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Martínez-García M, Servitja Tormo S, Vilariño Quintela N, Arance Fernández A, Berrocal Jaime A, Cantos Sánchez de Ibargüen B, Del Barco Berrón S, García Campelo R, Gironés Sarrió R, Manuel Sepúlveda-Sánchez J. SEOM-GEINO clinical guideline of systemic therapy and management of brain central nervous system metastases (2021). Clin Transl Oncol 2022; 24:703-711. [PMID: 35258806 PMCID: PMC8986739 DOI: 10.1007/s12094-022-02803-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 11/25/2022]
Abstract
Central nervous system (CNS) dissemination is a severe complication in cancer and a leading cause of cancer-related mortality. Brain metastases (BMs) are the most common types of malignant intracranial tumors and are reported in approximately 25% of patients with metastatic cancers. The recent increase in incidence of BMs is due to several factors including better diagnostic assessments and the development of improved systemic therapies that have lower activity on the CNS. However, newer systemic therapies are being developed that can cross the blood-brain barrier giving us additional tools to treat BMs. The guidelines presented here focus on the efficacy of new targeted systemic therapies and immunotherapies on CNS BMs from breast, melanoma, and lung cancers.
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Affiliation(s)
- María Martínez-García
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain
- CIOCC HM Delfos, Barcelona, Spain
| | | | - Noelia Vilariño Quintela
- Medical Oncology Department, Institut Català d’Oncologia L’Hospitalet, L’Hospitalet de Llobregat, Barcelona, Spain
| | | | - Alfonso Berrocal Jaime
- Medical Oncology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - Rosario García Campelo
- Medical Oncology Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Regina Gironés Sarrió
- Medical Oncology Department, Hospital Universitari i Politècnic la Fe, Valencia, Spain
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McGill MR, Findley DL, Mazur A, Yee EU, Allard FD, Powers A, Coward L, Blough ER, Gorman G, Hambuchen MD. Radiation Effects on Methamphetamine Pharmacokinetics and Pharmacodynamics in Rats. Eur J Drug Metab Pharmacokinet 2022; 47:319-330. [PMID: 35137360 DOI: 10.1007/s13318-022-00755-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVES Whole-body radiation exposure has been shown to alter the pharmacokinetics of certain drugs in both animal models and humans, but little is known about the effect of radiation on psychoactive medications. These drugs may have altered pharmacokinetics when administered during or after space travel or therapeutic or accidental radiation exposure, resulting in reduced efficacy or increased toxicity. METHODS Methamphetamine was used to determine the effects of acutely administered 1, 3, and 6 Gy radiation on drug pharmacokinetics and pharmacodynamics. Male Wistar rats were exposed to 0, 1, 3, or 6 Gy X-ray radiation on day 0. The serum pharmacokinetics of subcutaneously administered 1 mg/kg methamphetamine was determined on day 3. Methamphetamine-induced (1 mg/kg) locomotor activity was measured on day 5. Brain methamphetamine concentrations were determined 2 h after methamphetamine administration (1 mg/kg) on day 6. Renal and hepatic serum biomarkers were assessed on days 3 and 6, with liver histology performed on day 6. RESULTS While serum half-life and unchanged methamphetamine urine clearance were unaffected by any radiation dose, maximum methamphetamine concentrations and methamphetamine and amphetamine metabolite area under the serum concentration-time curve values from 0 to 300 min were significantly reduced after 6 Gy radiation exposure. Additionally, methamphetamine-induced locomotor activity and the brain to serum methamphetamine concentration ratio were significantly elevated after 6 Gy radiation. CONCLUSIONS While 1-6 Gy radiation exposure did not affect methamphetamine elimination, 6 Gy exposure had effects on both subcutaneous absorption and brain distribution. These effects should be considered when administering drugs during or after radiation exposure.
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Affiliation(s)
- Mitchell R McGill
- Department of Environmental and Occupational Health, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205, USA
| | - David L Findley
- Department of Pharmaceutical Science, Marshall University School of Pharmacy, Kopp Hall 353, 1 John Marshall Drive, Huntington, WV, 25755, USA
| | - Anna Mazur
- Department of Biomedical Science, Marshall University School of Medicine, 1 John Marshall Drive, Huntington, WV, 25755, USA
| | - Eric U Yee
- Department of Pathology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Felicia D Allard
- Department of Pathology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Allison Powers
- Office of Radiation Safety, Marshall University, 1 John Marshall Drive, Huntington, WV, 25755, USA
| | - Lori Coward
- Department of Pharmaceutical, Social and Administrative Sciences, Samford University McWhorter School of Pharmacy, 800 Lakeshore Drive, Birmingham, AL, 35229, USA
| | - Eric R Blough
- Department of Pharmaceutical Science, Marshall University School of Pharmacy, Kopp Hall 353, 1 John Marshall Drive, Huntington, WV, 25755, USA
| | - Greg Gorman
- Department of Pharmaceutical, Social and Administrative Sciences, Samford University McWhorter School of Pharmacy, 800 Lakeshore Drive, Birmingham, AL, 35229, USA
| | - Michael D Hambuchen
- Department of Pharmaceutical Science, Marshall University School of Pharmacy, Kopp Hall 353, 1 John Marshall Drive, Huntington, WV, 25755, USA.
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Sabatier R, Martin J, Vicier C, Guérin M, Monneur A, Provansal M, Tassy L, Tarpin C, Extra JM, Viret F, Goncalves A. Eribulin Efficacy on Brain Metastases in Heavily Pretreated Patients with Metastatic Breast Cancer. J Clin Med 2021; 10:jcm10061272. [PMID: 33803894 PMCID: PMC8003126 DOI: 10.3390/jcm10061272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 01/15/2023] Open
Abstract
The onset of brain metastases (BM) is a major turning point during advanced breast cancer (ABC) evolution, with only few treatment options when local therapies have failed. The therapeutic effect of eribulin, a wildly used drug in the treatment of ABC, remains unclear in this setting. Patients and Methods: We performed a retrospective observational study to assess eribulin efficacy in patients with ABC who displayed BM at time of eribulin initiation. We collected data from the medical files of all ABC patients who received eribulin at our institution from 2012 until 2020. Our main endpoint was the central nervous system (CNS) progression-free survival. (CNS-PFS). Other evaluation criteria were extra-cranial progression free survival (PFS) and overall survival (OS). Results: Twenty patients with BM monitoring data available were selected out of the 549 who received eribulin during the inclusion period. Fifteen patients (75%) had BM progressive as the best response, three patients (15%) had disease stabilization for more than 6 months and only one patient had a partial response according to RECIST 1.1 criteria. Median CNS-PFS was 3.39 months (95CI (3.02–3.76)). Cox univariate analysis identified molecular subtype as the only prognostic parameter in our cohort, with patients with hormone-receptor positive tumors less likely to experience CNS progression than those with triple-negative MBC (HR = 0.23 (95CI = 0.07–0.80), p = 0.021). Median extra-cranial PFS was 2.67 months (95CI (2.33–3.01)). Median OS was 7.68 months (95CI (0–17.41)). Conclusion: Eribulin seems to have only a limited impact on BM evolution. Hormone receptors expression may identify a subset of patients with better BM control.
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Affiliation(s)
- Renaud Sabatier
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (J.M.); (C.V.); (M.G.); (A.M.); (M.P.); (L.T.); (C.T.); (J.-M.E.); (F.V.); (A.G.)
- Aix-Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, 13009 Marseille, France
- Correspondence:
| | - Johan Martin
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (J.M.); (C.V.); (M.G.); (A.M.); (M.P.); (L.T.); (C.T.); (J.-M.E.); (F.V.); (A.G.)
- Aix-Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, 13009 Marseille, France
| | - Cécile Vicier
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (J.M.); (C.V.); (M.G.); (A.M.); (M.P.); (L.T.); (C.T.); (J.-M.E.); (F.V.); (A.G.)
| | - Mathilde Guérin
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (J.M.); (C.V.); (M.G.); (A.M.); (M.P.); (L.T.); (C.T.); (J.-M.E.); (F.V.); (A.G.)
| | - Audrey Monneur
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (J.M.); (C.V.); (M.G.); (A.M.); (M.P.); (L.T.); (C.T.); (J.-M.E.); (F.V.); (A.G.)
| | - Magali Provansal
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (J.M.); (C.V.); (M.G.); (A.M.); (M.P.); (L.T.); (C.T.); (J.-M.E.); (F.V.); (A.G.)
| | - Louis Tassy
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (J.M.); (C.V.); (M.G.); (A.M.); (M.P.); (L.T.); (C.T.); (J.-M.E.); (F.V.); (A.G.)
| | - Carole Tarpin
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (J.M.); (C.V.); (M.G.); (A.M.); (M.P.); (L.T.); (C.T.); (J.-M.E.); (F.V.); (A.G.)
| | - Jean-Marc Extra
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (J.M.); (C.V.); (M.G.); (A.M.); (M.P.); (L.T.); (C.T.); (J.-M.E.); (F.V.); (A.G.)
| | - Frédéric Viret
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (J.M.); (C.V.); (M.G.); (A.M.); (M.P.); (L.T.); (C.T.); (J.-M.E.); (F.V.); (A.G.)
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (J.M.); (C.V.); (M.G.); (A.M.); (M.P.); (L.T.); (C.T.); (J.-M.E.); (F.V.); (A.G.)
- Aix-Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, 13009 Marseille, France
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Ung C, Tsoli M, Liu J, Cassano D, Pocoví-Martínez S, Upton DH, Ehteda A, Mansfeld FM, Failes TW, Farfalla A, Katsinas C, Kavallaris M, Arndt GM, Vittorio O, Cirillo G, Voliani V, Ziegler DS. Doxorubicin-Loaded Gold Nanoarchitectures as a Therapeutic Strategy against Diffuse Intrinsic Pontine Glioma. Cancers (Basel) 2021; 13:1278. [PMID: 33805713 PMCID: PMC7999568 DOI: 10.3390/cancers13061278] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 01/11/2023] Open
Abstract
Diffuse Intrinsic Pontine Gliomas (DIPGs) are highly aggressive paediatric brain tumours. Currently, irradiation is the only standard treatment, but is palliative in nature and most patients die within 12 months of diagnosis. Novel therapeutic approaches are urgently needed for the treatment of this devastating disease. We have developed non-persistent gold nano-architectures (NAs) functionalised with human serum albumin (HSA) for the delivery of doxorubicin. Doxorubicin has been previously reported to be cytotoxic in DIPG cells. In this study, we have preclinically evaluated the cytotoxic efficacy of doxorubicin delivered through gold nanoarchitectures (NAs-HSA-Dox). We found that DIPG neurospheres were equally sensitive to doxorubicin and doxorubicin-loaded NAs. Colony formation assays demonstrated greater potency of NAs-HSA-Dox on colony formation compared to doxorubicin. Western blot analysis indicated increased apoptotic markers cleaved Parp, cleaved caspase 3 and phosphorylated H2AX in NAs-HSA-Dox treated DIPG neurospheres. Live cell content and confocal imaging demonstrated significantly higher uptake of NAs-HSA-Dox into DIPG neurospheres compared to doxorubicin alone. Despite the potency of the NAs in vitro, treatment of an orthotopic model of DIPG showed no antitumour effect. This disparate outcome may be due to the integrity of the blood-brain barrier and highlights the need to develop therapies to enhance penetration of drugs into DIPG.
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Affiliation(s)
- Caitlin Ung
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, High Street, Randwick, NSW 2052, Australia; (C.U.); (J.L.); (D.H.U.); (A.E.); (F.M.M.); (C.K.); (M.K.); (O.V.)
| | - Maria Tsoli
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, High Street, Randwick, NSW 2052, Australia; (C.U.); (J.L.); (D.H.U.); (A.E.); (F.M.M.); (C.K.); (M.K.); (O.V.)
- School of Women’s and Children’s Health, University of New South Wales, Kensington, NSW 2052, Australia
| | - Jie Liu
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, High Street, Randwick, NSW 2052, Australia; (C.U.); (J.L.); (D.H.U.); (A.E.); (F.M.M.); (C.K.); (M.K.); (O.V.)
| | - Domenico Cassano
- Center for Nanotechnology Innovation, Istituto Italiano di Tecnologia, Piazza San Silvestro 12, 56127 Pisa, Italy; (D.C.); (S.P.-M.); (V.V.)
| | - Salvador Pocoví-Martínez
- Center for Nanotechnology Innovation, Istituto Italiano di Tecnologia, Piazza San Silvestro 12, 56127 Pisa, Italy; (D.C.); (S.P.-M.); (V.V.)
| | - Dannielle H. Upton
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, High Street, Randwick, NSW 2052, Australia; (C.U.); (J.L.); (D.H.U.); (A.E.); (F.M.M.); (C.K.); (M.K.); (O.V.)
- School of Women’s and Children’s Health, University of New South Wales, Kensington, NSW 2052, Australia
| | - Anahid Ehteda
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, High Street, Randwick, NSW 2052, Australia; (C.U.); (J.L.); (D.H.U.); (A.E.); (F.M.M.); (C.K.); (M.K.); (O.V.)
| | - Friederike M. Mansfeld
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, High Street, Randwick, NSW 2052, Australia; (C.U.); (J.L.); (D.H.U.); (A.E.); (F.M.M.); (C.K.); (M.K.); (O.V.)
- School of Women’s and Children’s Health, University of New South Wales, Kensington, NSW 2052, Australia
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, Australian Centre for NanoMedicine, University of New South Wales, Kensington, NSW 2052, Australia
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, Monash University, Royal Parade, Parkville, VIC 3052, Australia
| | - Timothy W. Failes
- ACRF Drug Discovery Centre, Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, High Street, Randwick, NSW 2052, Australia; (T.W.F.); (G.M.A.)
| | - Annafranca Farfalla
- Department of Pharmacy Health and Nutritional Science, University of Calabria, 87036 Rende, Italy; (A.F.); (G.C.)
| | - Christopher Katsinas
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, High Street, Randwick, NSW 2052, Australia; (C.U.); (J.L.); (D.H.U.); (A.E.); (F.M.M.); (C.K.); (M.K.); (O.V.)
| | - Maria Kavallaris
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, High Street, Randwick, NSW 2052, Australia; (C.U.); (J.L.); (D.H.U.); (A.E.); (F.M.M.); (C.K.); (M.K.); (O.V.)
- School of Women’s and Children’s Health, University of New South Wales, Kensington, NSW 2052, Australia
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, Australian Centre for NanoMedicine, University of New South Wales, Kensington, NSW 2052, Australia
| | - Greg M. Arndt
- ACRF Drug Discovery Centre, Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, High Street, Randwick, NSW 2052, Australia; (T.W.F.); (G.M.A.)
| | - Orazio Vittorio
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, High Street, Randwick, NSW 2052, Australia; (C.U.); (J.L.); (D.H.U.); (A.E.); (F.M.M.); (C.K.); (M.K.); (O.V.)
- School of Women’s and Children’s Health, University of New South Wales, Kensington, NSW 2052, Australia
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, Australian Centre for NanoMedicine, University of New South Wales, Kensington, NSW 2052, Australia
| | - Giuseppe Cirillo
- Department of Pharmacy Health and Nutritional Science, University of Calabria, 87036 Rende, Italy; (A.F.); (G.C.)
| | - Valerio Voliani
- Center for Nanotechnology Innovation, Istituto Italiano di Tecnologia, Piazza San Silvestro 12, 56127 Pisa, Italy; (D.C.); (S.P.-M.); (V.V.)
| | - David S. Ziegler
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, High Street, Randwick, NSW 2052, Australia; (C.U.); (J.L.); (D.H.U.); (A.E.); (F.M.M.); (C.K.); (M.K.); (O.V.)
- School of Women’s and Children’s Health, University of New South Wales, Kensington, NSW 2052, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2052, Australia
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5
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Jung SU, Jeon CW, Choi JH. Long-term survival with eribulin monotherapy after whole brain radiation therapy in a patient with brain metastasis from breast cancer. Asian J Surg 2020; 43:1008-1009. [PMID: 32631621 DOI: 10.1016/j.asjsur.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/06/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sung Ui Jung
- Division of Breast Surgery, Department of Surgery, University of Kosin College of Medicine, Kosin Univ. Gospel Hospital, Busan, South Korea
| | - Chang Wan Jeon
- Division of Breast Surgery, Department of Surgery, University of Kosin College of Medicine, Kosin Univ. Gospel Hospital, Busan, South Korea
| | - Jin Hyuk Choi
- Division of Breast Surgery, Department of Surgery, University of Kosin College of Medicine, Kosin Univ. Gospel Hospital, Busan, South Korea.
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Li X, Yang J, Qiao Y, Duan Y, Xin Y, Nian Y, Zhu L, Liu G. Effects of Radiation on Drug Metabolism: A Review. Curr Drug Metab 2019; 20:350-360. [PMID: 30961479 DOI: 10.2174/1389200220666190405171303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/18/2019] [Accepted: 03/26/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Radiation is the fourth most prevalent type of pollution following the water, air and noise pollution. It can adversely affect normal bodily functions. Radiation alters the protein and mRNA expression of drugmetabolizing enzymes and drug transporters and the pharmacokinetic characteristics of drugs, thereby affecting drug absorption, distribution, metabolism, and excretion. Therefore, it is important to study the pharmacokinetic changes in drugs under radiation. METHODS To update data on the effects of ionizing radiation and non-ionizing radiation caused by environmental pollution or clinical treatments on the protein and mRNA expression of drug-metabolizing enzymes and drug transporters. Data and information on pharmacokinetic changes in drugs under radiation were analyzed and summarized. RESULTS The effect of radiation on cytochrome P450 is still a subject of debate. The widespread belief is that higherdose radiation increased the expression of CYP1A1 and CYP1B1 of rat, zebrafish or human, CYP1A2, CYP2B1, and CYP3A1 of rat, and CYP2E1 of mouse or rat, and decreased that of rat's CYP2C11 and CYP2D1. Radiation increased the expression of multidrug resistance protein, multidrug resistance-associated protein, and breast cancer resistance protein. The metabolism of some drugs, as well as the clearance, increased during concurrent chemoradiation therapy, whereas the half-life, mean residence time, and area under the curve decreased. Changes in the expression of cytochrome P450 and drug transporters were consistent with the changes in the pharmacokinetics of some drugs under radiation. CONCLUSION The findings of this review indicated that radiation caused by environmental pollution or clinical treatments can alter the pharmacokinetic characteristics of drugs. Thus, the pharmacokinetics of drugs should be rechecked and the optimal dose should be re-evaluated after radiation.
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Affiliation(s)
- Xiangyang Li
- State Key Laboratory of Plateau Ecology and Agriculture, Qinghai University, Xining, China.,Medical College, Qinghai University, Xining, China
| | - Jianxin Yang
- Medical College, Qinghai University, Xining, China
| | - Yijie Qiao
- Medical College, Qinghai University, Xining, China
| | - Yabin Duan
- Medical College, Qinghai University, Xining, China
| | - Yuanyao Xin
- College of Ecological and Environment Engineering, Qinghai University, Xining, China
| | - Yongqiong Nian
- College of Ecological and Environment Engineering, Qinghai University, Xining, China
| | - Lin Zhu
- College of Ecological and Environment Engineering, Qinghai University, Xining, China
| | - Guiqin Liu
- College of Ecological and Environment Engineering, Qinghai University, Xining, China
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Catania G, Malaguti P, Gasparro S, Cognetti F, Vidiri A, Fabi A. Activity of Eribulin Mesylate in Brain Metastasis from Breast Cancer: A Stone in a Pond? Oncology 2018; 94 Suppl 1:29-33. [PMID: 30041177 PMCID: PMC6193747 DOI: 10.1159/000489066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Brain metastases develop in approximately 10-25% of patients with metastatic breast cancer (MBC) and are associated with a very poor prognosis. CASE REPORT We report the case of a 40-year-old woman with MBC and associated lung, bone, liver, and brain metastases, who experienced a time to progression of several months with eribulin after whole-brain radiotherapy (WBRT), 2 lines of chemotherapy, and 1 line of hormonal therapy, maintaining a good toxicity profile. DISCUSSION Eribulin, in association with local treatment such as WBRT, can be well tolerated and effective in achieving a long progression-free survival and a good control of brain metastases in patients with MBC who have received multiple lines of treatment. The vascular remodeling properties of eribulin, combined with brain radiotherapy, might facilitate the passage of eribulin across the blood brain barrier, improving brain response. CONCLUSION Our anecdotal experience suggests that eribulin may have a potentially beneficial effect on brain metastases while maintaining a good systemic control of the disease in patients with MBC.
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Affiliation(s)
| | | | | | | | | | - Alessandra Fabi
- Division of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy
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Carvedilol abrogates hypoxia-induced oxidative stress and neuroinflammation in microglial BV2 cells. Eur J Pharmacol 2017; 814:144-150. [PMID: 28821450 DOI: 10.1016/j.ejphar.2017.08.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/17/2017] [Accepted: 08/14/2017] [Indexed: 12/22/2022]
Abstract
Microglia initially undergo rapid activation in response to injury and stressful stimuli, such as hypoxia. Oxidative stress and the inflammatory response play critical roles in hypoxic-ischemic brain injury. Carvedilol is a β-blocker used to treat high blood pressure and heart failure. In this study, we investigated whether carvedilol had a protective effect against hypoxia-induced oxidative stress and inflammation in microglial BV2 cells. Our results indicate that hypoxic exposure significantly reduced mean cell viability of BV2 microglia, which was significantly restored by carvedilol (10 and 50μM). In addition, carvedilol treatment significantly inhibited the hypoxia-induced increase in reactive oxygen species (ROS) and 4-hydroxy-2-nonenal (4-HNE). Administration of carvedilol significantly inhibited expression of IL-1β, TNF-α, and IL-6 at both the mRNA and protein levels. Mechanistically, we found that hypoxia significantly increased phosphorylation of IKK, IκBα, and NF-κB p65. However, treatment with carvedilol inhibited phosphorylation of these molecules. Notably, hypoxia resulted in a significant nuclear translocation of NF-κB p65, which was inhibited by administration of carvedilol. Luciferase reporter assay results demonstrate that treatment with carvedilol inhibited the hypoxia-induced increase in NF-κB binding activity. These data suggest that carvedilol may be of potential use as a novel therapy against hypoxia or ischemia.
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9
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Yun KL, Wang ZY. Target/signalling pathways of natural plant-derived radioprotective agents from treatment to potential candidates: A reverse thought on anti-tumour drugs. Biomed Pharmacother 2017; 91:1122-1151. [DOI: 10.1016/j.biopha.2017.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/15/2017] [Accepted: 05/01/2017] [Indexed: 02/07/2023] Open
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10
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Byun KD, Ahn SG, Baik HJ, Lee A, Bae KB, An MS, Kim KH, Shin JH, Park HK, Cho H, Jeong J, Kim TH. Eribulin Mesylate Combined with Local Treatment for Brain Metastasis from Breast Cancer: Two Case Reports. J Breast Cancer 2016; 19:214-7. [PMID: 27382400 PMCID: PMC4929265 DOI: 10.4048/jbc.2016.19.2.214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 05/26/2016] [Indexed: 12/02/2022] Open
Abstract
The prognosis associated with brain metastasis arising from breast cancer is very poor. Eribulin is a microtubule dynamic inhibitor synthesized from halichondrin B, a natural marine product. In a phase III study (EMBRACE), eribulin improved overall survival in patients with heavily pretreated metastatic breast cancers. However, these studies included few patients with brain metastases. Metastatic brain tumors (MBT) were detected during first-line palliative chemotherapy in a 43-year-old woman with breast cancer metastasis to the lung and mediastinal nodes; the genetic subtype was luminal B-like human epidermal growth factor receptor 2 (HER2)-negative. Whole brain radiotherapy (WBRT) followed by eribulin treatment continuously decreased the size, and induced regression, of the MBT with systemic disease stability for 12 months. Another 48-year-old woman with metastatic breast cancer (HER2+ subtype) presented with MBT. Following surgical resection of the tumor, eribulin with concurrent WBRT showed regression of the MBT without systemic progression for 18 months.
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Affiliation(s)
- Kyung-Do Byun
- Breast Center, Department of Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Medical Research Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Joo Baik
- Breast Center, Department of Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Anbok Lee
- Breast Center, Department of Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Ki Beom Bae
- Breast Center, Department of Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Min Sung An
- Breast Center, Department of Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Kwang Hee Kim
- Breast Center, Department of Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Jae Ho Shin
- Breast Center, Department of Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Ha Kyoung Park
- Breast Center, Department of Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Heunglae Cho
- Department of Radiation Oncology, Inje University Busan Paik Hospital, Busan, Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Medical Research Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hyun Kim
- Breast Center, Department of Surgery, Inje University Busan Paik Hospital, Busan, Korea
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Chang AY, Ying XX. Brain Metastases from Breast Cancer and Response to Treatment with Eribulin: A Case Series. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2015; 9:19-24. [PMID: 26052228 PMCID: PMC4444132 DOI: 10.4137/bcbcr.s21176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 03/10/2015] [Accepted: 03/12/2015] [Indexed: 02/04/2023]
Abstract
Brain metastases are common in patients with advanced breast cancer (BC), causing considerable morbidity and mortality. Eribulin is a microtubule dynamics inhibitor approved for treating certain patients with metastatic BC, previously treated with an anthracycline and a taxane. In the 301 phase 3 study in 1102 women with advanced BC, eribulin and capecitabine treatments did not differ for co-primary endpoints (overall survival [OS]: 15.9 vs 14.5 months, P = 0.056; progression-free survival [PFS]: 4.1 vs 4.2 months, P = 0.30). Here, we report outcomes for six patients (eribulin, n = 3; capecitabine, n = 3) who had received treatment for brain metastases from BC (BCBM) at baseline. All eribulin-treated patients experienced brain lesion shrinkage at some point during treatment, compared with one capecitabine-treated patient. Fewer patients in study 301 developed new BCBM with eribulin (13/544, 2.4%) compared with capecitabine (25/546, 4.6%). Eribulin does not cross the healthy blood-brain barrier (BBB), but could have the potential to do so after cranial radiation therapy. Capecitabine may cross the BBB and has demonstrated activity in BCBM. Data from these patients and previous cases suggest that further investigation of eribulin for BCBM may be warranted.
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Affiliation(s)
- Alex Y Chang
- Department of Medical Oncology, Johns Hopkins Singapore International Medical Centre, Johns Hopkins University, Singapore. ; Research Department, Johns Hopkins Singapore Pte Ltd, Singapore
| | - Xu Xiao Ying
- Research Department, Johns Hopkins Singapore Pte Ltd, Singapore
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Matsuoka H, Tsurutani J, Tanizaki J, Iwasa T, Komoike Y, Koyama A, Nakagawa K. Regression of brain metastases from breast cancer with eribulin: a case report. BMC Res Notes 2013; 6:541. [PMID: 24350786 PMCID: PMC3878316 DOI: 10.1186/1756-0500-6-541] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 12/13/2013] [Indexed: 12/02/2022] Open
Abstract
Background Eribulin is a recently approved new therapeutic option for patients with metastatic breast cancer. According to several reports, eribulin has limited ability to cross the blood brain barrier. Recently, capecitabine and eribulin have been recognized as drugs with similar application for patients with advanced breast cancer. Although there have been several case reports describing the efficacy of capecitabine against brain metastases, no report of eribulin demonstrating efficacy for brain metastases exists today. Case presentation We describe a case of a 57-year-old Japanese woman who was diagnosed with breast cancer stage IV metastasized to multiple organs including liver and lung. After she received 3 regimens, she showed evidence of brain metastases, and whole brain radiation therapy was performed. Lapatinib and capecitabine was then administered as fourth-line chemotherapy, but the patient was hospitalized due to the exacerbation of interstitial pneumonitis and progression of brain and liver metastases. To control the systemic disease, eribulin was commenced as fifth-line chemotherapy. One month later, a significant response of brain metastases had been achieved, and this response has persisted for the last 4 months. We now describe a remarkable antitumor effect of eribulin against brain metastases from breast cancer. This case is the first report which indicates potential treatment of brain metastases using this medication. Conclusion This report suggests that eribulin treatment may be beneficial for breast cancer patients with brain metastases progressing after whole brain radiation therapy. However, further clinical studies are warranted to determine the clinical effect of eribulin in brain metastases.
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Affiliation(s)
- Hiromichi Matsuoka
- Department of Medical Oncology, Kinki University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, Japan.
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Zhan K, Yao J, Huang J, Zhou G, Li W, Chen L, Hong M. Effect of X-ray irradiation on expression of organic anion transporting polypeptides. Int J Radiat Biol 2013; 89:832-40. [DOI: 10.3109/09553002.2013.784427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Early brain injury alters the blood-brain barrier phenotype in parallel with β-amyloid and cognitive changes in adulthood. J Cereb Blood Flow Metab 2013; 33:205-14. [PMID: 23149553 PMCID: PMC3564189 DOI: 10.1038/jcbfm.2012.154] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Clinical studies suggest that traumatic brain injury (TBI) hastens cognitive decline and development of neuropathology resembling brain aging. Blood-brain barrier (BBB) disruption following TBI may contribute to the aging process by deregulating substance exchange between the brain and blood. We evaluated the effect of juvenile TBI (jTBI) on these processes by examining long-term alterations of BBB proteins, β-amyloid (Aβ) neuropathology, and cognitive changes. A controlled cortical impact was delivered to the parietal cortex of male rats at postnatal day 17, with behavioral studies and brain tissue evaluation at 60 days post-injury (dpi). Immunoglobulin G extravasation was unchanged, and jTBI animals had higher levels of tight-junction protein claudin 5 versus shams, suggesting the absence of BBB disruption. However, decreased P-glycoprotein (P-gp) on cortical blood vessels indicates modifications of BBB properties. In parallel, we observed higher levels of endogenous rodent Aβ in several brain regions of the jTBI group versus shams. In addition at 60 dpi, jTBI animals displayed systematic search strategies rather than relying on spatial memory during the water maze. Together, these alterations to the BBB phenotype after jTBI may contribute to the accumulation of toxic products, which in turn may induce cognitive differences and ultimately accelerate brain aging.
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Rendic S, Guengerich FP. Summary of information on the effects of ionizing and non-ionizing radiation on cytochrome P450 and other drug metabolizing enzymes and transporters. Curr Drug Metab 2012; 13:787-814. [PMID: 22571481 PMCID: PMC4007673 DOI: 10.2174/138920012800840356] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 02/02/2012] [Accepted: 04/15/2012] [Indexed: 11/22/2022]
Abstract
The present paper is an update of data on the effects of ionizing radiation (γ-rays, X-rays, high energy UV, fast neutron) caused by environmental pollution or clinical treatments and the effects of non-ionizing radiation (low energy UV) on the expression and/or activity of drug metabolism (e.g., cytochrome P450 (CYP), glutathione transferase (GST)), enzymes involved in oxidative stress (e.g., peroxidases, catalase (CAT), aconitase (ACO), superoxide dismutase (SOD)), and transporters. The data are presented in tabular form (Tables 1-3) and are a continuation of previously published summaries on the effects of drugs and other chemicals on cytochrome P450 enzymes (Rendic, S.; Di Carlo, F. Drug Metab. Rev., 1997, 29 (1-2), 413-580, Rendic, S. Drug Metab. Rev., 2002, 34 (1-2), 83- 448) and of the data on the effects of diseases and environmental factors on the expression and/or activity of human cytochrome P450 enzymes and transporters (Guengerich, F.P.; Rendic, S. Curr. Drug Metab., 2010, 11(1), 1-3, Rendic, S.; Guengerich, F.P. Curr. Drug Metab., 2010, 11 (1), 4-84). The collective information is as presented by the cited author(s) in cases where several references are cited the latest published information is included. Remarks and conclusions suggesting clinically important impacts are highlighted, followed by discussion of the major findings. The searchable database is available as an Excel file (for information about file availability contact the corresponding author).
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Fauquette W, Amourette C, Dehouck MP, Diserbo M. Radiation-induced blood–brain barrier damages: An in vitro study. Brain Res 2012; 1433:114-26. [DOI: 10.1016/j.brainres.2011.11.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 10/13/2011] [Accepted: 11/08/2011] [Indexed: 11/29/2022]
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Nagengast WB, Oude Munnink TH, Dijkers ECF, Hospers GAP, Brouwers AH, Schröder CP, Lub-de Hooge M, de Vries EGE. Multidrug resistance in oncology and beyond: from imaging of drug efflux pumps to cellular drug targets. Methods Mol Biol 2010; 596:15-31. [PMID: 19949918 DOI: 10.1007/978-1-60761-416-6_2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Resistance of tumor cells to several structurally unrelated classes of natural products, including anthracyclines, taxanes, and epipodophyllotoxines, is often referred as multidrug resistance (MDR). This is associated with ATP-binding cassette transporters, which function as drug efflux pumps such as P-glycoprotein (Pgp) and multidrug resistance-associated protein 1 (MRP1). Because of the hypothesis in the early eighties that blockade of these efflux pumps by modulators would improve the effect of chemotherapy, extensive effort has been put to visualize these pumps using nuclear imaging with several specific tracers, using both SPECT and PET techniques. The methods and possibilities to visualize these pumps in both the tumor and the blood-brain barrier will be discussed. Because of the fact that the addition of Pgp or MRP modulators has not shown any clinical benefit in patient outcome, these specific MDR tracers are not routinely used in clinical practice. Evidence emerges that combination of chemotherapeutic drugs involved in MDR with the so-called targeted agents can improve patient outcome. The concept of molecular imaging can also be used to visualize the targets for these agents, such as HER2/neu and angiogenic factors such as vascular endothelial growth factor (VEGF). Potentially visualizing molecular drug targets in the tumor can function as biomarkers to support treatment decision for the individual patient.
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Affiliation(s)
- Wouter B Nagengast
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
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