-10.9 kcal/mol) among the key angiogenic molecules tested. In silico rat oral LD50 calculation indicates that AIF is moderate to slightly toxic at 146.4 mg/kg with 1.1 g/kg and 20.1 mg/kg upper and lower 95% confidence limits. Lastly, it sufficiently complies with Lipinski's, Veber's, Egan's, Ghose's, and Muegge's Rule, supporting its oral drug-like property. CONCLUSION This study revealed that AIF possesses characteristics of a phytoestrogen compound with significant binding affinity, inhibitory activity against pro-angiogenic proteins, and cytotoxic potential against ER + breast cancer cells.The acceptable and considerable safety and drug-likeness profiles of AIF are worthy of further confirmation in vivo and advanced pre-clinical studies so that AIF can be elevated as a promising molecule for breast cancer therapy.
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Art of prevention: The importance of dermatologic care when using aromatase inhibitors. Int J Womens Dermatol 2022; 7:769-773. [PMID: 35028380 PMCID: PMC8714559 DOI: 10.1016/j.ijwd.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/05/2021] [Accepted: 07/10/2021] [Indexed: 11/24/2022] Open
Abstract
As of January 2021, there are more than 3.8 million women in the United States with a history of breast cancer. The current standard of care for breast cancer involves surgical resection, radiation therapy, adjuvant endocrine therapy, and/or adjuvant chemotherapy. Aromatase inhibitors (AIs) are the gold standard for endocrine therapy in postmenopausal women. Dermatologic adverse events (dAEs) associated with AIs are rare but have been reported in the literature. Commonly reported dAEs include unspecified rash, pruritus, alopecia, vulvovaginal atrophy, vasculitis, and autoimmune/connective tissue disorders. Appropriate preventative strategies and careful management considerations have the potential to optimize the comprehensive care of patients with cancer and improve quality of life. Furthermore, prevention of dAEs can lead to a reduction in cancer treatment interruptions and discontinuations. Herein, we characterize dAEs of AIs and discuss preventative management to reduce the incidence of AI therapy interruption.
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Bagatin E, Rocha MADD, Freitas THP, Costa CS. Treatment challenges in adult female acne and future directions. Expert Rev Clin Pharmacol 2021; 14:687-701. [PMID: 33957838 DOI: 10.1080/17512433.2021.1917376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Acne is a chronic, inflammatory, and immune-mediated disease of the pilosebaceous unit, highly prevalent in adolescents. However, an increasing number of adults over 25 years old with facial acne, particularly women, have been observed. It is considered a different disease when compared to acne vulgaris. Face is the mainly involved area with inflammatory lesions and more sensitive skin, pointing out the need of a holistic approach.Areas covered: We performed a comprehensive literature search on PubMed database, up to January 2021, regarding adult female acne. We synthesized data about pathogenesis; differences compared to acne vulgaris; and treatment, with focus in the management challenges and perspectives.Expert opinion: It is essential to value the negative impact on quality of life of adult female acne, independently of severity. The disease has prolonged evolution, and patient might be resilient once the improvement, regardless of the treatment option, will just be noticeable after 3 months. Aggravating factors should be clearly discussed, such as the need of changing many habits, especially lesions manipulation. The therapeutic regimen includes make-up and tailored skin care (considering proneness to sensitivity), while anti-acne drugs should be chosen in accordance with desire to be pregnant, presence of pregnancy or breastfeeding.
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Affiliation(s)
| | | | | | - Caroline Sousa Costa
- Department of Specialized Medicine, Discipline of Dermatology - Universidade Federal Do Piauí, Teresina, Brazil
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Anoop TM, Joseph P R, Pn M, Kp P, Gopan G, Chacko S. Cutaneous Toxicities in Breast Cancer Patients Receiving Chemotherapy and Targeted Agents--An Observational Clinical Study. Clin Breast Cancer 2021; 21:e434-e447. [PMID: 33608219 DOI: 10.1016/j.clbc.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/17/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Systemic chemotherapy and targeted agents are associated with various cutaneous toxicities. Even though cutaneous toxicities are manageable, it often results in treatment discontinuation and worsens the patients' quality of life. AIM The study aimed to determine the spectrum of cutaneous toxicities in patients receiving systemic chemotherapy and targeted agents for breast cancer patients. PATIENTS AND METHODS A total of 250 out of 720 patients with breast cancer who developed various cutaneous toxicities to chemotherapeutic or targeted agents were included in the study. RESULTS Among 250 patients, 57 patients were on neoadjuvant chemotherapy, 89 patients were on adjuvant chemotherapy, 68 were on palliative chemotherapy for metastatic breast cancer and 36 were on targeted treatment for metastatic breast cancer. The most frequently affected site was hair (96%), followed by skin (92%), nail (34%), and mucosa (26%). The most common dermatological toxicity noticed in our study involved the hair in the form of chemotherapy induced alopecia (anagen effluvium) in 93.6%, followed by skin toxicity with generalized xerosis in 92% and, nail toxicity in 34%, and mucosal toxicity in 26%. The most common chemotherapeutic agent which caused frequent cutaneous toxicities in our patients was docetaxel followed by paclitaxel, capecitabine, doxorubicin, epirubicine, cyclophosphamide, 5-flurouracil and targeted agents like lapatinib, everolimus, and tamoxifen. CONCLUSION Cutaneous toxicities are common following systemic chemotherapy and targeted agents. Early recognition of cutaneous side effects of these agents and prompt early interventions can reduce the significant morbidity, cosmetic disfigurement, unnecessary treatment interruptions, and psychological distress in women treated for breast cancers.
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Affiliation(s)
- T M Anoop
- Department of Medical Oncology, Regional Cancer Center, Thiruvananthapuram, Kerala, India.
| | - Rona Joseph P
- Department of Medical Oncology, Regional Cancer Center, Thiruvananthapuram, Kerala, India
| | - Mini Pn
- KIMS Hospital, Thiruvananthapuram, Kerala, India
| | - Pranab Kp
- Department of Medical Oncology, Regional Cancer Center, Thiruvananthapuram, Kerala, India
| | - Gayatri Gopan
- Department of Medical Oncology, Regional Cancer Center, Thiruvananthapuram, Kerala, India
| | - Steffi Chacko
- Department of Medical Oncology, Regional Cancer Center, Thiruvananthapuram, Kerala, India
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Hegde S, Mizaj Z, Bhat G, Amin V, Pinto M, Shenoy M. Nail manifestations in cancer chemotherapy: A cross-sectional study. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2020. [DOI: 10.4103/jdds.jdds_79_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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