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Oskam JA, Danesh-Meyer HV. Neuro-ophthalmic complications of modern anti-cancer drugs. Graefes Arch Clin Exp Ophthalmol 2024; 262:2269-2281. [PMID: 38345654 PMCID: PMC11222285 DOI: 10.1007/s00417-023-06350-4] [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: 08/20/2023] [Revised: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 07/04/2024] Open
Abstract
PURPOSE Targeted cancer therapies have been responsible for a dramatic shift in treatment strategies for cancer, and the number of drugs, classes, and indications are continually growing. Neuro-ophthalmic complications of these medications are an uncommon but important subset of adverse events which profoundly impact vision. This review aims to collate studies and reports of known neuro-ophthalmic complications of targeted therapies and describe their management. METHODS The anti-cancer drugs included in the review were any drugs targeting specific molecules involved in the cancer disease process. PubMed, EMBASE, and Web of Science were searched using the generic names of each drug and keywords of neuro-ophthalmic conditions. The prescribing information published by the US Food and Drug Administration (FDA) for each drug was also reviewed. RESULTS Several classes of targeted anti-cancer drugs were found to cause neuro-ophthalmic adverse effects. Immune checkpoint inhibitors are responsible for a raft of immune-related adverse events such as optic neuritis, ischemic optic neuropathy, PRES, and myasthenia gravis. Therapies with anti-VEGF activity can provoke posterior reversible leukoencephalopathy, which commonly presents with visual loss and can be fatal if not treated promptly. Inhibitors of BCR-ABL1, VEGF, ALK, and proteasomes have all been linked to optic nerve disorders which can have debilitating consequences for vision. CONCLUSION The neuro-ophthalmic complications of modern anti-cancer drugs can limit or necessitate the withdrawal of these life-prolonging medications. Ophthalmologists should be alert for neuro-ophthalmic complications in these medications to facilitate prompt diagnosis and treatment and reduce the risk of severe and permanent consequences.
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Affiliation(s)
- Joshua A Oskam
- School of Optometry and Vision Science, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland, Auckland, New Zealand.
| | - Helen V Danesh-Meyer
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland, Auckland, New Zealand
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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2
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Jo S, Yoo JW, Kim S, Lee JW, Im SA, Cho B, Chung NG. Case report: First report of isolated central nervous system lymphoblastic crisis in a child with chronic myeloid leukemia on dasatinib therapy. Front Oncol 2023; 13:1122714. [PMID: 37035148 PMCID: PMC10076740 DOI: 10.3389/fonc.2023.1122714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/09/2023] [Indexed: 04/11/2023] Open
Abstract
Most children with chronic myeloid leukemia (CML) present with the chronic phase (CML-CP) at diagnosis, exhibiting an excellent treatment response to contemporary tyrosine kinase inhibitors (TKIs). However, despite TKI therapy, patients with CML-CP may progress to blastic crisis (BC). CML-BC rarely occurs in extramedullary sites, and isolated central nervous system (CNS) BC is an extremely rare condition. It may with present various neurologic symptoms that necessitates differential diagnosis from other causes such as TKI toxicity. Information on the diagnosis and treatment of this condition is lacking, as are well-established diagnostic criteria. Here, we report a case of isolated CNS lymphoblastic crisis in a child with CML-CP who was treated with dasatinib. The patient, an 8-year-old girl, was admitted owing to visual disturbance and severe headache. We highlight the importance of a CSF study for the differential diagnosis of CNS BC in patients with CML-CP who present with common neurologic symptoms during TKI therapy.
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Affiliation(s)
- Suejung Jo
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Won Yoo
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- *Correspondence: Jae Won Yoo,
| | - Seongkoo Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Wook Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo-Ah Im
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bin Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Nack-Gyun Chung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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3
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Haddad F, Kantarjian H, Issa GC, Jabbour E, Sasaki K. Intracranial hypertension associated with BCR-ABL1 tyrosine kinase inhibitors in chronic myeloid leukemia. Leuk Lymphoma 2022; 63:1714-1717. [DOI: 10.1080/10428194.2022.2045599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Fadi Haddad
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ghayas C. Issa
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Koji Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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4
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Dahlén T, Edgren G, Ljungman P, Flygt H, Richter J, Olsson‐Strömberg U, Wadenvik H, Dreimane A, Myhr‐Eriksson K, Zhao J, Själander A, Höglund M, Stenke L. Adverse outcomes in chronic myeloid leukemia patients treated with tyrosine kinase inhibitors: Follow-up of patients diagnosed 2002-2017 in a complete coverage and nationwide agnostic register study. Am J Hematol 2022; 97:421-430. [PMID: 35015312 PMCID: PMC9306877 DOI: 10.1002/ajh.26463] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 11/05/2022]
Abstract
Tyrosine kinase inhibitors (TKIs) have profoundly improved the clinical outcome for patients with chronic myeloid leukemia (CML), but their overall survival is still subnormal and the treatment is associated with adverse events. In a large cohort-study, we assessed the morbidity in 1328 Swedish CML chronic phase patients diagnosed 2002-2017 and treated with TKIs, as compared to that in carefully matched control individuals. Several Swedish patient registers with near-complete nationwide coverage were utilized for data acquisition. Median follow-up was 6 (IQR, 3-10) years with a total follow-up of 8510 person-years for the full cohort. Among 670 analyzed disease categories, the patient cohort showed a significantly increased risk in 142 while, strikingly, no category was more common in controls. Increased incidence rate ratios/IRR (95% CI) for more severe events among patients included acute myocardial infarction (AMI) 2.0 (1.5-2.6), heart failure 2.6 (2.2-3.2), pneumonia 2.8 (2.3-3.5), and unspecified sepsis 3.5 (2.6-4.7). When comparing patients on 2nd generation TKIs vs. imatinib in a within-cohort analysis, nilotinib generated elevated IRRs for AMI (2.9; 1.5-5.6) and chronic ischemic heart disease (2.2; 1.2-3.9), dasatinib for pleural effusion (11.6; 7.6-17.7) and infectious complications, for example, acute upper respiratory infections (3.0; 1.4-6.0). Our extensive real-world data reveal significant risk increases of severe morbidity in TKI-treated CML patients, as compared to matched controls, particularly for 2nd generation TKIs. Whether this increased morbidity may also translate into increased mortality, thus preventing CML patients to achieve a normalized overall survival, needs to be further explored.
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Affiliation(s)
- Torsten Dahlén
- Department of Medicine Solna, Clinical Epidemiology Division Karolinska Institutet Stockholm Sweden
- Department of Hematology Karolinska University Hospital Stockholm Sweden
| | - Gustaf Edgren
- Department of Medicine Solna, Clinical Epidemiology Division Karolinska Institutet Stockholm Sweden
- Department of Cardiology Södersjukhuset Stockholm Sweden
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation Karolinska University Hospital Huddinge, Stockholm Sweden
- Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | - Hjalmar Flygt
- Department of Medical Science and Division of Hematology University Hospital Uppsala Sweden
| | - Johan Richter
- Department of Hematology, Oncology and Radiation Physics Skåne University Hospital Lund Sweden
| | - Ulla Olsson‐Strömberg
- Department of Medical Science and Division of Hematology University Hospital Uppsala Sweden
| | - Hans Wadenvik
- Section of Hematology Sahlgrenska University Hospital Gothenburg Sweden
| | - Arta Dreimane
- Department of Hematology Linköping University Hospital Linköping Sweden
| | | | - Jingcheng Zhao
- Department of Medicine Solna, Clinical Epidemiology Division Karolinska Institutet Stockholm Sweden
| | - Anders Själander
- Department of Public Health and Clinical Medicine Umeå University Sundsvall Sweden
| | - Martin Höglund
- Department of Medical Science and Division of Hematology University Hospital Uppsala Sweden
| | - Leif Stenke
- Department of Hematology Karolinska University Hospital Stockholm Sweden
- Department of Medicine Solna Karolinska Institutet Stockholm Sweden
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5
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Abstract
The proliferation of targeted anticancer agents over the last two decades has revolutionized cancer treatment and improved survival in many previously refractory malignancies. However, many agents are associated with characteristic ophthalmic adverse effects. It is important that ophthalmologists recognize and maintain a high index of suspicion for these side effects in patients on targeted therapy. Most ophthalmic adverse effects can be treated with specific ocular therapy without discontinuation of cancer treatment, although it is important to be aware of the life-threatening and vision-threatening circumstances that would require therapy cessation in conjunction with the patient's oncologist. This review aims to summarize the ophthalmic adverse effects of targeted and hormonal anticancer agents and briefly describe their management.
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6
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Bindiganavile SH, Bhat N, Lee AG, Gombos DS, Al-Zubidi N. Targeted Cancer Therapy and Its Ophthalmic Side Effects: A Review. JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2021; 4:6-15. [PMID: 35664825 PMCID: PMC9161666 DOI: 10.36401/jipo-20-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/06/2020] [Indexed: 06/15/2023]
Abstract
Targeted cancer therapy agents are the latest development in cancer therapeutics. Although the spectrum of their use continues to expand, ocular side effects are frequently encountered with the use of cancer therapeutics. This review describes the ocular side effects of targeted cancer therapy agents.
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Affiliation(s)
| | - Nita Bhat
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Andrew G. Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
- Texas A and M College of Medicine, Bryan, TX, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Section of Ophthalmology, Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dan S. Gombos
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
- Section of Ophthalmology, Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nagham Al-Zubidi
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
- Section of Ophthalmology, Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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7
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Optic neuritis associated with sunitinib. Neurol Sci 2020; 42:1165-1167. [PMID: 32914245 DOI: 10.1007/s10072-020-04713-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
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8
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Rafei H, Jabbour EJ, Kantarjian H, Sinicrope KD, Kamiya-Matsuoka C, Mehta RS, Daver NG, Kadia TM, Naqvi K, Cortes J, Konopleva M. Neurotoxic events associated with BCR-ABL1 tyrosine kinase inhibitors: a case series. Leuk Lymphoma 2019; 60:3292-3295. [DOI: 10.1080/10428194.2019.1633635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Hind Rafei
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elias Joseph Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kaylyn D. Sinicrope
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos Kamiya-Matsuoka
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rohtesh S. Mehta
- Departement of Stem Cell Transplant and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naval G. Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tapan M. Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kiran Naqvi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jorge Cortes
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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9
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14th EUNOS Congress: PORTO, PORTUGAL, 16-19 JUNE 2019. Neuroophthalmology 2019; 43:1-221. [PMID: 31528195 PMCID: PMC6736494 DOI: 10.1080/01658107.2019.1608780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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10
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Birnbaum FA, Meekins LC, Srinivasan A, Murchison AP. A lot of nerve. Surv Ophthalmol 2019; 65:272-277. [PMID: 31029580 DOI: 10.1016/j.survophthal.2019.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 04/15/2019] [Indexed: 10/27/2022]
Abstract
A 71-year-old woman with a history of acute lymphoblastic leukemia presented with unilateral optic disc edema. Laboratory evaluations for infectious, inflammatory, and neoplastic etiologies were negative. Magnetic resonance imaging of the orbits with and without contrast demonstrated enhancement and thickening of the right optic nerve with mild stranding of the intraconal fat. She underwent three large-volume lumbar punctures, all of which were negative for malignancy. An optic nerve biopsy was ultimately performed, demonstrating malignant cells on immunohistochemical staining. This case illustrates a rare case of biopsy-proven leukemic infiltration of the optic nerve head as the presenting sign of leukemic relapse despite a negative systemic workup. Leukemic infiltration should be considered in the differential diagnosis for cases of acquired disc edema, especially in patients with a past medical history of leukemia.
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Affiliation(s)
- Faith A Birnbaum
- Department of Ophthalmology, Duke Eye Center, Durham, North Carolina, USA
| | - Landon C Meekins
- Department of Ophthalmology, Duke Eye Center, Durham, North Carolina, USA.
| | - Archana Srinivasan
- Skull Base Division, Neuro-ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Ann P Murchison
- Skull Base Division, Neuro-ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA; Director, Wills Eye Emergency Department, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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11
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Kavanagh S, Bril V, Lipton JH. Peripheral neuropathy associated with imatinib therapy for chronic myeloid leukemia. Blood Res 2018; 53:172-174. [PMID: 29963528 PMCID: PMC6021569 DOI: 10.5045/br.2018.53.2.172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 12/28/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Simon Kavanagh
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Vera Bril
- The Prosserman Family Neurology Clinic, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Jeffrey H Lipton
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
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12
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Mistry S, Sudharshan S, Ganesan S, Akbar AB, Biswas J. Vogt-Koyanagi-Harada disease like presentation in patients with chronic myeloid leukemia. Am J Ophthalmol Case Rep 2018; 10:221-225. [PMID: 29780937 PMCID: PMC5956718 DOI: 10.1016/j.ajoc.2018.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/08/2018] [Accepted: 03/08/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose To report two rare cases of chronic myeloid leukemia (CML) on tyrosine kinase inhibitors presenting as bilateral serous retinal detachment and ocular inflammation, simulating Vogt-Koyanagi-Harada (VKH) disease. Methods Case series and review of literature. Result Two young patients (one male and one female) with CML on treatment with tyrosine kinase inhibitors (imatinib and dasatanib) under remission presented with bilateral sudden vision loss. One patient had bilateral multiple pockets of serous retinal fluid while the other had panuveitis with exudative retinal detachment. There was neither prodromal symptoms nor systemic signs and symptoms suggestive of VKH in both cases. They responded well to systemic steroid therapy without recurrences with complete visual recovery. Conclusion and importance CML patients can have features similar to VKH even during stable hematological phase and may be possibly associated with the use of tyrosine kinase inhibitors. Hence it is important not to misdiagnose and treat such patients with long term immunomodulators.
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Affiliation(s)
- Saurabh Mistry
- Sankara Nethralaya, Medical Research Foundation, Chennai, India
| | - S Sudharshan
- Sankara Nethralaya, Medical Research Foundation, Chennai, India
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13
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Abstract
This last decade has yielded more robust development of cancer treatments and first-in-class agents than ever before. Since 2006, nearly one hundred new drugs have received regulatory approval for the treatment of hematological and solid organ neoplasms. Moreover, older conventional therapies have received approval for new clinical indications and are being used in combination with these newer small-molecule targeted treatments. The nervous system is vulnerable to many of the traditional cancer therapies, manifesting both already well-described acute and chronic toxicities. However, newer agents may produce toxicities that may seem indistinguishable from the underlying cancer. Early recognition of neurotoxicities from new therapeutics is vital to avoid irreversible neurological injury. This review focuses on cancer therapies in use in the last 10 years and approved by the FDA from January 2006 through January 1, 2017.
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Affiliation(s)
- Alicia M Zukas
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia
| | - David Schiff
- Department of Neurology, University of Virginia, Charlottesville, Virginia
- Department of Neurological Surgery, and Medicine, University of Virginia, Charlottesville, Virginia
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14
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Abstract
Chronic myeloid leukemia (CML) is a clonal myeloproliferative stem cell disorder. Bosutinib is an oral, once-daily SRC/ABL tyrosine kinase inhibitor with very potent inhibitory activity. Bosutinib is effective against all phases of intolerant or resistant Philadelphia chromosome-positive CML that do not harbor the T315I or V299LABL kinase domain mutations. Peak plasma concentrations of bosutinib occur at 4-6 h following oral administration, and dose-proportional increases in exposure are observed at doses ranging from 200 to 800 mg. Absorption of bosutinib increases with food. Bosutinib is distributed extensively into the tissues. It is highly plasma protein bound (94 %) and is primarily metabolized in the liver by cytochrome P450 3A4. Bosutinib is well tolerated overall and has a unique but manageable toxicity profile. This article provides a review of the available clinical pharmacokinetic, pharmacodynamic, and drug-drug interaction data on bosutinib in healthy subjects, patients with CML, and special populations.
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Affiliation(s)
- Richat Abbas
- Pfizer Inc, 500 Arcola Road, Collegeville, PA, 19426, USA.
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15
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Myers KA, Nikolic A, Romanchuk K, Weis E, Brundler MA, Lafay-Cousin L, Costello F. Optic neuropathy in the context of leukemia or lymphoma: diagnostic approach to a neuro-oncologic emergency. Neurooncol Pract 2016; 4:60-66. [PMID: 31386008 DOI: 10.1093/nop/npw006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Indexed: 11/12/2022] Open
Abstract
Background Optic neuropathy in the context of leukemia or lymphoma has a broad differential diagnosis, including infiltration, infection, inflammation, compression, and medication effects. Confirming the underlying etiology in a timely manner is crucial as, while infiltration carries a poor prognosis, treatment modalities can have serious consequences themselves. Methods A review of the literature was conducted for cases of isolated optic neuropathy in the context of leukemia or lymphoma, in which the underlying etiology remained unclear following initial clinical examination and neuroimaging. Clinical, radiological, and pathological characteristics of the cases are summarized. Results Ninety-two cases meeting inclusion criteria were identified. Leukemic or lymphomatous infiltration was the presumed diagnosis in 72% of the reports, indicating this is the most likely etiology in such cases. The remaining reports were attributed to inflammation, infection, or drug toxicity. For illustrative purposes, the previously unpublished case of an 11-year-old girl with remitted T lymphoblastic lymphoma is presented. She suffered recurrence in the form of isolated left optic nerve infiltration that required transconjunctival biopsy to confirm diagnosis. Conclusions Optic nerve infiltration by leukemia or lymphoma requires both diagnostic certainty and urgent management. Recommendations are made for a step-wise, yet rapid investigative approach that may ultimately require biopsy of the optic nerve.
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Affiliation(s)
- Kenneth A Myers
- Department of Pediatrics, Section of Neurology; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (K.A.M.); Department of Pathology & Laboratory Medicine; Foothills Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (A.N.); Department of Ophthalmology; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (K.R); Department of Ophthalmology and Visual Sciences, University of Alberta, Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada (E.W.); Departments of Pathology & Laboratory Medicine and Pediatrics; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (M.-A.B.); Departments of Oncology and Pediatrics; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (L.L.-C.); Department of Clinical Neurosciences; Foothills Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (F.C.)
| | - Ana Nikolic
- Department of Pediatrics, Section of Neurology; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (K.A.M.); Department of Pathology & Laboratory Medicine; Foothills Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (A.N.); Department of Ophthalmology; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (K.R); Department of Ophthalmology and Visual Sciences, University of Alberta, Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada (E.W.); Departments of Pathology & Laboratory Medicine and Pediatrics; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (M.-A.B.); Departments of Oncology and Pediatrics; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (L.L.-C.); Department of Clinical Neurosciences; Foothills Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (F.C.)
| | - Kenneth Romanchuk
- Department of Pediatrics, Section of Neurology; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (K.A.M.); Department of Pathology & Laboratory Medicine; Foothills Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (A.N.); Department of Ophthalmology; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (K.R); Department of Ophthalmology and Visual Sciences, University of Alberta, Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada (E.W.); Departments of Pathology & Laboratory Medicine and Pediatrics; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (M.-A.B.); Departments of Oncology and Pediatrics; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (L.L.-C.); Department of Clinical Neurosciences; Foothills Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (F.C.)
| | - Ezekiel Weis
- Department of Pediatrics, Section of Neurology; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (K.A.M.); Department of Pathology & Laboratory Medicine; Foothills Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (A.N.); Department of Ophthalmology; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (K.R); Department of Ophthalmology and Visual Sciences, University of Alberta, Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada (E.W.); Departments of Pathology & Laboratory Medicine and Pediatrics; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (M.-A.B.); Departments of Oncology and Pediatrics; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (L.L.-C.); Department of Clinical Neurosciences; Foothills Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (F.C.)
| | - Marie-Anne Brundler
- Department of Pediatrics, Section of Neurology; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (K.A.M.); Department of Pathology & Laboratory Medicine; Foothills Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (A.N.); Department of Ophthalmology; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (K.R); Department of Ophthalmology and Visual Sciences, University of Alberta, Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada (E.W.); Departments of Pathology & Laboratory Medicine and Pediatrics; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (M.-A.B.); Departments of Oncology and Pediatrics; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (L.L.-C.); Department of Clinical Neurosciences; Foothills Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (F.C.)
| | - Lucie Lafay-Cousin
- Department of Pediatrics, Section of Neurology; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (K.A.M.); Department of Pathology & Laboratory Medicine; Foothills Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (A.N.); Department of Ophthalmology; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (K.R); Department of Ophthalmology and Visual Sciences, University of Alberta, Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada (E.W.); Departments of Pathology & Laboratory Medicine and Pediatrics; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (M.-A.B.); Departments of Oncology and Pediatrics; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (L.L.-C.); Department of Clinical Neurosciences; Foothills Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (F.C.)
| | - Fiona Costello
- Department of Pediatrics, Section of Neurology; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (K.A.M.); Department of Pathology & Laboratory Medicine; Foothills Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (A.N.); Department of Ophthalmology; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (K.R); Department of Ophthalmology and Visual Sciences, University of Alberta, Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada (E.W.); Departments of Pathology & Laboratory Medicine and Pediatrics; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (M.-A.B.); Departments of Oncology and Pediatrics; Alberta Children's Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (L.L.-C.); Department of Clinical Neurosciences; Foothills Hospital, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada (F.C.)
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