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Babakoohi S, Gu SL, Ehsan H, Markova A. Dermatologic complications in transplantation and cellular therapy for acute leukemia. Best Pract Res Clin Haematol 2023; 36:101464. [PMID: 37353285 PMCID: PMC10291442 DOI: 10.1016/j.beha.2023.101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023]
Abstract
Adoptive cellular immunotherapy, mainly hematopoietic stem cell transplant and CAR-T cell therapy have revolutionized treatment of patients with acute leukemia. Indications and inclusion criteria for these treatments have expanded in recent years. While these therapies are associated with significant improvements in disease response and overall survival, patients may experience adverse events from associated chemotherapy conditioning, engraftment, cytokine storm, supportive medications, and post-transplant maintenance targeted therapies. Supportive oncodermatology is a growing specialty to manage cutaneous toxicities resulting from the anti-cancer therapies. In this review, we summarize diagnosis and management of the common cutaneous adverse events including drug eruptions, graft-versus-host disease, neoplastic and paraneoplastic complications in patients undergoing cellular therapies.
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Affiliation(s)
- Shahab Babakoohi
- Levine Cancer Institute, Atrium Health Wake Forest Baptist, Charlotte, NC, USA.
| | - Stephanie L Gu
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Hamid Ehsan
- Levine Cancer Institute, Atrium Health Wake Forest Baptist, Charlotte, NC, USA
| | - Alina Markova
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA.
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2
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Satragno C, Verrico A, Giannelli F, Ferrero A, Campora S, Turazzi M, Cavagnetto F, Schiavetti I, Garrè ML, Garibotto F, Milanaccio C, Piccolo G, Crocco M, Ramaglia A, Di Profio S, Barra S, Belgioia L. High dose craniospinal irradiation as independent risk factor of permanent alopecia in childhood medulloblastoma survivors: cohort study and literature review. J Neurooncol 2022; 160:659-668. [PMID: 36369416 PMCID: PMC9758075 DOI: 10.1007/s11060-022-04186-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE Our aim was to determine the main risk factors related to the occurrence of permanent alopecia in childhood medulloblastoma (MB) survivors. METHODS We retrospectively analyzed the clinical features of all consecutive MB survivors treated at our institute. We divided the patients into 3 groups depending on the craniospinal irradiation (CSI) dose received and defined permanent alopecia first in terms of the skin region affected (whole scalp and nape region), then on the basis of the toxicity degree (G). Any relationship between permanent alopecia and other characteristics was investigated by a univariate and multivariate analysis and Odds ratio (OR) with confidence interval (CI) was reported. RESULTS We included 41 patients with a mean10-year follow-up. High dose CSI resulted as an independent factor leading to permanent hair loss in both groups: alopecia of the whole scalp (G1 p-value 0.030, G2 p-value 0.003) and of the nape region (G1 p-value 0.038, G2 p-value 0.006). The posterior cranial fossa (PCF) boost volume and dose were not significant factors at multivariate analysis neither in permanent hair loss of the whole scalp nor only in the nuchal region. CONCLUSION In pediatric patients with MB, the development of permanent alopecia seems to depend only on the CSI dose ≥ 36 Gy. Acute damage to the hair follicle is dose dependent, but in terms of late side effects, constant and homogeneous daily irradiation of a large volume may have a stronger effect than a higher but focal dose of radiotherapy.
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Affiliation(s)
- C Satragno
- Dipartimento Di Medicina Sperimentale (DIMES), Università Degli Studi Di Genova, Via Leon Battista Alberti, 16132, Genova, GE, Italia.
| | - A Verrico
- Unità di Neuroncologia, IRCCS Istituto Giannina Gaslini, Genova, Italia
| | - F Giannelli
- UO Radioterapia Oncologica, IRCCS Ospedale Policlinico San Martino, Genova, Italia
| | - A Ferrero
- Dipartimento Di Medicina Sperimentale (DIMES), Università Degli Studi Di Genova, Via Leon Battista Alberti, 16132, Genova, GE, Italia
| | - S Campora
- Dipartimento di Scienza Della Salute (DISSAL), Università Degli Studi di Genova, Genova, Italia
| | - M Turazzi
- Dipartimento di Scienza Della Salute (DISSAL), Università Degli Studi di Genova, Genova, Italia
| | - F Cavagnetto
- UO Fisica Sanitaria, IRCCS Ospedale Policlinico San Martino, Genova, Italia
| | - I Schiavetti
- Dipartimento di Scienze Della Salute (DISSAL), Sezione di Biostatistica, Università Degli Studi di Genova, Genova, Italia
| | - M L Garrè
- Unità di Neuroncologia, IRCCS Istituto Giannina Gaslini, Genova, Italia
| | - F Garibotto
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica, Ginecologia e Pediatria (DINOGMI), Università Degli Studi di Genova, Genova, Italia
| | - C Milanaccio
- Unità di Neuroncologia, IRCCS Istituto Giannina Gaslini, Genova, Italia
| | - G Piccolo
- Unità di Neuroncologia, IRCCS Istituto Giannina Gaslini, Genova, Italia
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica, Ginecologia e Pediatria (DINOGMI), Università Degli Studi di Genova, Genova, Italia
| | - M Crocco
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica, Ginecologia e Pediatria (DINOGMI), Università Degli Studi di Genova, Genova, Italia
| | - A Ramaglia
- Unità di Neuroradiologia, IRCCS Istituto Giannina Gaslini, Genova, Italia
| | - S Di Profio
- Unità di Psicologia, IRCCS Istituto Giannina Gaslini, Genova, Italia
| | - S Barra
- UO Radioterapia Oncologica, IRCCS Ospedale Policlinico San Martino, Genova, Italia
| | - L Belgioia
- Dipartimento di Scienza Della Salute (DISSAL), Università Degli Studi di Genova, Genova, Italia
- UO Radioterapia Oncologica, IRCCS Ospedale Policlinico San Martino, Genova, Italia
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Stojanova J, Carland JE, Murnion B, Seah V, Siderov J, Lemaitre F. Therapeutic drug monitoring in oncology - What’s out there: A bibliometric evaluation on the topic. Front Oncol 2022; 12:959741. [PMID: 36439413 PMCID: PMC9685987 DOI: 10.3389/fonc.2022.959741] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/07/2022] [Indexed: 11/12/2022] Open
Abstract
Pharmacological therapy is the mainstay of treatment for cancer patients. Despite wide interpatient variability in systemic drug concentrations for numerous antineoplastics, dosing based on body size remains the predominant approach. Therapeutic drug monitoring (TDM) is used for few antineoplastics in specific scenarios. We conducted a rapid bibliometric evaluation of TDM in oncology to capture a snapshot of research in this area over time and explore topics that reflect development in the field. Reports with the composite, indexed term ‘therapeutic drug monitoring’ in the title and abstract were extracted from MEDLINE (inception to August 2021). Reports related to applications in cancer were selected for inclusion and were tagged by study design, antineoplastic drugs and concepts related to TDM. We present a timeline from 1980 to the present indicating the year of first report of antineoplastic agents and key terms. The reports in our sample primarily reflected development and validation of analytical methods with few relating to clinical outcomes to support implementation. Our work emphasises evidence gaps that may contribute to poor uptake of TDM in oncology.
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Affiliation(s)
- Jana Stojanova
- Department of Clinical Pharmacology and Toxicology, St. Vincent’s Hospital, Sydney, NSW, Australia
- Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaiíso, Valparaiíso, Chile
- *Correspondence: Jana Stojanova,
| | - Jane E. Carland
- Department of Clinical Pharmacology and Toxicology, St. Vincent’s Hospital, Sydney, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Bridin Murnion
- Department of Clinical Pharmacology and Toxicology, St. Vincent’s Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Vincent Seah
- Department of Clinical Pharmacology and Toxicology, St. Vincent’s Hospital, Sydney, NSW, Australia
| | - Jim Siderov
- Pharmacy Department, Austin Health, Heidelberg, VIC, Australia
| | - Florian Lemaitre
- Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Rennes, France
- INSERM, Centre d’Investigation Clinique, Rennes, France
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4
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Piccini I, Brunken L, Chéret J, Ghatak S, Ramot Y, Alam M, Purba TS, Hardman J, Erdmann H, Jimenez F, Paus R, Bertolini M. PPARγ signaling protects hair follicle stem cells from chemotherapy-induced apoptosis and epithelial-mesenchymal transition. Br J Dermatol 2021; 186:129-141. [PMID: 34496034 DOI: 10.1111/bjd.20745] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Permanent chemotherapy-induced alopecia (pCIA), for which preventive interventions remain limited, can manifest with scarring. While the underlying pathomechanisms of pCIA are unclear, depletion of epithelial hair follicle (HF) stem cells (eHFSCs) is likely to play a role. OBJECTIVES To explore the hypothesis that eHFSCs undergo pathological epithelial-mesenchymal transition (EMT) besides apoptosis in pCIA, thus explaining the scarring phenotype. Furthermore, we tested whether a PPARγ modulator can prevent pCIA-associated pathomechanisms. METHODS Organ-cultured human scalp HFs were treated with the cyclophosphamide metabolite, 4-hydroperoxycyclophosphamide (4-HC). Additionally, HFs were pre-treated with the agnostic PPARγ modulator, N-Acetyl-GED-0507-34-Levo (NAGED), which we had previously shown to promote K15 expression and antagonize EMT in eHFSCs. RESULTS In accordance with anticipated hair bulb cytotoxicity, dystrophy and catagen induction, 4-HC promoted apoptosis along with increased p53 expression, DNA damage and pathological EMT in keratin 15+ (K15) bulge eHFSCs, as evidenced by decreased E-cadherin expression and the appearance of fibronectin- and vimentin-positive cells in the bulge. Pre-treatment with NAGED protected from 4-HC-induced hair bulb cytotoxicity/dystrophy, and halted apoptosis, p53 up-regulation, and EMT in the bulge, thereby significantly preventing the depletion of K15+ human eHFSCs ex vivo. CONCLUSIONS A cyclophosphamide metabolite alone suffices to damage and deplete human scalp eHFSCs by promoting apoptosis, DNA damage, and EMT ex vivo. Therefore, pCIA-therapeutic strategies need to target these pathological processes. Our data introduce the stimulation of PPARγ signaling as a novel intervention strategy for the prevention of pCIA, given the ability of NAGED to prevent chemotherapy-induced eHFSCs damage ex vivo.
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Affiliation(s)
- I Piccini
- Monasterium Laboratory, Münster, Germany
| | - L Brunken
- Monasterium Laboratory, Münster, Germany
| | - J Chéret
- Monasterium Laboratory, Münster, Germany.,Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - S Ghatak
- Monasterium Laboratory, Münster, Germany
| | - Y Ramot
- Department of Dermatology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - M Alam
- Monasterium Laboratory, Münster, Germany.,Universidad Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain.,Dept. of Dermatology & Venereology, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Academic Health System, Doha, Qatar
| | - T S Purba
- Centre for Dermatology Research, University of Manchester, NIHR Biomedical Research Centre, Manchester, UK
| | - J Hardman
- Centre for Dermatology Research, University of Manchester, NIHR Biomedical Research Centre, Manchester, UK.,St John's Institute of Dermatology, King's College London, London, United Kingdom
| | | | - F Jimenez
- Universidad Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain.,Mediteknia Dermatology Clinic, Las Palmas de Gran Canaria, Spain
| | - R Paus
- Monasterium Laboratory, Münster, Germany.,Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Centre for Dermatology Research, University of Manchester, NIHR Biomedical Research Centre, Manchester, UK
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Kate A, Basu S. Systemic Immunosuppression in Cornea and Ocular Surface Disorders: A Ready Reckoner for Ophthalmologists. Semin Ophthalmol 2021; 37:330-344. [PMID: 34423717 DOI: 10.1080/08820538.2021.1966059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: Many diseases of the cornea and ocular surface are manifestations of an underlying autoimmune process and require systemic immunosuppression for their management. These cases often present to a general ophthalmologist before being referred to an ocular immunologist or rheumatologist. However, the patients do need to be followed by the ophthalmologist to assess disease progression or for management of ocular co-morbidities and for taking care of ocular complications of the disease. Undeniably, there is a certain hesitance to promptly initiate them on systemic therapy because the literature regarding the indications, dosages, and side effects of this group of drugs is vast and dispersed.The aim of this review is to provide a source of ready reference for the general ophthalmologist as well as trainees and residents, on systemic immunosuppression for corneal and ocular surface disease. Methods: This review included 153 studies which were published as randomized controlled trials, systematic reviews, or as nonrandomized comparative studies (cohort or case-control series) on the topic of systemic immunosuppression in cornea and ocular surface disorders.Results: This review provides a concise summary of both the types of drugs and the common indications where they would be indicated, along with treatment and monitoring algorithms for each specific disease condition. The most used group of drugs are corticosteroids, which have significant side effects, particularly when administered systemically or for longer periods of time. To overcome this, steroid-sparing immunosuppressants are recommended. The four main classes of immunosuppressants used today are antimetabolites, T-cell inhibitors, alkylating agents and biologic agents. This review details the use of these drugs in ocular surface inflammation, including the dosing schedule, side effects and monitoring in allergic conjunctivitis, mucous membrane pemphigoid, peripheral ulcerative keratitis, immunological rejection against corneal allografts, anterior scleritis and aqueous deficiency dry eyes. Conclusions: This review provides an uncluttered and wholesome understanding of systemic immunosuppression in cornea and ocular surface diseases, with the hope that this will serve as a ready reckoner and help bridge the gap between ophthalmology and rheumatology for the betterment of our patients.
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Affiliation(s)
- Anahita Kate
- The Cornea Institute, KVC Campus, LV Prasad Eye Institute, Vijayawada, India
| | - Sayan Basu
- The Cornea Institute, KAR Campus, LV Prasad Eye Institute, Hyderabad, India.,Prof. Brien Holden Eye Research Centre (BHERC), LV Prasad Eye Institute, Hyderabad, India
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6
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Milic M, Hall M, Hawkins A, Gogbashian A, Rustin G, Sharma A. A Qualitative Analysis of the Impact of Carboplatin AUC 10 on Physical, Work Functioning and Bone Marrow Toxicity Among Seminoma Patients - A Single-centre Experience. In Vivo 2018; 33:233-237. [PMID: 30587629 DOI: 10.21873/invivo.11465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 10/26/2018] [Accepted: 11/01/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Single-agent carboplatin at area under the curve 10 (AUC10) is an effective treatment for metastatic seminoma. As far as we are aware of, there have been no studies reporting its effects on short-term quality of life. The objective was to study the efficacy, safety and tolerability, using health-related quality of life, of carboplatin AUC10 chemotherapy in patients with metastatic seminoma. PATIENTS AND METHODS Forty-four patients with metastatic seminoma treated at Mount Vernon Cancer Centre with carboplatin AUC10 were included in this study. Response to treatment was determined by radiological imaging (Response Evaluation Criteria in Solid Tumors v 1.1) and serum tumour markers. Toxicities were evaluated using the Common Terminology Criteria for Adverse Events Version 4.0. Quality of life treatment-related toxicities were assessed during treatment at pre-chemotherapy assessments. After treatment, toxicity was assessed using a defined telephone questionnaire consisting of four questions relating to hair loss, hearing impairment, days absent from work, and neuropathy. RESULTS At a median follow-up of 27.5 (range=4-84) months, no patient had experienced relapse. Grade 3/4 neutropenia was seen in 15 (35%) patients, nine (21%) required prophylactic granulocyte colony-stimulating factor, 13 (30%) patients had grade 3/4 thrombocytopenia. Commonest non-haematological toxicities were fatigue in 28 (65%) and nausea 14 (33%) patients. They were grade 1 in 82% and 92% of cases, respectively. Six out of 44 (14%) had residual tinnitus. One patient had residual grade 1 peripheral neuropathy. Ten patients continued to work throughout treatment and two patients were retired. Of the remaining patients, 16 (37%), took fewer than 5 days off work. CONCLUSION Carboplatin AUC10 is a safe and effective treatment for stage II/III seminoma with better health-related quality of life than experienced with combination cisplatin-based chemotherapy.
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Affiliation(s)
- Marina Milic
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, U.K
| | - Marcia Hall
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, U.K
| | - Annette Hawkins
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, U.K
| | - Andrew Gogbashian
- Department of Radiology, Mount Vernon Cancer Centre, Paul Strickland Scanner Centre, Northwood, U.K
| | - Gordon Rustin
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, U.K
| | - Anand Sharma
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, U.K.
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Abstract
The interaction between hair and malignancy is complicated. Various hair abnormalities can manifest in oncology patients as a clinical manifestation, the result of cancer therapy, or due to a paraneoplastic condition. The mechanisms of these changes remain unclear. Alopecia is one of the common clinical presentations occurring in oncology patients that affects their quality of life. The condition can concomitantly develop during the course of malignancy or when patients undergo cancer treatment. It is important for physicians to understand alopecia in association with malignancy as it may be an important associated finding or provide the clues to aid diagnosis. The aim of this review is to summarize the clinical characteristics of alopecia that occur in cancer patients and their relationship with the type of malignancy and its treatment.
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8
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Freites-Martinez A, Shapiro J, van den Hurk C, Goldfarb S, Jimenez JJ, Rossi AM, Paus R, Lacouture ME. Hair disorders in cancer survivors. J Am Acad Dermatol 2018; 80:1199-1213. [PMID: 29660423 DOI: 10.1016/j.jaad.2018.03.056] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/06/2018] [Accepted: 03/11/2018] [Indexed: 12/19/2022]
Abstract
With increasing survival rates across all cancers, survivors represent a growing population that is frequently affected by persistent or permanent hair growth disorders as a result of systemic therapies, radiotherapy, surgical procedures, and therapeutic transplants. These hair disorders include persistent chemotherapy-induced alopecia, persistent radiotherapy-induced alopecia, endocrine therapy-induced alopecia and hirsutism, postsurgery alopecia and localized hypertrichosis, and persistent stem cell transplantation and targeted therapy-induced alopecia. The information contained in this continuing medical education series should facilitate a better understanding on hair disorders in cancer survivors so that adequate support and therapies may be provided.
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Affiliation(s)
- Azael Freites-Martinez
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Corina van den Hurk
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Shari Goldfarb
- Breast Cancer Medicine Service, Department of Medicine, Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joaquin J Jimenez
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Anthony M Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ralf Paus
- Dermatology Research Centre, University of Manchester, and the National Institute of Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom; National Institute of Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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Fonia A, Cota C, Setterfield JF, Goldberg LJ, Fenton DA, Stefanato CM. Permanent alopecia in patients with breast cancer after taxane chemotherapy and adjuvant hormonal therapy: Clinicopathologic findings in a cohort of 10 patients. J Am Acad Dermatol 2017; 76:948-957. [DOI: 10.1016/j.jaad.2016.12.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 12/18/2022]
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10
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Bresters D, Wanders DCM, Louwerens M, Ball LM, Fiocco M, van Doorn R. Permanent diffuse alopecia after haematopoietic stem cell transplantation in childhood. Bone Marrow Transplant 2017; 52:984-988. [DOI: 10.1038/bmt.2017.15] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/28/2016] [Accepted: 01/10/2017] [Indexed: 12/12/2022]
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Millsop JW, Sharon VR, Petukhova T, Fung MA, Kiuru M. Chemotherapy reaction induced by ixabepilone, a microtubule stabilizing agent, mimicking extramammary Paget's disease in a patient with breast carcinoma. J Cutan Pathol 2016; 43:1215-1219. [PMID: 27686876 DOI: 10.1111/cup.12833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 12/31/2022]
Abstract
The histopathologic characteristics of reactions caused by the many novel anticancer agents are under-recognized. We report a case of a 67-year-old female with locally advanced metastatic breast cancer, who initially presented with an extensive reticulated erythematous patch on the trunk caused by intravascular metastases confirmed by a skin biopsy. Owing to disease progression, she was started on ixabepilone, a mitotic inhibitor. While receiving ixabepilone, another skin biopsy was obtained and initially interpreted as extramammary Paget's disease. However, the biopsy showed metaphase arrest of numerous keratinocytes in the basilar and suprabasilar epidermis. Atypical epithelial cells were only present in the intravascular spaces similar to the initial biopsy. Given the temporal association between the initiation of ixabepilone therapy and the epidermal mitotic arrest, a diagnosis of chemotherapy reaction to ixabepilone was rendered. Ixabepilone is an analog of epothilone, a microtubule stabilizer causing mitotic arrest of the cell cycle approved for the treatment of metastatic and locally advanced treatment-resistant breast cancer. The demonstration of epidermal mitotic arrest caused by ixabepilone is without precedent. The case emphasizes the importance of considering a chemotherapy reaction in the histologic differential diagnosis of epidermal mitotic arrest in a cancer patient receiving chemotherapy.
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Affiliation(s)
| | | | | | - Maxwell A Fung
- Department of Dermatology, University of California, Davis, CA, USA.,Department of Pathology, University of California, Davis, CA, USA
| | - Maija Kiuru
- Department of Dermatology, University of California, Davis, CA, USA.,Department of Pathology, University of California, Davis, CA, USA
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12
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Basilio FMA, Brenner FM, Werner B, Rastelli GJC. Clinical and histological study of permanent alopecia after bone marrow transplantation. An Bras Dermatol 2016; 90:814-21. [PMID: 26734861 PMCID: PMC4689068 DOI: 10.1590/abd1806-4841.20154013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/02/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Permanent alopecia after bone marrow transplantation is rare, but more
and more cases have been described, typically involving high doses of
chemotherapeutic agents used in the conditioning regimen for the
transplant. Busulfan, classically described in cases of irreversible
alopecia, remains associated in recent cases. The pathogenesis
involved in hair loss is not clear and there are few studies
available. In addition to chemotherapeutic agents, another factor that
has been implicated as a cause is chronic graft-versus-host disease.
However, there are no histopathological criteria for defining this
diagnosis yet. OBJECTIVE the study aims to evaluate clinical and histological aspects in cases of
permanent alopecia after bone marrow transplantation, identifying
features of permanent alopecia induced by myeloablative chemotherapy
and alopecia as a manifestation of chronic graft-versus-host
disease. METHODS data were collected from medical records of 7 patients, with description
of the clinical features and review of slides and paraffin blocks of
biopsies. RESULTS Two distinct histological patterns were found: one similar to
androgenetic alopecia, non-scarring pattern, and other similar to
lichen planopilaris, scarring alopecia. CONCLUSION The first pattern corroborates the literature cases of permanent
alopecia induced by chemotherapeutic agents, and the second is
compatible with manifestation of chronic graft-versus-host disease on
scalp, that has never been described yet. The results contribute to
the elucidation of the factors involved in these cases, including the
development of therapeutic methods
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Affiliation(s)
| | | | - Betina Werner
- Universidade Federal do Paraná, Curitiba, PR, Brazil
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13
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Cutaneous reactions to chemotherapeutic drugs and targeted therapies for cancer: part I. Conventional chemotherapeutic drugs. J Am Acad Dermatol 2014; 71:203.e1-203.e12; quiz 215-6. [PMID: 25037800 DOI: 10.1016/j.jaad.2014.04.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 04/07/2014] [Accepted: 04/09/2014] [Indexed: 02/07/2023]
Abstract
Conventional chemotherapy continues to be an important part of cancer management, but may cause various cutaneous reactions because it disturbs specific cell cycle phases. The alkylating agents cyclophosphamide, ifosfamide, and thiotepa can produce hyperpigmentation, while hypersensitivity reactions can be seen with platinum alkylating agents. Antimetabolites vary in reactions from exanthematous to bullous skin lesions. 5-fluorouracil and its derivatives and liposomal doxorubicin and daunorubicin are characteristically known to cause hand-foot syndrome, while bleomycin can cause fibrosis and flagellate dermatitis. Several hypersensitivity reactions may also occur from mitotic inhibitors and topoisomerase inhibitors. These different characteristic presentations are important to dermatologists in identifying the correct diagnosis and management for the cancer patient.
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Choi M, Kim MS, Park SY, Park GH, Jo SJ, Cho KH, Lee JW, Park KD, Shin HY, Kang HJ, Kwon O. Clinical characteristics of chemotherapy-induced alopecia in childhood. J Am Acad Dermatol 2014; 70:499-505. [DOI: 10.1016/j.jaad.2013.10.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/14/2013] [Accepted: 10/16/2013] [Indexed: 11/28/2022]
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Breed WPM, van den Hurk CJG, Peerbooms M. Presentation, impact and prevention of chemotherapy-induced hair loss: scalp cooling potentials and limitations. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.10.76] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Haider M, Hamadah I, Almutawa A. Radiation- and Chemotherapy-Induced Permanent Alopecia: Case Series. J Cutan Med Surg 2013; 17:55-61. [DOI: 10.2310/7750.2012.12033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Radiation- and chemotherapy-induced alopecia is mostly temporary. However, permanent scalp alopecia is reported, albeit infrequently. Objective: The objective of this observational case series was to determine the kind and doses of chemotherapeutic agents and radiation in inducing permanent alopecia of the scalp. Methods and Results: Eleven patients referred to our department over a period of 3 years for permanent alopecia after chemotherapy/radiotherapy or combination therapy were included. A detailed medical and therapeutic history was obtained from each patient and from medical records. Photography was done, and the scalp biopsies were taken. Patients were divided into three groups according to the type of therapy. The first group received conditioning chemotherapy prior to bone marrow transplantation. The second group had radiation for brain tumors, and the third group received both. Conclusion: A comprehensive multicenter and multidisciplinary study is required to determine the definite causative agents, doses, and other cofactors that induce permanent alopecia following chemotherapy/radiotherapy, as well as the means to avoid this distressing outcome in surviving patients.
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Affiliation(s)
- Mansoor Haider
- From the Departments of Dermatology and Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Issam Hamadah
- From the Departments of Dermatology and Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdulmonem Almutawa
- From the Departments of Dermatology and Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Kluger N, Jacot W, Frouin E, Rigau V, Poujol S, Dereure O, Guillot B, Romieu G, Bessis D. Permanent scalp alopecia related to breast cancer chemotherapy by sequential fluorouracil/epirubicin/cyclophosphamide (FEC) and docetaxel: a prospective study of 20 patients. Ann Oncol 2012; 23:2879-2884. [PMID: 22571858 DOI: 10.1093/annonc/mds095] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND To analyze the clinical and histological features of permanent alopecia following a sequential fluorouracil/epirubicin/cyclophosphamide (FEC) and docetaxel regimen for adjuvant breast cancer treatment. PATIENTS AND METHODS Women treated for breast cancer by a sequential adjuvant FEC and docetaxel regimen who developed permanent alopecia diagnosed between 2007 and 2011 were identified from the Department of Dermatology (Saint-Eloi Hospital, Montpellier, France) and the Department of Medical Oncology (CRLC Val d'Aurelle, Montpellier, France). Data were collected regarding demographics, type of cancer, delay of onset after chemotherapy, Dermatology Life Quality Index (DLQI), clinical description of the lesions, scalp biopsies, laboratory explorations investigating steroid hormonal, iron, zinc and thyroid status, therapy and outcome. RESULTS Twenty white Caucasian females were included. Hair loss presented with a moderate or intense androgenetic-like pattern of scalp alopecia. Biopsy specimen examinations were normal or displayed the androgenetic-like pattern. Laboratory explorations ruled out iron or zinc deficiency and thyroid disorders and confirmed hormonal menopause without hyperandrogenism. The overall mean DLQI score reflected the distressing psychological consequences in the patients' lives. No spontaneous regrowth of the scalp hair was noted. Treatment including vitamins, minoxidil, psoralen and ultraviolet A therapy and spironolactone proved to be ineffective. CONCLUSION Permanent and severe alopecia is a newly reported complication of the FEC 100-docetaxel breast cancer regimen.
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Affiliation(s)
- N Kluger
- University of Montpellier 1, Montpellier; Department of Dermatology, Saint-Eloi Hospital, Montpellier
| | - W Jacot
- University of Montpellier 1, Montpellier; Department of Medical Oncology, CRLC Val d'Aurelle, Montpellier
| | - E Frouin
- University of Montpellier 1, Montpellier; Department of Pathology, Hôpital Gui-de-Chauliac, Montpellier
| | - V Rigau
- University of Montpellier 1, Montpellier; Department of Pathology, Hôpital Gui-de-Chauliac, Montpellier
| | - S Poujol
- University of Montpellier 1, Montpellier; Oncopharmacology Department, CRLC Val d'Aurelle, Montpellier, France
| | - O Dereure
- University of Montpellier 1, Montpellier; Department of Dermatology, Saint-Eloi Hospital, Montpellier
| | - B Guillot
- University of Montpellier 1, Montpellier; Department of Dermatology, Saint-Eloi Hospital, Montpellier
| | - G Romieu
- University of Montpellier 1, Montpellier; Department of Medical Oncology, CRLC Val d'Aurelle, Montpellier
| | - D Bessis
- University of Montpellier 1, Montpellier; Department of Dermatology, Saint-Eloi Hospital, Montpellier.
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Chon SY, Champion RW, Geddes ER, Rashid RM. Chemotherapy-induced alopecia. J Am Acad Dermatol 2012; 67:e37-47. [DOI: 10.1016/j.jaad.2011.02.026] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 02/05/2011] [Accepted: 02/13/2011] [Indexed: 11/15/2022]
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Kinahan KE, Sharp LK, Seidel K, Leisenring W, Didwania A, Lacouture ME, Stovall M, Haryani A, Robison LL, Krull KR. Scarring, disfigurement, and quality of life in long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor study. J Clin Oncol 2012; 30:2466-74. [PMID: 22614987 DOI: 10.1200/jco.2011.39.3611] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Childhood cancer survivors are at increased risk for adverse outcomes and chronic medical conditions. Treatment-related scarring, disfigurement, and persistent hair loss, in addition to their long-term impact on psychological distress or health-related quality of life (HRQOL), have received little attention. PATIENTS AND METHODS Self-reported scarring/disfigurement and persistent hair loss were examined in 14,358 survivors and 4,023 siblings from the Childhood Cancer Survivor Study. Multivariable models were used to examine associations with demographic and cancer treatment. The impact of disfigurement and hair loss on HRQOL (ie, Medical Outcomes Short Form-36) and emotional distress (ie, Brief Symptom Inventory-18) was examined. RESULTS Survivors reported a significantly higher rate of scarring/disfigurement compared with siblings for head/neck (25.1% v 8.4%), arms/legs (18.2% v 10.2%), and chest/abdomen (38.1% v 9.1%), as well as hair loss (14.0% v 6.3%). In age-, sex-, and race-adjusted models, cranial radiation exposure ≥ 36 Gy increased risk for head/neck disfigurement (relative risk [RR], 2.42; 95% CI, 2.22 to 2.65) and hair loss (RR, 4.24; 95% CI, 3.63 to 4.95). Adjusting for cranial radiation, age, sex, race, education, and marital status, survivor hair loss increased risk of anxiety (RR, 1.60; 95% CI, 1.23 to 2.07), whereas head/neck disfigurement increased risk of depression (RR, 1.19; 95% CI, 1.01 to 1.41). Limitations due to emotional symptoms were associated with head/neck disfigurement (RR, 1.24; 95% CI, 1.10 to 1.41), arm/leg disfigurement (RR, 1.19; 95% CI, 1.05 to 1.35), and hair loss (RR, 1.26; 95% CI, 1.09 to 1.47). CONCLUSION Survivors of childhood cancer are at increased risk for disfigurement and persistent hair loss, which is associated with future emotional distress and reduced quality of life. Future studies are needed to better identify and manage functional outcomes in these patients.
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22
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Permanent Alopecia After Systemic Chemotherapy: A Clinicopathological Study of 10 Cases. Am J Dermatopathol 2011; 33:345-50. [DOI: 10.1097/dad.0b013e3181fcfc25] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Permanent chemotherapy-induced alopecia: Case report and review of the literature. J Am Acad Dermatol 2010; 63:333-6. [DOI: 10.1016/j.jaad.2009.06.063] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 06/09/2009] [Accepted: 06/16/2009] [Indexed: 12/27/2022]
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Zandvliet AS, Schellens JHM, Beijnen JH, Huitema ADR. Population Pharmacokinetics and Pharmacodynamics for Treatment Optimization??in Clinical Oncology. Clin Pharmacokinet 2008; 47:487-513. [DOI: 10.2165/00003088-200847080-00001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Machado M, Moreb JS, Khan SA. Six cases of permanent alopecia after various conditioning regimens commonly used in hematopoietic stem cell transplantation. Bone Marrow Transplant 2007; 40:979-82. [PMID: 17846605 DOI: 10.1038/sj.bmt.1705817] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Alopecia, a side effect of chemotherapy, is usually temporary and reversible. Irreversible alopecia has been reported after high-dose chemotherapy (HDC) and hematopoietic stem cell transplantation (HSCT) especially related to BuCy containing conditioning regimens; however, the overall incidence is not known. We conducted a retrospective study to identify patients with chemotherapy-induced permanent alopecia after HSCT. We describe six such patients, two males and four females, among 760 patients transplanted between 1997 and 2004. Median age was 45 years (range, 37-65). There were three Caucasians and three African-Americans. Median follow-up was 30 months. Conditioning regimens included BuCy, Bu/Cy and etoposide (VP16) (one of these patients received second autograft after Cy and TBI) and CyVP16 and TBI. Our data show that permanent alopecia is a significant long-term side effect of HSCT and can be seen across the spectrum of diseases and transplant types and with non-busulfan containing regimens. We have observed that patients usually accept permanent alopecia as the price for the cure and therefore true incidence of permanent alopecia may be underestimated. Our findings may also have medico legal and psychosocial implications that need to be taken into consideration when consenting patients for HSCT.
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Affiliation(s)
- M Machado
- Department of Medicine, University of Florida, Gainesville Florida, FL 32610, USA
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Bodó E, Tobin DJ, Kamenisch Y, Bíró T, Berneburg M, Funk W, Paus R. Dissecting the impact of chemotherapy on the human hair follicle: a pragmatic in vitro assay for studying the pathogenesis and potential management of hair follicle dystrophy. THE AMERICAN JOURNAL OF PATHOLOGY 2007; 171:1153-67. [PMID: 17823286 PMCID: PMC1988866 DOI: 10.2353/ajpath.2007.061164] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Chemotherapy-induced alopecia represents one of the major unresolved problems of clinical oncology. The underlying molecular pathogenesis in humans is virtually unknown because of the lack of adequate research models. Therefore, we have explored whether microdissected, organ-cultured, human scalp hair follicles (HFs) in anagen VI can be exploited for dissecting and manipulating the impact of chemotherapy on human HFs. Here, we show that these organ-cultured HFs respond to a key cyclophosphamide metabolite, 4-hydroperoxycyclophosphamide (4-HC), in a manner that resembles chemotherapy-induced HF dystrophy as it occurs in vivo: namely, 4-HC induced melanin clumping and melanin incontinence, down-regulated keratinocyte proliferation, massively up-regulated apoptosis of hair matrix keratinocytes, prematurely induced catagen, and up-regulated p53. In addition, 4-HC induced DNA oxidation and the mitochondrial DNA common deletion. The organ culture system facilitated the identification of new molecular targets for chemotherapy-induced HF damage by microarray technology (eg, interleukin-8, fibroblast growth factor-18, and glypican 6). It was also used to explore candidate chemotherapy protectants, for which we used the cytoprotective cytokine keratinocyte growth factor as exemplary pilot agent. Thus, this novel system serves as a powerful yet pragmatic tool for dissecting and manipulating the impact of chemotherapy on the human HF.
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Affiliation(s)
- Eniko Bodó
- Department of Dermatology, University Hospital Schleswig-Holstein, University of Lübeck, D-23538 Lübeck, Ratzeburger Allee 160, Germany.
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de Jonge ME, Huitema ADR, Rodenhuis S, Beijnen JH. Sparse Sampling Design for Therapeutic Drug Monitoring of Sequentially Administered Cyclophosphamide, Thiotepa, and Carboplatin (CTC). Ther Drug Monit 2005; 27:393-402. [PMID: 15905813 DOI: 10.1097/01.ftd.0000158081.38330.5e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The alkylating agents cyclophosphamide, thiotepa, and carboplatin (CTC) are administered simultaneously in high-dose chemotherapy regimens. This regimen is sometimes complicated by severe organ toxicities, which may be caused by interindividual variability in the pharmacokinetics of the agents. Monitoring plasma levels and adapting doses may reduce variability in exposure to the compounds and their metabolites. The aim of this study was to develop and validate a sparse sampling design for routine dose individualization of cyclophosphamide, thiotepa, and carboplatin both during and between courses in the CTC regimen. Models describing the population pharmacokinetics of the prodrug cyclophosphamide (4000 or 6000 mg/m) and its activated metabolite 4-hydroxycylophosphamide, thiotepa (320 or 480 mg/m), and its equipotent metabolite tepa, and carboplatin (1067 or 1600 mg/m) in the 4-day CTC regimen have been developed previously using the program NONMEM. Based on these models, plasma concentrations were calculated in 20 groups of 50 simulated patients in each group during multiple courses of therapy, and the exposure, expressed as area under the plasma concentration-versus-time curve (AUC), was calculated. Subsequently, individual model-predicted AUCs were calculated for all courses, based on selected simulated plasma concentrations during the first course of therapy. Strategies were compared by assessment of their predictive performance of the AUC and their applicability in clinical practice. Withdrawal of 3 samples on the first day of the course at 190, 290, and 400 minutes after start of cyclophosphamide infusion resulted in unbiased and precise first course AUC predictions of 4-hydroxycylophosphamide, thiotepa and tepa, and carboplatin (precision [root mean squared relative prediction error, %RMSE] 20%, 16%, 8.8%, respectively). Applying this same strategy at day 3 (or 4) of the course, with an additional sample at 600 minutes on both days, resulted in unbiased and precise predictions of the AUC of a following course (%RMSE 21%, 18%, 17%, respectively). Prospective validation of the strategies in 23 additional patients yielded comparable results. It can be concluded that a good and useful sparse sampling design was developed for precise and accurate estimation of the AUCs of 4-hydroxycyclophosphamide, thiotepa and tepa, and carboplatin in the CTC regimen. This method is valuable in pharmacokinetically guided dose adaptation both during and between CTC courses.
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Affiliation(s)
- Milly E de Jonge
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute/Slotervaart Hospital, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands.
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