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Spooner C, Vivat B, White N, Bruun A, Rohde G, Kwek PX, Stone P. What outcomes do studies use to measure the impact of prognostication on people with advanced cancer? Findings from a systematic review of quantitative and qualitative studies. Palliat Med 2023; 37:1345-1364. [PMID: 37586031 PMCID: PMC10548779 DOI: 10.1177/02692163231191148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
BACKGROUND Studies evaluating the impact of prognostication in advanced cancer patients vary in the outcomes they measure, and there is a lack of consensus about which outcomes are most important. AIM To identify outcomes previously reported in prognostic research with people with advanced cancer, as a first step towards constructing a core outcome set for prognostic impact studies. DESIGN A systematic review was conducted and analysed in two subsets: one qualitative and one quantitative. (PROSPERO ID: CRD42022320117; 29/03/2022). DATA SOURCES Six databases were searched from inception to September 2022. We extracted data describing (1) outcomes used to measure the impact of prognostication and (2) patients' and informal caregivers' experiences and perceptions of prognostication in advanced cancer. We classified findings using the Core Outcome Measures in Effectiveness Trials (COMET) initiative taxonomy, along with a narrative description. We appraised retrieved studies for quality, but quality was not a basis for exclusion. RESULTS We identified 42 eligible studies: 32 quantitative, 6 qualitative, 4 mixed methods. We extracted 70 outcomes of prognostication in advanced cancer and organised them into 12 domains: (1) survival; (2) psychiatric outcomes; (3) general outcomes; (4) spiritual/religious/existential functioning/wellbeing, (5) emotional functioning/wellbeing; (6) cognitive functioning; (7) social functioning; (8) global quality of life; (9) delivery of care; (10) perceived health status; (11) personal circumstances; and (12) hospital/hospice use. CONCLUSION Outcome reporting and measurement varied markedly across the studies. A standardised approach to outcome reporting in studies of prognosis is necessary to enhance data synthesis, improve clinical practice and better align with stakeholders' priorities.
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Affiliation(s)
- Caitlin Spooner
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Bella Vivat
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Nicola White
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Andrea Bruun
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Gudrun Rohde
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Pei Xing Kwek
- University College Dublin School of Medicine, University College Dublin, Dublin, Ireland
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, University College London, London, UK
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Abou-Kassem D, Kurita GP, Sjøgren P, Diasso PDK. Long-term opioid treatment and endocrine measures in patients with cancer-related pain: a systematic review. Scand J Pain 2022; 22:421-435. [PMID: 35316595 DOI: 10.1515/sjpain-2021-0196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/02/2022] [Indexed: 02/28/2024]
Abstract
OBJECTIVES Opioid analgesics are the main stay for cancer pain management; however, long-term opioid treatment (L-TOT) may suppress the endocrine system. This systemic review aimed at investigating effects of L-TOT on the endocrine system in patients with cancer-related pain. METHODS A search on MEDLINE, EMBASE and Web of Science databases was performed. Inclusion criteria were clinical studies investigating endocrine measures in adult patients with cancer-related pain in L-TOT (≥4 weeks). Outcomes and quality of evidence were assessed. RESULTS A total of 252 abstracts were identified; out of which 247 were excluded and five cross-sectional studies were included and analyzed. L-TOT was associated with lower serum concentration levels of total- and free testosterone in males, follicular stimulating hormone in females, and luteinizing hormone in both sexes. Moreover, higher morphine equivalent daily doses (MEDDs) were correlated with higher levels of cortisol and lower levels of LH in both sexes, and lower levels of total- and free testosterone in males. Sexual dysfunction was associated with low sex hormone levels. Level of evidence was low/very low. CONCLUSIONS The studies identified demonstrated that patients with cancer-related pain in L-TOT may have gonadal hypofunction causing sexual dysfunction, which may be correlated with opioid dose level. In addition, high serum concentrations of cortisol were positively correlated with high opioid dose levels. However, the evidence was weak and further research is necessary. PROSPERO, ID-number: CRD42020213059.
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Affiliation(s)
- Dalia Abou-Kassem
- Department of Oncology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
- Multidisciplinary Pain Centre, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - Geana P Kurita
- Department of Oncology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
- Multidisciplinary Pain Centre, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Sjøgren
- Department of Oncology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pernille D K Diasso
- Department of Oncology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
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Wang B, He Y, Zhang P, Huang Y, Xiang H. The function of nuclear hormone receptor 4A signaling in the human reproductive system: A review. J Obstet Gynaecol Res 2022; 48:1501-1512. [PMID: 35445497 DOI: 10.1111/jog.15264] [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: 12/20/2021] [Revised: 03/18/2022] [Accepted: 03/27/2022] [Indexed: 11/29/2022]
Abstract
AIM This review aims to summarize the research focused upon the functions of nuclear hormone receptor 4A (NR4A) in the human reproductive system. The research questions addressed are to decipher what role the NR4A subfamily plays in the regulation of the human reproductive system and effects upon fertility issues through regulation of the expression of the NR4A subfamily. METHODS The electronic database PubMed was searched for studies published before November 2021. Keywords included "NR4A," "trophoblast," "decidualization," "folliculogenesis," "estrogen," "pregnancy," "Leydig cells," "fertility," and "reproductive." Relevant references from retrieved manuscripts and review articles were also searched manually. RESULTS NR4A subfamily are involved in trophoblast differentiation, endometrial decidualization, embryo adhesion, secretion of related hormones, and regulation of spontaneous term labor. Besides, many studies have provided strong evidence that they play critical roles in spermatogenesis. Furthermore, Multiple mechanisms can affect the expression of NR4As. Broadly, NR4A family receptors affect the human reproductive system in multiple ways. CONCLUSIONS Further research is needed to specifically dissect the functions and regulatory mechanisms of these receptors and their pharmaceutical antagonists and agonists. The connection between the NR4A subfamily and a variety of reproductive disorders needs to be proven experimentally such that further examination of human tissue is required to assess the role of these receptors in human reproductive diseases.
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Affiliation(s)
- Boya Wang
- Department of Gynecology and Obstetrics, The Fourth Affiliated Hospital of Anhui Medical, Anhui, China.,Department of Gynecology and Obstetrics, The First Affiliated Hospital of Anhui Medical University, Anhui, China.,NHC Key Laboratory of study on abnormal gametes and reproductive tract (Anhui Medical University), Hefei, Anhui, China
| | - Yingming He
- Department of Gynecology and Obstetrics, The Fourth Affiliated Hospital of Anhui Medical, Anhui, China.,Department of Gynecology and Obstetrics, The First Affiliated Hospital of Anhui Medical University, Anhui, China.,NHC Key Laboratory of study on abnormal gametes and reproductive tract (Anhui Medical University), Hefei, Anhui, China
| | - Pin Zhang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Anhui Medical University, Anhui, China.,NHC Key Laboratory of study on abnormal gametes and reproductive tract (Anhui Medical University), Hefei, Anhui, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University),Ministry of Education of the People's Republic of China, Hefei, Anhui, China
| | - Yue Huang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Anhui Medical University, Anhui, China.,NHC Key Laboratory of study on abnormal gametes and reproductive tract (Anhui Medical University), Hefei, Anhui, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University),Ministry of Education of the People's Republic of China, Hefei, Anhui, China
| | - Huifen Xiang
- Department of Gynecology and Obstetrics, The Fourth Affiliated Hospital of Anhui Medical, Anhui, China.,Department of Gynecology and Obstetrics, The First Affiliated Hospital of Anhui Medical University, Anhui, China.,NHC Key Laboratory of study on abnormal gametes and reproductive tract (Anhui Medical University), Hefei, Anhui, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University),Ministry of Education of the People's Republic of China, Hefei, Anhui, China
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Lee JK, Park YS, Lee K, Youn SI, Won Y, Min SH, Ahn SH, Park DJ, Kim HH. Prognostic significance of surgery-induced sarcopenia in the survival of gastric cancer patients: a sex-specific analysis. J Cachexia Sarcopenia Muscle 2021; 12:1897-1907. [PMID: 34533290 PMCID: PMC8718034 DOI: 10.1002/jcsm.12793] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 08/01/2021] [Accepted: 08/23/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Preoperative sarcopenia is associated with a poor long-term prognosis in patients with gastric cancer (GC). Most GC patients rapidly lose muscle mass after gastrectomy. This retrospective cohort study analysed the effect of postoperative muscle loss and surgery-induced sarcopenia on the long-term outcomes of patients with GC. METHODS Preoperative and postoperative 1 year abdominal computed tomography scans were available for 1801 GC patients who underwent curative gastrectomy between January 2009 and December 2013 at Seoul National University Bundang Hospital. The patients were categorized into normal, presarcopenia, and sarcopenia groups according to the skeletal muscle index (SMI) measured on computed tomography scans. Patients who were not sarcopenic prior to gastrectomy but became sarcopenic after surgery were defined as the surgery-induced sarcopenia group. RESULTS There were 1227 men and 574 women included in the study. The mean age of the patients was 59.5 ± 12.3 years. Multivariable Cox-regression analyses showed that preoperative SMI was not associated with overall survival (OS). However, postoperative sarcopenia was associated with significantly worse OS only in men [hazard ratio (HR), 1.75; 95% confidence interval (CI), 1.08-2.85]. SMI loss was an independent risk factor for OS in the entire cohort and in men (HR, 1.01; 95% CI, 1.00-1.02, for the entire cohort; HR, 1.02; 95% CI, 1.01-1.04, for men). The surgery-induced sarcopenia group was associated with significantly higher mortality (HR, 1.84; 95% CI, 1.16-2.90, for the cohort; HR, 2.73; 95% CI, 1.54-4.82, for men), although SMI loss and surgery-induced sarcopenia were not risk factors in women. Similar results were obtained for relapse-free survival. CONCLUSIONS Postoperative muscle mass loss and surgery-induced sarcopenia are prognostic factors for survival in patients with GC. Impact of postoperative muscle mass loss and surgery-induced sarcopenia on survival outcomes is dependent on the sex.
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Affiliation(s)
- Ja Kyung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kanghaeng Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Sang Il Youn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Yongjoon Won
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Sa-Hong Min
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Izumi K, Iwamoto H, Yaegashi H, Nohara T, Shigehara K, Kadono Y, Nanjo S, Yamada T, Ohtsubo K, Yano S, Mizokami A. Androgen replacement therapy for cancer-related symptoms in male: result of prospective randomized trial (ARTFORM study). J Cachexia Sarcopenia Muscle 2021; 12:831-842. [PMID: 34029455 PMCID: PMC8350213 DOI: 10.1002/jcsm.12716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 03/23/2021] [Accepted: 04/21/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hypogonadism associated with cancer is reported to cause cachexia and a variety of physical and psychological symptoms. This study aims to evaluate whether androgen replacement therapy can improve cancer-related symptoms in male advanced cancer patients. METHODS An investigator-initiated, prospective, and randomized controlled study was conducted. Patients with low serum testosterone levels (total or free testosterone levels were <2.31 ng/mL or <11.8 pg/mL, respectively) were randomly assigned to the control or testosterone enanthate administration (testosterone group) groups. Testosterone enanthate was injected into the muscle tissue at a dose of 250 mg every 4 weeks (baseline, week 4, and week 8). Differences in quality of life questionnaires and cachexia-related serum protein levels between groups were assessed. RESULTS This study enrolled and randomized 106 and 81 patients, respectively. Moreover, 41 and 40 patients were in the control and testosterone groups, respectively. Although no significant differences in the change of subscales and total scores in Functional Assessment of Anorexia/Cachexia Treatment were noted from the baseline between the two groups, the testosterone group showed a significantly better change in the 'unhappiness' item of the Edmonton Symptom Assessment System at week 12 compared with baseline versus the control group (-1.4 and 0.0 points, respectively; mean, P = 0.007). No significant differences exist in the change of serum interleukin-6 and insulin-like growth factor-1 levels at week 12 from the baseline between the control and testosterone groups. Consequently, the testosterone group significantly inhibited the change in serum tumour necrotic factor-α level at week 12 from the baseline compared with the control group (+0.4 and +0.1 pg/mL, respectively; mean, P = 0.005). CONCLUSIONS Although testosterone enanthate did not improve most of the items in health-related quality of life questionnaires, testosterone enanthate induced a significantly better change in the 'unhappiness' item at week 12 compared with the control. Testosterone enanthate may be a potential treatment option for male advanced cancer patients.
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Affiliation(s)
- Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Hiroaki Iwamoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Hiroshi Yaegashi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Takahiro Nohara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
| | - Shigeki Nanjo
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan
| | - Tadaaki Yamada
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan.,Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koshiro Ohtsubo
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan
| | - Seiji Yano
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
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Teng TZJ, Shelat VG. Testosterone gel improves appetite and reduces tiredness in males with advanced cancer. BMJ Support Palliat Care 2021; 11:145. [PMID: 33468510 DOI: 10.1136/bmjspcare-2020-002662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/06/2021] [Indexed: 02/05/2023]
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Liang J, Jin G, Liu T, Wen J, Li G, Chen L, Wang W, Wang Y, Liao W, Song J, Ding Z, Chen XP, Zhang B. Clinical characteristics and risk factors for mortality in cancer patients with COVID-19. Front Med 2021; 15:264-274. [PMID: 33754280 PMCID: PMC7985225 DOI: 10.1007/s11684-021-0845-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023]
Abstract
Patients with cancer are at increased risk of severe infections. From a cohort including 3060 patients with confirmed COVID-19, 109 (3.4%) cancer patients were included in this study. Among them, 23 (21.1%) patients died in the hospital. Cancer patients, especially those with hematological malignancies (41.6%), urinary carcinoma (35.7%), malignancies of the digestive system (33.3%), gynecological malignancies (20%), and lung cancer (14.3%), had a much higher mortality than patients without cancer. A total of 19 (17.4%) cancer patients were infected in the hospital. The clinical characteristics of deceased cancer patients were compared with those of recovered cancer patients. Multivariate Cox regression analysis indicated that a Nutritional Risk Screening (NRS2002) score ⩾ 3 (adjusted hazard ratio (HR) 11.00; 95% confidence interval (CI) 4.60–26.32; P < 0.001), high-risk type (adjusted HR 18.81; 95% CI 4.21–83.93; P < 0.001), tumor stage IV (adjusted HR 4.26; 95% CI 2.34–7.75; P < 0.001), and recent adjuvant therapy (< 1 month) (adjusted HR 3.16; 95% CI 1.75–5.70; P < 0.01) were independent risk factors for in-hospital death after adjusting for age, comorbidities, D-dimer, and lymphocyte count. In conclusion, cancer patients showed a higher risk of COVID-19 infection with a poorer prognosis than patients without cancer. Cancer patients with high-risk tumor, NRS2002 score ⩾ 3, advanced tumor stage, and recent adjuvant therapy (< 1 month) may have high risk of mortality.
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Affiliation(s)
- Junnan Liang
- Hepatic Surgery Center, Liver Cancer Institute, and Hubei Key Laboratory of HPB Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Guannan Jin
- Department of Internal Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Tongtong Liu
- Tongji Multidisciplinary Team for Treating COVID-19 (TTTC), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jingyuan Wen
- Hepatic Surgery Center, Liver Cancer Institute, and Hubei Key Laboratory of HPB Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ganxun Li
- Hepatic Surgery Center, Liver Cancer Institute, and Hubei Key Laboratory of HPB Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lin Chen
- Hepatic Surgery Center, Liver Cancer Institute, and Hubei Key Laboratory of HPB Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Tongji Multidisciplinary Team for Treating COVID-19 (TTTC), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wei Wang
- Hepatic Surgery Center, Liver Cancer Institute, and Hubei Key Laboratory of HPB Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yuwei Wang
- Hepatic Surgery Center, Liver Cancer Institute, and Hubei Key Laboratory of HPB Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wei Liao
- Hepatic Surgery Center, Liver Cancer Institute, and Hubei Key Laboratory of HPB Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jia Song
- Hepatic Surgery Center, Liver Cancer Institute, and Hubei Key Laboratory of HPB Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zeyang Ding
- Hepatic Surgery Center, Liver Cancer Institute, and Hubei Key Laboratory of HPB Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Tongji Multidisciplinary Team for Treating COVID-19 (TTTC), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Liver Cancer Institute, and Hubei Key Laboratory of HPB Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Tongji Multidisciplinary Team for Treating COVID-19 (TTTC), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Bixiang Zhang
- Hepatic Surgery Center, Liver Cancer Institute, and Hubei Key Laboratory of HPB Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Tongji Multidisciplinary Team for Treating COVID-19 (TTTC), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Morio K, Yamamoto K, Yano I. Relationship Between Tramadol Response and Cancer Cachexia: A Retrospective Cohort Study. Am J Hosp Palliat Care 2020; 38:276-282. [PMID: 32734768 DOI: 10.1177/1049909120945570] [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: 11/17/2022] Open
Abstract
OBJECTIVE It was reported that the administration of tramadol in patients with cancer pain who have a higher interleukin 6 (IL-6) serum level led to insufficient pain relief. Cytokines produced by tumors, including IL-6, are associated with cancer cachexia. However, whether nonresponse to tramadol is related to cancer cachexia is unknown. The purpose of this study was to examine the relationship between tramadol response and cancer cachexia in patients with cancer pain. METHODS We conducted a retrospective cohort study of patients with cancer who received tramadol treatment for mild to moderate pain from January 2016 to June 2019. Patients who experienced <20% pain reduction based on the numeric rating scale from baseline to day 7 after treatment with tramadol were defined as nonresponders. Univariate and multivariate logistic regression analyses were conducted to examine the relationships between tramadol response and various patient characteristics, including cancer cachexia. RESULTS Of 115 patients, 79 were included in the analysis. A total of 24 patients experienced cancer cachexia, and 22 patients were nonresponders. In the univariate logistic analysis, cancer cachexia (odds ratio [OR]: 6.04, 95% confidence interval [CI]: 2.06-17.7), higher white blood cell counts (× 103/μL; OR: 1.28, 95% CI: 1.04-1.61), and lower body mass index (OR: 0.79, 95% CI: 0.66-0.96) were significantly associated with nonresponse to tramadol. The multivariate logistic analysis revealed that cancer cachexia (OR: 5.27, 95% CI: 1.75-15.9) was the only significant factor associated with nonresponse to tramadol. CONCLUSIONS Cancer cachexia in patients with cancer pain can be associated with nonresponse to tramadol.
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Affiliation(s)
- Kayoko Morio
- Department of Pharmacy, 38617Kobe University Hospital, Kobe, Japan
| | | | - Ikuko Yano
- Department of Pharmacy, 38617Kobe University Hospital, Kobe, Japan
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Luteinizing Hormone Levels Relate to the Unfavorable Pathology of Prostate Cancer. J Clin Med 2020; 9:jcm9051281. [PMID: 32365474 PMCID: PMC7287653 DOI: 10.3390/jcm9051281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/10/2020] [Accepted: 04/27/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose: This study analyzed the association between sex hormone concentrations and stage/condition in patients with prostate cancer. Materials and methods: The concentrations of sex hormones, including testosterone (total, free, and bioavailable), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), and follicle-stimulating hormone (FSH), were measured in 415 patients diagnosed with prostate cancer. Differences in serum hormone concentrations after receiving androgen deprivation therapy (ADT) and after withdrawal from ADT were evaluated. Pathologic characteristics were assessed in the 225 patients unexposed to ADT with a history of radical prostatectomy. Logistic regression analysis was performed to identify factors predictive of unfavorable pathology (Grade ≥3, ≥T3a, or N1). Results: Of the 415 prostate cancer patients, 130 (31.3%) were assessed before treatment, 171 (41.2%) after surgery, 35 (8.4%) after biochemical recurrence, and 59 (14.2%) during ADT, whereas 20 (4.8%) had castration-resistant prostate cancer. FSH was significantly lower after compared to before prostatectomy (3.229 ± 4.486 vs. 5.941 ± 7.044 mIU/mL, p < 0.001). LH, FSH, and testosterone decreased significantly 3 months after starting ADT, but increased 3 months after ADT withdrawal, whereas SHBG was unchanged. Multivariate analysis showed that high LH (odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.03–2.47, p = 0.0376) and prostate-specific antigen (PSA) (OR: 1.13, 95% CI: 1.03–1.24, p = 0.0133) concentrations were significantly associated with a high risk of unfavorable pathology. Conclusions: Sex hormones, including LH, FSH, and testosterone, were affected by ADT. The FSH level decreased after radical prostatectomy. High baseline LH concentration in patients unexposed to ADT was associated with an unfavorable pathology.
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de Vries F, Bruin M, Lobatto DJ, Dekkers OM, Schoones JW, van Furth WR, Pereira AM, Karavitaki N, Biermasz NR, Zamanipoor Najafabadi AH. Opioids and Their Endocrine Effects: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab 2020; 105:5568226. [PMID: 31511863 PMCID: PMC7054712 DOI: 10.1210/clinem/dgz022] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/24/2019] [Indexed: 12/17/2022]
Abstract
CONTEXT The increased use of opioids has resulted in an unprecedented opioid epidemic. Chronic opioid use causes hypogonadism, but its frequency, as well as the effects of opioids on other hypothalamo-pituitary-end organ hormone axes, remains unclear. OBJECTIVE The aim of this systematic review and meta-analysis was to assess the effects of opioid use on pituitary function. METHODS Eight electronic databases were searched for articles published up to May 8, 2018. Fixed or random effects meta-analysis was performed to estimate pooled proportions with 95% confidence intervals (CI). This study is reported following the PRISMA and MOOSE guidelines. DATA SYNTHESIS 52 studies (22 low risk of bias) were included describing 18 428 subjects, consisting of patients with chronic pain (n = 21 studies) or on maintenance treatment for opioid addiction (n = 9) and healthy volunteers (n = 4). The most frequently used opioid was methadone (n = 13 studies), followed by morphine (n = 12). Prevalence of hypogonadism was 63% (95% CI: 55%-70%, 15 studies, 3250 patients, 99.5% males). Prevalence of hypocortisolism relying on dynamic and nondynamic testing was 15% (95% CI: 6%-28%, 5 studies, 205 patients, 57.5% males) and including only studies using the insulin tolerance tests 24% (95% CI 16%-33%, 2 studies, n = 97 patients). In 5 out of 7 studies, hyperprolactinemia was present. No clear effects on the somatotropic and hypothalamo-pituitary-thyroid axes were described. CONCLUSIONS Hypogonadism occurs in more than half of male opioid users, and hypocortisolism in approximately one-fifth of all patients. Periodical evaluation of at least the gonadal and adrenal axes is therefore advisable.
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Affiliation(s)
- Friso de Vries
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Centre for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Mees Bruin
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Centre for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Daniel J Lobatto
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Olaf M Dekkers
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Centre for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan W Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands
| | - Wouter R van Furth
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Centre for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Centre for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Amir H Zamanipoor Najafabadi
- Centre for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Correspondence and Reprint Requests: Amir H. Zamanipoor Najafabadi, Department of Neurosurgery, Clinical Epidemiology, Center for Endocrine Tumor Leiden, and Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands. E-mail:
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11
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Liva SG, Tseng Y, Dauki AM, Sovic MG, Vu T, Henderson SE, Kuo Y, Benedict JA, Zhang X, Remaily BC, Kulp SK, Campbell M, Bekaii‐Saab T, Phelps MA, Chen C, Coss CC. Overcoming resistance to anabolic SARM therapy in experimental cancer cachexia with an HDAC inhibitor. EMBO Mol Med 2020; 12:e9910. [PMID: 31930715 PMCID: PMC7005646 DOI: 10.15252/emmm.201809910] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/26/2019] [Accepted: 11/29/2019] [Indexed: 12/12/2022] Open
Abstract
No approved therapy exists for cancer-associated cachexia. The colon-26 mouse model of cancer cachexia mimics recent late-stage clinical failures of anabolic anti-cachexia therapy and was unresponsive to anabolic doses of diverse androgens, including the selective androgen receptor modulator (SARM) GTx-024. The histone deacetylase inhibitor (HDACi) AR-42 exhibited anti-cachectic activity in this model. We explored combined SARM/AR-42 therapy as an improved anti-cachectic treatment paradigm. A reduced dose of AR-42 provided limited anti-cachectic benefits, but, in combination with GTx-024, significantly improved body weight, hindlimb muscle mass, and grip strength versus controls. AR-42 suppressed the IL-6/GP130/STAT3 signaling axis in muscle without impacting circulating cytokines. GTx-024-mediated β-catenin target gene regulation was apparent in cachectic mice only when combined with AR-42. Our data suggest cachectic signaling in this model involves catabolic signaling insensitive to anabolic GTx-024 therapy and a blockade of GTx-024-mediated anabolic signaling. AR-42 mitigates catabolic gene activation and restores anabolic responsiveness to GTx-024. Combining GTx-024, a clinically established anabolic therapy, with AR-42, a clinically evaluated HDACi, represents a promising approach to improve anabolic response in cachectic patients.
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Affiliation(s)
- Sophia G Liva
- Division of Pharmaceutics and PharmacologyCollege of PharmacyThe Ohio State UniversityColumbusOHUSA
| | - Yu‐Chou Tseng
- Division of Medicinal Chemistry and PharmacognosyCollege of PharmacyThe Ohio State UniversityColumbusOHUSA
| | - Anees M Dauki
- Division of Pharmaceutics and PharmacologyCollege of PharmacyThe Ohio State UniversityColumbusOHUSA
| | - Michael G Sovic
- Division of Pharmaceutics and PharmacologyCollege of PharmacyThe Ohio State UniversityColumbusOHUSA
| | - Trang Vu
- Division of Pharmaceutics and PharmacologyCollege of PharmacyThe Ohio State UniversityColumbusOHUSA
| | - Sally E Henderson
- Department of Veterinary BiosciencesCollege of Veterinary MedicineOhio State UniversityColumbusOHUSA
| | - Yi‐Chiu Kuo
- Division of Medicinal Chemistry and PharmacognosyCollege of PharmacyThe Ohio State UniversityColumbusOHUSA
| | - Jason A Benedict
- Center for BiostatisticsDepartment of Biomedical InformaticsThe Ohio State UniversityColumbusOHUSA
| | - Xiaoli Zhang
- Center for BiostatisticsDepartment of Biomedical InformaticsThe Ohio State UniversityColumbusOHUSA
| | - Bryan C Remaily
- Division of Pharmaceutics and PharmacologyCollege of PharmacyThe Ohio State UniversityColumbusOHUSA
| | - Samuel K Kulp
- Division of Pharmaceutics and PharmacologyCollege of PharmacyThe Ohio State UniversityColumbusOHUSA
| | - Moray Campbell
- Division of Pharmaceutics and PharmacologyCollege of PharmacyThe Ohio State UniversityColumbusOHUSA
- The Ohio State University Comprehensive Cancer CenterThe Ohio State UniversityColumbusOHUSA
| | | | - Mitchell A Phelps
- Division of Pharmaceutics and PharmacologyCollege of PharmacyThe Ohio State UniversityColumbusOHUSA
- The Ohio State University Comprehensive Cancer CenterThe Ohio State UniversityColumbusOHUSA
| | - Ching‐Shih Chen
- Division of Medicinal Chemistry and PharmacognosyCollege of PharmacyThe Ohio State UniversityColumbusOHUSA
- Department of Medical ResearchChina Medical University HospitalChina Medical UniversityTaichungTaiwan
| | - Christopher C Coss
- Division of Pharmaceutics and PharmacologyCollege of PharmacyThe Ohio State UniversityColumbusOHUSA
- The Ohio State University Comprehensive Cancer CenterThe Ohio State UniversityColumbusOHUSA
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12
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Abstract
In dermato-oncological treatment there are many gonadotoxic interventions. Alkylating and hormonally active substances as well as gonadal irradiation, in particular, are known to have a fertilization-limiting effect in men. Since 2017 certified skin cancer centers in Germany therefore have the task to implement counselling on preservation of fertility. This is supported by the S2k guidelines on preservation of fertility in oncological treatment. Because recommendation of the various interventions from the dermato-oncological guidelines are dependent on the stage, the authors advocate at least the question "Is the desire to have children of interest to you?" when patients reach the appropriate stage. Fertility protection of men via cryopreservation of ejaculates or testicular tissue is then a simple and safe option. The procedure is standardized and usually available. In addition, the possibility of cryopreservation of testicular tissue from prepubertal male children and infants is now available via the new Androprotect project. If signs of hypogonadism occur during therapy, a treatment can be considered by weighing up the effects of testosterone but in this case it is important to take the anabolic and immunomodulating effects into account.
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Affiliation(s)
- T Weberschock
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Deutschland. .,Arbeitsgruppe EbM Frankfurt, Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt/Main, Deutschland.
| | - S Grunewald
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | - F Ochsendorf
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Deutschland
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13
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Izumi K, Shigehara K, Nohara T, Narimoto K, Kadono Y, Nanjo S, Yamada T, Ohtsubo K, Yano S, Mizokami A. Androgen replacement therapy for cancer-related symptoms in male advanced cancer patients: study protocol for a randomised prospective trial (ARTFORM study). THE JOURNAL OF MEDICAL INVESTIGATION 2018; 64:202-204. [PMID: 28954982 DOI: 10.2152/jmi.64.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Recent studies reveal that hypogonadism with low serum androgen levels is associated with advanced cancer and induction of most cancer-related symptoms. We designed an ARTFORM study to evaluate the efficacy of androgen replacement therapy in male advanced cancer patients. The ARTFORM study is an investigator-initiated, randomised controlled trial comparing intramuscle injection of testosterone enanthate with non-administration in male advanced cancer patients with non-curative locally advanced or metastatic lesions. Serum total and free testosterone levels are measured and patients with low testosterone level are randomised. The primary endpoint is the difference in validated health-related quality of life questionnaires at week 12. Trial registration of the ARTFORM study is assigned to University hospital Medical Information Network, Center identifier UMIN 000010939. J. Med. Invest. 64: 202-204, August, 2017.
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Affiliation(s)
- Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science
| | - Takahiro Nohara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science
| | - Kazutaka Narimoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science
| | - Shigeki Nanjo
- Division of Medical Oncology Cancer Research Institute, Kanazawa University
| | - Tadaaki Yamada
- Division of Medical Oncology Cancer Research Institute, Kanazawa University
| | - Koushiro Ohtsubo
- Division of Medical Oncology Cancer Research Institute, Kanazawa University
| | - Seiji Yano
- Division of Medical Oncology Cancer Research Institute, Kanazawa University
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science
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14
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Nam YS, Lee G, Yun JM, Cho B. Testosterone Replacement, Muscle Strength, and Physical Function. World J Mens Health 2018; 36:110-122. [PMID: 29623702 PMCID: PMC5924952 DOI: 10.5534/wjmh.182001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 12/19/2017] [Accepted: 12/26/2017] [Indexed: 12/15/2022] Open
Abstract
Muscle strength and physical function decrease in older men, as do testosterone levels. Nonetheless, the effects of testosterone replacement therapy on muscle strength and physical function remain inconclusive and equivocal. We conducted a rapid systematic review, the results of which showed that testosterone replacement does not affect muscle strength (measured by hand grip strength and leg muscle strength), although it may increase physical function (measured by the 6-minute walk test, Physical Activity Scale for the Elderly score, and other physical performance tests). However, most of the studies were conducted in the United States or Europe and did not include participants from Asian or other ethnic backgrounds; therefore, further studies are needed to evaluate the effects of testosterone replacement in a broader population.
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Affiliation(s)
- You Seon Nam
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gyeongsil Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae Moon Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Belong Cho
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Advanced Institutes of Convergence Technology, Seoul National University, Suwon, Korea.,Institute on Aging, Seoul National University College of Medicine, Seoul, Korea.
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15
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Vigano AAL, Morais JA, Ciutto L, Rosenthall L, di Tomasso J, Khan S, Olders H, Borod M, Kilgour RD. Use of routinely available clinical, nutritional, and functional criteria to classify cachexia in advanced cancer patients. Clin Nutr 2016; 36:1378-1390. [PMID: 27793524 DOI: 10.1016/j.clnu.2016.09.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 04/04/2016] [Accepted: 09/13/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cachexia is a highly prevalent syndrome in cancer and chronic diseases. However, due to the heterogeneous features of cancer cachexia, its identification and classification challenge clinical practitioners. OBJECTIVE To determine the clinical relevance of a cancer cachexia classification system in advanced cancer patients. DESIGN Beginning with the four-stage classification system proposed for cachexia [non-cachexia (NCa), pre-cachexia (PCa), cachexia (Ca) and refractory cachexia (RCa)], we assigned patients to these cachexia stages according to five classification criteria available in clinical practice: 1) biochemistry (high C-reactive protein or leukocytes, or hypoalbuminemia, or anemia), 2) food intake (normal/decreased), weight loss: 3) moderate (≤5%) or 4) significant (>5%/past six months) and 5) performance status (Eastern Cooperative Oncology Group Performance Status ≥ 3). We then determined if symptom severity, body composition changes, functional levels, hospitalizations and survival rates varied significantly across cachexia stages. RESULTS Two-hundred and ninety-seven advanced cancer patients with primary gastrointestinal and lung tumors were included. Patients were classified into Ca (36%), PCa and RCa (21%, respectively) and NCa (15%). Significant (p < 0.05) differences were observed among cachexia stages for most of the outcome measures (symptoms, body composition, handgrip strength, emergency room visits and length of hospital stays) according to cachexia severity. Survival also differed between cachexia stages (except between PCa and Ca). CONCLUSION Five clinical criteria can be used to stage cancer cachexia patients and predict important clinical, nutritional and functional outcomes. The lack of statistical difference between PCa and Ca in almost all clinical outcomes examined suggests either that the PCa group includes patients already affected by early cachexia or that more precise criteria are needed to differentiate PCa from Ca patients. More studies are required to validate these findings.
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Affiliation(s)
- Antonio A L Vigano
- McGill Nutrition and Performance Laboratory (MNUPAL), 105B, Place Vendôme, 5252 de Maisonneuve West, Montreal, Quebec, H4A 3S5, Canada; Supportive and Palliative Care, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec, H4A 3J1, Canada.
| | - José A Morais
- Geriatric Medicine, McGill University Health Centre, Royal Victoria Hospital, Room H6.61, 687 Pine Avenue West, Montreal, Quebec, H3A 1A1, Canada.
| | - Lorella Ciutto
- McGill Nutrition and Performance Laboratory (MNUPAL), 105B, Place Vendôme, 5252 de Maisonneuve West, Montreal, Quebec, H4A 3S5, Canada; School of Dietetics and Human Nutrition, McGill University, Macdonald-Stewart Building, Macdonald Campus, 21111 Lakeshore Road, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada; Centre Hospitalier Universitaire Vaudois, Service d'endocrinologie, diabétologie et métabolisme, Nutrition clinique, Bureau 08/112, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Leonard Rosenthall
- Department of Radiology, McGill University Health Centre, 1650 Cedar Ave, Montreal, Quebec, H3G 1A4, Canada.
| | - Jonathan di Tomasso
- McGill Nutrition and Performance Laboratory (MNUPAL), 105B, Place Vendôme, 5252 de Maisonneuve West, Montreal, Quebec, H4A 3S5, Canada; School of Dietetics and Human Nutrition, McGill University, Macdonald-Stewart Building, Macdonald Campus, 21111 Lakeshore Road, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada.
| | - Sarah Khan
- McGill Nutrition and Performance Laboratory (MNUPAL), 105B, Place Vendôme, 5252 de Maisonneuve West, Montreal, Quebec, H4A 3S5, Canada.
| | - Henry Olders
- McGill Nutrition and Performance Laboratory (MNUPAL), 105B, Place Vendôme, 5252 de Maisonneuve West, Montreal, Quebec, H4A 3S5, Canada.
| | - Manuel Borod
- Supportive and Palliative Care, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec, H4A 3J1, Canada.
| | - Robert D Kilgour
- McGill Nutrition and Performance Laboratory (MNUPAL), 105B, Place Vendôme, 5252 de Maisonneuve West, Montreal, Quebec, H4A 3S5, Canada; Department of Exercise Science, Concordia University, The Richard J. Renaud Science Complex, Room SP-165-03, 7141 Sherbrooke Street West, Montreal, Quebec, H4B 1R6, Canada.
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16
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Abstract
The incidence of many types of cancer arising in organs with non-reproductive functions is significantly higher in male populations than in female populations, with associated differences in survival. Occupational and/or behavioural factors are well-known underlying determinants. However, cellular and molecular differences between the two sexes are also likely to be important. In this Opinion article, we focus on the complex interplay that sex hormones and sex chromosomes can have in intrinsic control of cancer-initiating cell populations, the tumour microenvironment and systemic determinants of cancer development, such as the immune system and metabolism. A better appreciation of these differences between the two sexes could be of substantial value for cancer prevention as well as treatment.
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Affiliation(s)
- Andrea Clocchiatti
- Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, Massachusetts 02129, USA
| | - Elisa Cora
- Department of Biochemistry, University of Lausanne, Epalinges, CH-1066, Switzerland
| | - Yosra Zhang
- Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, Massachusetts 02129, USA; and the Department of Biochemistry, University of Lausanne, Epalinges, CH-1066, Switzerland
| | - G Paolo Dotto
- Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, Massachusetts 02129, USA; and the Department of Biochemistry, University of Lausanne, Epalinges, CH-1066, Switzerland
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17
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Mohindra NA, Patel JD. Towards manageable toxicities from targeted lung cancer treatment. Lung Cancer Manag 2015. [DOI: 10.2217/lmt.15.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Targeted agents are now considered standard of care for patients whose tumors possess a sensitizing mutation in EGFR or ALK rearrangement. As the toxicity profiles of these agents differ significantly from that of cytotoxic chemotherapy, physicians need to be cognizant of the clinically relevant adverse events and manage them aggressively. Early recognition of these toxicities is vital to ensure medication compliance and maintain quality of life for patients. As more novel agents enter the treatment armamentarium, such as third-generation EGFR and ALK inhibitors, it will be important for physicians to understand class-specific toxicities and rare but serious side effects associated with these drugs.
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Affiliation(s)
- Nisha A Mohindra
- Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Robert H Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Jyoti D Patel
- Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Robert H Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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18
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Fuoco D, di Tomasso J, Boulos C, Kilgour RD, Morais JA, Borod M, Vigano A. Identifying nutritional, functional, and quality of life correlates with male hypogonadism in advanced cancer patients. Ecancermedicalscience 2015; 9:561. [PMID: 26316882 PMCID: PMC4544574 DOI: 10.3332/ecancer.2015.561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Indexed: 11/30/2022] Open
Abstract
With the availability of a potential treatment to reverse male hypogonadism (MH), the primary aim of this case series study was to determine independent relationships between this condition and the nutritional, functional, and quality of life characteristics of advanced cancer patients (ACP). Free testosterone levels were measured in 100 male patients with advanced lung and gastrointestinal (GI) cancer. Routine blood markers of nutrition and inflammation, self-reporting questionnaires for symptom, nutrition, and functional status along with handgrip dynamometry were assessed for all patients at bedside. Almost half of this cohort underwent further assessments (body composition, lower body strength, in depth quality of life and fatigue questionnaires) at the McGill Nutrition and Performance Laboratory (mnupal.mcgill.ca). Multiple regression analyses were performed to identify independent correlations between free testosterone and the above measures. Seventy-six percent of patients were diagnosed with MH. Using multiple linear regression, low free testosterone (31.2 pmol/L) was independently associated with lower albumin (B = –3.8 g/L; 95% confidence interval CI –6.8:–0.8), muscle strength (–11.7 lbs; –20.4: –3.0) and mass in upper limbs (–0.8 kg; –1.4: –0.1), overall performance status (Eastern Cooperative Oncology Group Performance Scale, ECOG PS 0.6; 0.1:1.1), cancer-related fatigue (Brief Fatigue Inventory, BFI 16.7; 2.0: 31.3), and overall quality of life (MQoL total score –1.42; –2.5: –0.3). Thus MH seems to be highly prevalent in ACP, and it is independently associated with important nutritional, functional, and quality of life characteristics in this patient population.
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Affiliation(s)
- Domenico Fuoco
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal H4A 3S5, Canada ; Division of Supportive and Palliative Care Medicine, McGill University Health Centre, Montreal H4A 3S5, Canada
| | - Jonathan di Tomasso
- Division of Supportive and Palliative Care Medicine, McGill University Health Centre, Montreal H4A 3S5, Canada
| | - Caroline Boulos
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal H4A 3S5, Canada
| | - Robert D Kilgour
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal H4A 3S5, Canada ; Department of Exercise Science, Concordia University, Montreal H4B 1R6, Canada
| | - Jose A Morais
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal H4A 3S5, Canada ; Department of Geriatric Medicine, McGill University, Montreal H4A 3S5, Canada
| | - Manuel Borod
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal H4A 3S5, Canada ; Division of Supportive and Palliative Care Medicine, McGill University Health Centre, Montreal H4A 3S5, Canada
| | - Antonio Vigano
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal H4A 3S5, Canada ; Division of Supportive and Palliative Care Medicine, McGill University Health Centre, Montreal H4A 3S5, Canada
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19
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Couch ME, Dittus K, Toth MJ, Willis MS, Guttridge DC, George JR, Chang EY, Gourin CG, Der-Torossian H. Cancer cachexia update in head and neck cancer: Pathophysiology and treatment. Head Neck 2015; 37:1057-72. [PMID: 24634283 DOI: 10.1002/hed.23696] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 01/10/2023] Open
Abstract
The pathophysiology of cancer cachexia remains complex. A comprehensive literature search was performed up to April 2013 using PubMed, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and the Google search engine. In this review, we focus on the different mediators of impaired anabolism and upregulated catabolism that alter the skeletal muscle homeostasis resulting in the wasting of cancer cachexia. We present recent evidence of targeted treatment modalities from clinical trials along with their potential mechanisms of action. We also report on the most current evidence from randomized clinical trials using multimodal treatments in patients with cancer cachexia, but also the evidence from head and neck cancer-specific trials. A more complete understanding of the pathophysiology of the syndrome may lead to more effective targeted therapies and improved outcomes for patients.
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Affiliation(s)
- Marion E Couch
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Vermont Cancer Center, University of Vermont, College of Medicine, Burlington, Vermont
| | - Kim Dittus
- Division of Hematology-Oncology, Department of Medicine, Vermont Cancer Center, University of Vermont, College of Medicine, Burlington, Vermont
| | - Michael J Toth
- Department of Molecular Physiology and Biophysics, University of Vermont, College of Medicine, Burlington, Vermont
| | - Monte S Willis
- Department of Pathology and Laboratory Medicine, McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina
| | - Denis C Guttridge
- Department of Molecular Virology, Immunology, and Medical Genetics, Ohio State University, Columbus, Ohio
| | - Jonathan R George
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, California
| | - Eric Y Chang
- University of Vermont, College of Medicine, Burlington, Vermont
| | - Christine G Gourin
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Hirak Der-Torossian
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Vermont Cancer Center, University of Vermont, College of Medicine, Burlington, Vermont
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20
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Muraleedharan V, Jones TH. Testosterone and mortality. Clin Endocrinol (Oxf) 2014; 81:477-87. [PMID: 25041142 DOI: 10.1111/cen.12503] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/11/2014] [Accepted: 05/13/2014] [Indexed: 11/26/2022]
Abstract
Epidemiological studies have found that men with low or low normal endogenous testosterone are at an increased risk of mortality than those with higher levels. Cardiovascular disease accounts for the greater proportion of deaths in those with low testosterone. Cancer and respiratory deaths in some of the studies are also significantly more prevalent. Disease-specific studies have identified that there are higher mortality rates in men with cardiovascular, respiratory and renal diseases, type 2 diabetes and cancer with low testosterone. Obesity, metabolic syndrome, type 2 diabetes, cardiovascular disease and inflammatory disorders are all associated with an increased prevalence of testosterone deficiency. Two major questions that arise from these findings are (1) is testosterone deficiency directly involved in the pathogenesis of these conditions and/or a contributory factor impairing the body's natural defences or is it merely a biomarker of ill health and the severity of underlying disease process? (2) Does testosterone replacement therapy retard disease progression and ultimately enhance the clinical prognosis and survival? This review will discuss the current state of knowledge and discuss whether or not there are any answers to either of these questions. There is convincing evidence that low testosterone is a biomarker for disease severity and mortality. Testosterone deficiency is associated with adverse effects on certain cardiovascular risk factors that when combined could potentially promote atherosclerosis. The issue of whether or not testosterone replacement therapy improves outcomes is controversial. Two retrospective studies in men with diagnosed hypogonadism with or without type 2 diabetes have reported significantly improved survival.
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Affiliation(s)
- Vakkat Muraleedharan
- Robert Hague Centre for Diabetes & Endocrinology, Barnsley Hospital, NHS Foundation Trust, Barnsley; Department of Human Metabolism, University of Sheffield Medical School, Sheffield, UK
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Abstract
Hypogonadism is common throughout the illness trajectory of patients with cancer. About two thirds of male patients with advanced cancer have hypothalamic-pituitary-gonadal dysfunction and low testosterone levels. Chronic inflammation, comorbidities, cachexia, chemotherapy, and medications such as opioids, megestrol acetate, and corticosteroids contribute to primary and secondary hypogonadism. Studies have reported increased symptom burden, diminished quality of life, and poor prognosis associated with low testosterone levels in males with cancer. The Endocrine Society has published clinical practice guidelines for replacing testosterone in symptomatic patients with chronic illness and in patients receiving opioids; however, the role of testosterone therapy specifically in patients with cancer is not addressed. This review explores the potential benefits and limitations of testosterone replacement on the basis of current evidence.
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Abstract
There is an interdependent relationship between insomnia and fatigue in the medical literature, but both remain distinct entities. Insomnia entails problematic sleep initiation, maintenance, or restoration with an accompanying decrease in perceived daytime function. Lethargy is a symptom that has a wide differential diagnosis that heavily overlaps with cancer-related fatigue; however, insomnia may contribute to worsened fatigue and lethargy in cancer patients. Insomnia is a major risk factor for mood disturbances such as depression, which may also contribute to lethargy in this at-risk population. The pathophysiology of fatigue and insomnia is discussed in this review, including their differential diagnoses as well as the emerging understanding of the roles of neurotransmitters, branched-chain amino acids, and inflammatory cytokines. Treatment approaches for insomnia and fatigue are also discussed and reviewed, including the role of hypnotics, psychotropics, hormonal agents, and alternative therapies.
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Velázquez KT, Enos RT, Narsale AA, Puppa MJ, Davis JM, Murphy EA, Carson JA. Quercetin supplementation attenuates the progression of cancer cachexia in ApcMin/+ mice. J Nutr 2014; 144:868-75. [PMID: 24759931 PMCID: PMC4018949 DOI: 10.3945/jn.113.188367] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Although there are currently no approved treatments for cancer cachexia, there is an intensified interest in developing therapies because of the high mortality index associated with muscle wasting diseases. Successful treatment of the cachectic patient focuses on improving or maintaining body weight and musculoskeletal function. Nutraceutical compounds, including the natural phytochemical quercetin, are being examined as potential treatments because of their anti-inflammatory, antioxidant, and anticarcinogenic properties. The purpose of this study was to determine the effect of quercetin supplementation on the progression of cachexia in the adenomatous polyposis coli (Apc)(Min/+) mouse model of colorectal cancer. At 15 wk of age, C57BL/6 and male Apc(Min/+) mice were supplemented with 25 mg/kg of quercetin or vehicle solution mix of Tang juice and water (V) daily for 3 wk. Body weight, strength, neuromuscular performance, and fatigue were assessed before and after quercetin or V interventions. Indicators of metabolic dysfunction and inflammatory signaling were also assessed. During the treatment period, the relative decrease in body weight in the Apc(Min/+) mice gavaged with V (Apc(Min/+)V; -14% ± 2.3) was higher than in control mice gavaged with V (+0.6% ± 1.0), control mice gavaged with quercetin (-2% ± 1.0), and Apc(Min/+) mice gavaged with quercetin (Apc(Min/+)Q; -9% ± 1.3). At 18 wk of age, the loss of grip strength and muscle mass shown in Apc(Min/+)V mice was significantly attenuated (P < 0.05) in Apc(Min/+)Q mice. Furthermore, Apc(Min/+)V mice had an induction of plasma interleukin-6 and muscle signal transducer and activator of transcription 3 phosphorylation, which were significantly (P < 0.05) mitigated in Apc(Min/+)Q mice, despite having a similar tumor burden. Quercetin treatment did not improve treadmill run-time-to-fatigue, hyperglycemia, or hyperlipidemia in cachectic Apc(Min/+) mice. Overall, quercetin supplementation positively affected several aspects of cachexia progression in mice and warrants further exploration as a potential anticachectic therapeutic.
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Affiliation(s)
- Kandy T. Velázquez
- Division of Applied Physiology, Department of Exercise Science, and,Department of Pathology, Microbiology, and Immunology, School of Medicine, University of South Carolina, Columbia, SC
| | - Reilly T. Enos
- Division of Applied Physiology, Department of Exercise Science, and,Department of Pathology, Microbiology, and Immunology, School of Medicine, University of South Carolina, Columbia, SC
| | - Aditi A. Narsale
- Division of Applied Physiology, Department of Exercise Science, and
| | - Melissa J. Puppa
- Division of Applied Physiology, Department of Exercise Science, and
| | - J. Mark Davis
- Division of Applied Physiology, Department of Exercise Science, and
| | - E. Angela Murphy
- Department of Pathology, Microbiology, and Immunology, School of Medicine, University of South Carolina, Columbia, SC
| | - James A. Carson
- Division of Applied Physiology, Department of Exercise Science, and,To whom correspondence should be addressed. E-mail:
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Couch ME, Dittus K, Toth MJ, Willis MS, Guttridge DC, George JR, Barnes CA, Gourin CG, Der-Torossian H. Cancer cachexia update in head and neck cancer: Definitions and diagnostic features. Head Neck 2014; 37:594-604. [DOI: 10.1002/hed.23599] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/21/2013] [Accepted: 01/07/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Marion E. Couch
- Division of Otolaryngology - Head and Neck Surgery; Department of Surgery; Vermont Cancer Center; University of Vermont, College of Medicine; Burlington Vermont
| | - Kim Dittus
- Division of Hematology - Oncology; Department of Medicine; Vermont Cancer Center; University of Vermont, College of Medicine; Burlington Vermont
| | - Michael J. Toth
- Department of Molecular Physiology and Biophysics; University of Vermont, College of Medicine; Burlington Vermont
| | - Monte S. Willis
- Department of Pathology and Laboratory Medicine; McAllister Heart Institute; University of North Carolina; Chapel Hill North Carolina
| | - Denis C. Guttridge
- Department of Molecular Virology; Immunology; and Medical Genetics; Ohio State University; Columbus Ohio
| | - Jonathan R. George
- Department of Otolaryngology - Head and Neck Surgery; University of California; San Francisco California
| | - Christie A. Barnes
- Division of Otolaryngology - Head and Neck Surgery; Department of Surgery; Vermont Cancer Center; University of Vermont, College of Medicine; Burlington Vermont
| | - Christine G. Gourin
- Department of Otolaryngology - Head and Neck Surgery; Johns Hopkins University; Baltimore Maryland
| | - Hirak Der-Torossian
- Division of Otolaryngology - Head and Neck Surgery; Department of Surgery; Vermont Cancer Center; University of Vermont, College of Medicine; Burlington Vermont
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A systematic review of opioid effects on the hypogonadal axis of cancer patients. Support Care Cancer 2014; 22:1699-704. [DOI: 10.1007/s00520-014-2195-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 03/02/2014] [Indexed: 10/25/2022]
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Rothenstein JM, Letarte N. Managing treatment-related adverse events associated with Alk inhibitors. ACTA ACUST UNITED AC 2014; 21:19-26. [PMID: 24523601 DOI: 10.3747/co.21.1740] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Anaplastic lymphoma kinase (ALK) rearrangements have been identified as key oncogenic drivers in a small subset of non-small-cell lung cancers (nsclcs). Small-molecule Alk kinase inhibitors such as crizotinib have transformed the natural history of nsclc for this subgroup of patients. Because of the prevalence of nsclc, ALK-positive patients represent an important example of the paradigm for personalized medicine. Although Alk inhibitors such as crizotinib are well tolerated, there is a potential for adverse events to occur. Proactive monitoring, treatment, and education concerning those adverse events will help to optimize the therapeutic index of the drugs. The present review summarizes the management of treatment-related adverse events that can arise with Alk inhibitors such as crizotinib.
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Affiliation(s)
- J M Rothenstein
- R.S. McLaughlin Durham Regional Cancer Centre, Oshawa, and Department of Oncology, Queen's University, Kingston, ON
| | - N Letarte
- Department of Pharmacy, Centre hospitalier de l'Université de Montréal, and Faculty of Pharmacy, University of Montreal, Montreal, QC
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Seelaender MC, Batista ML. Adipose tissue inflammation and cancer cachexia: the role of steroid hormones. Horm Mol Biol Clin Investig 2014; 17:5-12. [DOI: 10.1515/hmbci-2013-0040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 09/25/2013] [Indexed: 11/15/2022]
Abstract
AbstractAdipose tissue inflammation plays a role in the etiology of many chronic diseases, and has been the focus of much attention in the context of obesity and metabolic syndrome. Similarly, during cancer cachexia, a syndrome that markedly increases cancer-associated morbidity and mortality, local adipose inflammation is reported in animal models and in patients, potentially contributing to the chronic systemic inflammation that constitutes the hallmark of this condition. We discuss, on the basis of information generated by obesity-related studies, the possible relation between adipose tissue inflammation and compromised steroid hormone secretion and action in cachexia.
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Glukokortikoide und Androgene zur Behandlung von Müdigkeit und Schwäche bei Palliativpatienten. Schmerz 2013; 26:550-67. [DOI: 10.1007/s00482-012-1214-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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White JP, Gao S, Puppa MJ, Sato S, Welle SL, Carson JA. Testosterone regulation of Akt/mTORC1/FoxO3a signaling in skeletal muscle. Mol Cell Endocrinol 2013; 365:174-86. [PMID: 23116773 PMCID: PMC3529800 DOI: 10.1016/j.mce.2012.10.019] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 09/14/2012] [Accepted: 10/18/2012] [Indexed: 01/07/2023]
Abstract
Low endogenous testosterone production, known as hypogonadism is commonly associated with conditions inducing muscle wasting. Akt signaling can control skeletal muscle mass through mTOR regulation of protein synthesis and FoxO regulation of protein degradation, and this pathway has been previously identified as a target of androgen signaling. However, the testosterone sensitivity of Akt/mTOR signaling requires further understanding in order to grasp the significance of varied testosterone levels seen with wasting disease on muscle protein turnover regulation. Therefore, the purpose of this study is to determine the effect of androgen availability on muscle Akt/mTORC1/FoxO3a regulation in skeletal muscle and cultured C(2)C(12) myotubes. C57BL/6 mice were either castrated for 42 days or castrated and treated with the nandrolone decanoate (ND) (6 mg/kg bw/wk). Testosterone loss (TL) significantly decreased volitional grip strength, body weight, and gastrocnemius (GAS) muscle mass, and ND reversed these changes. Related to muscle mass regulation, TL decreased muscle IGF-1 mRNA, the rate of myofibrillar protein synthesis, Akt phosphorylation, and the phosphorylation of Akt targets, GSK3β, PRAS40 and FoxO3a. TL induced expression of FoxO transcriptional targets, MuRF1, atrogin1 and REDD1. Muscle AMPK and raptor phosphorylation, mTOR inhibitors, were not altered by low testosterone. ND restored IGF-1 expression and Akt/mTORC1 signaling while repressing expression of FoxO transcriptional targets. Testosterone (T) sensitivity of Akt/mTORC1 signaling was examined in C(2)C(12) myotubes, and mTOR phosphorylation was induced independent of Akt activation at low T concentrations, while a higher T concentration was required to activate Akt signaling. Interestingly, low concentration T was sufficient to amplify myotube mTOR and Akt signaling after 24 h of T withdrawal, demonstrating the potential in cultured myotubes for a T initiated positive feedback mechanism to amplify Akt/mTOR signaling. In summary, androgen withdrawal decreases muscle myofibrillar protein synthesis through Akt/mTORC1 signaling, which is independent of AMPK activation, and readily reversible by anabolic steroid administration. Acute Akt activation in C(2)C(12) myotubes is sensitive to a high concentration of testosterone, and low concentrations of testosterone can activate mTOR signaling independent of Akt.
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MESH Headings
- Adenylate Kinase/metabolism
- Androgens/pharmacology
- Animals
- Cell Line
- Enzyme Activation
- Forkhead Box Protein O3
- Forkhead Transcription Factors/metabolism
- Gene Expression
- Insulin-Like Growth Factor I/genetics
- Insulin-Like Growth Factor I/metabolism
- Male
- Mechanistic Target of Rapamycin Complex 1
- Mice
- Mice, Inbred C57BL
- Multiprotein Complexes
- Muscle Fibers, Skeletal/drug effects
- Muscle Fibers, Skeletal/metabolism
- Muscle Fibers, Skeletal/physiology
- Muscle Strength
- Muscle, Skeletal/drug effects
- Muscle, Skeletal/metabolism
- Muscle, Skeletal/physiology
- Nandrolone/analogs & derivatives
- Nandrolone/pharmacology
- Nandrolone Decanoate
- Orchiectomy
- Phosphorylation
- Protein Processing, Post-Translational
- Proteins/metabolism
- Proto-Oncogene Proteins c-akt/metabolism
- Receptors, Androgen/genetics
- Receptors, Androgen/metabolism
- Signal Transduction
- TOR Serine-Threonine Kinases
- Testosterone/physiology
- Transcriptional Activation
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Affiliation(s)
- James P. White
- Integrative Muscle Biology Laboratory, Division of Applies Physiology, Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Song Gao
- Integrative Muscle Biology Laboratory, Division of Applies Physiology, Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Melissa J. Puppa
- Integrative Muscle Biology Laboratory, Division of Applies Physiology, Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Shuichi Sato
- Integrative Muscle Biology Laboratory, Division of Applies Physiology, Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Stephen L. Welle
- Department of Medicine, University of Rochester Medical School, Rochester, NY
| | - James A. Carson
- Integrative Muscle Biology Laboratory, Division of Applies Physiology, Department of Exercise Science, University of South Carolina, Columbia, SC
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Ramalingam SS, Shaw AT. Hypogonadism related to crizotinib therapy. Cancer 2012; 118:E1-2. [DOI: 10.1002/cncr.27561] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 03/08/2012] [Indexed: 11/11/2022]
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Horstman AM, Dillon EL, Urban RJ, Sheffield-Moore M. The role of androgens and estrogens on healthy aging and longevity. J Gerontol A Biol Sci Med Sci 2012; 67:1140-52. [PMID: 22451474 DOI: 10.1093/gerona/gls068] [Citation(s) in RCA: 230] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aging is associated with a loss of sex hormone in both men (andropause) and women (menopause). In men, reductions in testosterone can trigger declines in muscle mass, bone mass, and in physical function. In women, the impact of the loss of sex hormones, such as estradiol, on bone is well elucidated, but evidence is limited on whether the loss of estradiol negatively affects muscle mass and physical function. However, deficiencies in multiple anabolic hormones have been shown to predict health status and longevity in older persons. Thus, consideration should be given as to whether targeted hormone replacement therapies may prove effective at treating clinical conditions, such as age-related sarcopenia, cancer cachexia, and/or acute or chronic illnesses. If initiated carefully in the appropriate clinical population, hormone replacement therapies in men and women may prevent and reverse muscle and bone loss and functional declines and perhaps promote healthy aging and longevity.
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Affiliation(s)
- Astrid M Horstman
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-1060, USA.
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Aydogan U, Eroglu A, Akbulut H, Yildiz Y, Gok DE, Sonmez A, Aydin T, Bolu E, Saglam K. Evaluation of the isokinetic muscle strength, balance and anaerobic performance in patients with young male hypogonadism. Endocr J 2012; 59:321-7. [PMID: 22277727 DOI: 10.1507/endocrj.ej11-0242] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hypogonadism is a clinical condition that occurs due to infrequent abnormalities in the hypothalamic-pituitary-gonadal (HPG) axis in adolescence. Symptoms include weakening of muscle and bone strength. 30 young male patients with congenital hypogonadotropic hypogonadism (CHH) and 20 healthy young males were included in the present study. Quadriceps and hamstring muscle strength, balance and anaerobic performance capacities of the study group were measured both before and six months after Testosterone replacement therapy (TRT). The strength of the extensor and flexor muscles of both legs showed a statistically significant increase in the isokinetic test values at 60(0)/sec and 180(0)/sec angular velocity (p < 0.05). When the parameters related to balance were investigated, a statistically significant difference was found for stability indices of left and right between pre-TRT and post-TRT (p = 0.001 for both comparisons). According to the patients' anaerobic performance measurement results, a statistically significant improvement (p < 0.001) was also found between pre-TRT and post-TRT values for each parameter. It was shown that TRT significantly increases muscle strength, balance, and anaerobic performance of patients with male CHH. As a result, we absolutely recommend the use of TRT in patients with male CHH.
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Affiliation(s)
- Umit Aydogan
- Gulhane Military Medical Academy, Department of Family Medicine, Ankara, Turkey.
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Cleve A, Fritzemeier KH, Haendler B, Heinrich N, Möller C, Schwede W, Wintermantel T. Pharmacology and clinical use of sex steroid hormone receptor modulators. Handb Exp Pharmacol 2012:543-587. [PMID: 23027466 DOI: 10.1007/978-3-642-30726-3_24] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Sex steroid receptors are ligand-triggered transcription factors. Oestrogen, progesterone and androgen receptors form, together with the glucocorticoid and mineralocorticoid receptors, a subgroup of the superfamily of nuclear receptors. They share a common mode of action, namely translating a hormone-i.e. a small-molecule signal-from outside to changes in gene expression and cell fate, and thereby represent "natural" pharmacological targets.For pharmacological therapy, these receptors have originally been addressed by hormones and synthetic hormone analogues in order to overcome pathologies related to deficiencies in the natural ligands. Another major use for female sex hormone receptor modulators is oral contraception, i.e. birth control.On the other side, blocking the activity of sex steroid receptors has become an established way to treat hormone-dependent malignancies, such as breast and prostate cancer.In this review, we will discuss how the experience gained from the classical pharmacology of these receptors and their molecular similarities led to new options for the treatment of gender-specific diseases and highlight recent progress in medicinal chemistry of sex hormone-modulating drugs.
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Affiliation(s)
- A Cleve
- Bayer Pharma AG, Muellerstr. 178, Berlin, Germany
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Thum T, Springer J. Breakthrough in cachexia treatment through a novel selective androgen receptor modulator?! J Cachexia Sarcopenia Muscle 2011; 2:121-123. [PMID: 21966638 PMCID: PMC3177042 DOI: 10.1007/s13539-011-0040-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 08/26/2011] [Indexed: 01/06/2023] Open
Abstract
Cachexia, and particularly the loss of metabolically active lean tissue, leads to increased morbidity and mortality in affected patients. An impairment of strength and functional status is usually associated with cachexia. A variety of anabolic and appetite-stimulating agents have been studied in patients with cachexia caused by various underlying diseases. Overall, these studies have demonstrated that treatment can increase body weight and/or lean body mass. However, these therapies may have severe side effects, particularly when utilizing testosterone and related anabolic steroids targeting the androgen receptor. These side effects include cardiovascular problems, prostate hyperplasia and cancer in men, as well as virilization in women.
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Affiliation(s)
- Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), IFB-Tx; Hannover Medical School; Carl-Neuberg-Str. 1 30625 Hannover
- Centre for Clinical and Basic Research; IRCCS San Raffaele; Rome
| | - Jochen Springer
- Applied Cachexia Research, Department of Cardiology; Charité Campus Virchow-Klinikum Berlin
- Center for Cardiovascular Research; Charite Medical School; Berlin
- Norwich Medical School; University of East Anglia; Norwich
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Tvarijonaviciute A, Martinez-Subiela S, Carrillo-Sanchez JD, Tecles F, Ceron JJ. Effects of Orchidectomy in Selective Biochemical Analytes in Beagle Dogs. Reprod Domest Anim 2011; 46:957-63. [DOI: 10.1111/j.1439-0531.2011.01765.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bibliography. PROGRESS IN PALLIATIVE CARE 2010. [DOI: 10.1179/096992610x12775428636944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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