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Nakasone ES, Bustillos HC, Gui X, Konnick EQ, Sham JG, Cohen SA. Multidisciplinary Approach for the Management of Metastatic Poorly Differentiated Neuroendocrine Carcinoma of the Pancreas: A Case Report of an Exceptional Responder. Pancreas 2024; 53:e487-e491. [PMID: 38460151 DOI: 10.1097/mpa.0000000000002322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
ABSTRACT Poorly differentiated pancreatic neuroendocrine carcinomas (pNECs) are rare, highly aggressive neoplasms. Frequently metastatic at diagnosis, prognosis is poor with median overall survival estimated to be less than 1 year. Although multidisciplinary management, including systemic medications and locoregional therapies aimed at reducing and preventing symptoms caused by mass effect, is the mainstay of treatment for patients with metastatic well-differentiated pancreatic neuroendocrine tumors, rapid progression, organ dysfunction, and poor performance status often preclude initiation of even single-modality palliative chemotherapy for patients with metastatic pNEC, limiting the use of and recommendation for multidisciplinary management.We describe the case of a 51-year-old male patient diagnosed with pNEC metastatic to liver and lymph nodes presenting with impending cholestatic liver failure for whom we were able to successfully initiate and dose-escalate cytotoxic chemotherapy with excellent radiographic response. After multidisciplinary review of his case, the patient underwent pancreaticoduodenectomy and hepatic wedge biopsies, with pathology demonstrating a pathologic complete response to chemotherapy in both the pancreas and liver. Surveillance scans at 2 years from initial diagnosis and 1 year from surgery remain without evidence of locoregional or distant recurrence, highlighting the importance and utility of multidisciplinary management in select cases.
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Affiliation(s)
| | - Hannah C Bustillos
- Clinical Pharmacy, University of Washington/Fred Hutchinson Cancer Center
| | - Xianyong Gui
- Departments of Laboratory Medicine and Pathology
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Carobeli LR, Santos ABC, Martins LBM, Damke E, Consolaro MEL. Recent advances in photodynamic therapy combined with chemotherapy for cervical cancer: a systematic review. Expert Rev Anticancer Ther 2024; 24:263-282. [PMID: 38549400 DOI: 10.1080/14737140.2024.2337259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Despite the evidence that photodynamic therapy (PDT) associated with chemotherapy presents great potential to overcome the limitations of monotherapy, little is known about the current status of this combination against cervical cancer. This systematic review aimed to address the currently available advances in combining PDT and chemotherapy in different research models and clinical trials of cervical cancer. METHODS We conducted a systematic review based on PRISMA Statement and Open Science Framework review protocol using PubMed, Web of Science, Embase, Scopus, LILACS, and Cochrane databases. We selected original articles focusing on 'Uterine Cervical Neoplasms' and 'Photochemotherapy and Chemotherapy' published in the last 10 years. The risk of bias in the studies was assessed using the CONSORT and SYRCLE tools. RESULTS Twenty-three original articles were included, focusing on HeLa cells, derived from endocervical adenocarcinoma and on combinations of several chemotherapeutics. Most of the combinations used modern drug delivery systems for improved simultaneous delivery and presented promising results with increased cytotoxicity compared to monotherapy. CONCLUSION Despite the scarcity of animal studies and the absence of clinical studies, the combination of chemotherapy with PDT presents a potential option for cervical cancer therapy requiring additional studies. OSF REGISTRATION https://doi.org/10.17605/OSF.IO/WPHN5 [Figure: see text].
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Affiliation(s)
- Lucimara Rodrigues Carobeli
- Department of Clinical Analysis and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
- Graduate Program in Biosciences and Physiopathology, State University of Maringá, Maringá, Paraná, Brazil
| | - Ana Beatriz Camillo Santos
- Department of Clinical Analysis and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
- Graduate Program in Biosciences and Physiopathology, State University of Maringá, Maringá, Paraná, Brazil
| | | | - Edilson Damke
- Department of Clinical Analysis and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Marcia Edilaine Lopes Consolaro
- Department of Clinical Analysis and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
- Graduate Program in Biosciences and Physiopathology, State University of Maringá, Maringá, Paraná, Brazil
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3
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Wu X, Zhou L, Li Z, Rong K, Gao S, Chen Y, Zuo J, Tang W. Arylacryl amides: Design, synthesis and the protection against cisplatin-induced acute kidney injury via TLR4/STING/NF-κB pathway. Bioorg Chem 2024; 146:107303. [PMID: 38521012 DOI: 10.1016/j.bioorg.2024.107303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 03/25/2024]
Abstract
Arylpropionic ester scaffold was found as anti-inflammatory agents for the treatment and prevention of acute kidney injury (AKI). To further study the structure-activity relationship (SAR) of this scaffold, a series of acryl amides were designed, synthesized, and evaluated their anti-inflammation. Of these, compound 9d displayed the protective effect on renal tubular epithelial cells to significantly enhance the survival rate through inhibiting NF-κB phosphorylation and promoting cell proliferation in cisplatin-induced HK2 cells. Furthermore, 9d can interact with TLR4 to inhibit TLR4/STING/NF-κB pathway in the RAW264.7 cell. In vivo AKI mice model, 9d significantly downregulated the level of serum creatinine (Scr), blood urea nitrogen (BUN) and the inflammatory factors (IL-1β, IL-6, TNF-α) to improve kidney function. Morphological and KIM-1 analyses showed that 9d alleviated cisplatin-induced tubular damage. In a word, 9d was a promising lead compound for preventive and therapeutic of AKI.
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Affiliation(s)
- Xiaoming Wu
- School of Pharmacy, Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei 230032, China
| | - Long Zhou
- School of Pharmacy, Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei 230032, China
| | - Ziyun Li
- School of Pharmacy, Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei 230032, China
| | - Kuanrong Rong
- School of Pharmacy, Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei 230032, China
| | - Shan Gao
- School of Pharmacy, Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei 230032, China
| | - Yun Chen
- School of Pharmacy, Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei 230032, China
| | - Jiawei Zuo
- Department of Pharmacy, The Second Affiliated Hospital of Anhui Medical University, Hefei 230011, China.
| | - Wenjian Tang
- School of Pharmacy, Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei 230032, China.
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Tsurui T, Hirasawa Y, Kubota Y, Yoshimura K, Tsunoda T. Anti-EGFR antibody monotherapy for colorectal cancer with severe hyperbilirubinemia: A case report. World J Gastrointest Oncol 2024; 16:557-562. [PMID: 38425406 PMCID: PMC10900148 DOI: 10.4251/wjgo.v16.i2.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/13/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Hyperbilirubinemia with hepatic metastases is a common complication and a poor prognostic factor for colorectal cancer (CRC). Effective drainage is often impossible before initiating systemic chemotherapy, owing to the liver's diffuse metastatic involvement. Moreover, an appropriate chemotherapeutic approach for the treatment of hyperbilirubinemia is currently unavailable. CASE SUMMARY The patient, a man in his 50s, presented with progressive fatigue and severe jaundice. Computed tomography revealed multiple hepatic masses with thickened walls in the sigmoid colon, which was pathologically confirmed as a well-differentiated adenocarcinoma. No RAS or BRAF mutations were detected. The Eastern Cooperative Oncology Group (ECOG) performance status (PS) score was 2. Biliary drainage was impossible due to the absence of a dilated bile duct, and panitumumab monotherapy was promptly initiated. Subsequently, the bilirubin level decreased and then normalized, and the patient's PS improved to zero ECOG score after four cycles of therapy without significant adverse events. CONCLUSION Anti-EGFR antibody monotherapy is a safe and effective treatment for RAS wild-type CRC and hepatic metastases with severe hyperbilirubinemia.
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Affiliation(s)
- Toshiaki Tsurui
- Department of Medical Oncology, Showa University, Tokyo 1428555, Japan
| | - Yuya Hirasawa
- Department of Medical Oncology, Showa University, Tokyo 1428555, Japan
| | - Yutaro Kubota
- Department of Medical Oncology, Showa University, Tokyo 1428555, Japan
| | - Kiyoshi Yoshimura
- Department of Medical Oncology, Showa University, Tokyo 1428555, Japan
- Department of Clinical Immuno Oncology, Clinical Research Institute of Clinical Pharmacology and Therapeutics, Showa University, Tokyo 1578577, Japan
| | - Takuya Tsunoda
- Department of Medical Oncology, Showa University, Tokyo 1428555, Japan
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Yang H, Lin M, Liu M, Gu H, Li D, Shi Y, Hou X. Evaluate the value of prolonging the duration of tiopronin for injection administration in preventing hepatotoxicity. Sci Rep 2024; 14:3674. [PMID: 38351216 PMCID: PMC10864266 DOI: 10.1038/s41598-024-54314-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/11/2024] [Indexed: 02/16/2024] Open
Abstract
As part of supportive therapy, prophylaxis with tiopronin for injection (TI) against common hepatotoxicity complications has often been used. However, methods to prevent hepatotoxicity have not been established. Therefore, our study was aimed to find out the relationship between the periods of TI prophylaxis and post-treatment hepatotoxicity, and evaluated the value of prolonging the duration of TI administration in preventing hepatotoxicity. Hepatotoxicity was detected through liver transaminases, bilirubin, alkaline phosphatase, and clinical features of liver insufficiency. Multivariable logistic regressions were conducted to examine the association of the periods of TI prophylaxis and post-treatment hepatotoxicity. Between January 2022 and March 2023, a total of 452 patients with gynecological cancer were enrolled in the study, of which 93 (20.58%) participants were post-treatment hepatotoxicity positive. TI with different prevention days were no significant difference among participants with or without post-treatment hepatotoxicity in crude model (P > 0.05). The P-value, the odds ratios (OR) and 95% confidence intervals (CI) of participants with TI prophylaxis for 1 day for post-treatment hepatotoxicity were 0.040, 3.534 (1.061-11.765) in fully adjusted model. Past history of hepatotoxicity is a confounding variable, and there was no significant difference for post-treatment hepatotoxicity when stratified by past history of hepatotoxicity (P > 0.05). The study indicate that the periods of TI prophylaxis is not associated with post-treatment hepatotoxicity, suggesting that prolonged the periods of TI prophylaxis might be an invalid method for the prevention of post-treatment hepatotoxicity.
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Affiliation(s)
- Hongye Yang
- Department of Pharmacy, The Affiliated Anyang Tumor Hospital of Henan University of Science and Technology, Huanbin North Road, Anyang City, 455000, Henan Province, China.
| | - Mingzhu Lin
- Department of Pharmacy, The Affiliated Anyang Tumor Hospital of Henan University of Science and Technology, Huanbin North Road, Anyang City, 455000, Henan Province, China
| | - Mengxing Liu
- Department of Pharmacy, The Affiliated Anyang Tumor Hospital of Henan University of Science and Technology, Huanbin North Road, Anyang City, 455000, Henan Province, China
| | - Huawei Gu
- Department of Pharmacy, The Affiliated Anyang Tumor Hospital of Henan University of Science and Technology, Huanbin North Road, Anyang City, 455000, Henan Province, China
| | - Dan Li
- Department of Pharmacy, The Affiliated Anyang Tumor Hospital of Henan University of Science and Technology, Huanbin North Road, Anyang City, 455000, Henan Province, China
| | - Yu Shi
- Department of Pharmacy, The Affiliated Anyang Tumor Hospital of Henan University of Science and Technology, Huanbin North Road, Anyang City, 455000, Henan Province, China
| | - Xidong Hou
- Department of Pharmacy, The Affiliated Anyang Tumor Hospital of Henan University of Science and Technology, Huanbin North Road, Anyang City, 455000, Henan Province, China
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D'Angelo CR. Diagnostic, Pathologic, and Therapeutic Considerations for Primary CNS Lymphoma. JCO Oncol Pract 2024; 20:195-202. [PMID: 37967301 DOI: 10.1200/op.23.00294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 11/17/2023] Open
Abstract
Primary CNS lymphoma (PCNSL) is a rare lymphoma representing 3% of CNS malignancies. The diagnosis is complicated by the unique risks associated with brain biopsy, and the treatment is similarly complicated by the restriction of effective therapeutics able to cross the blood-brain barrier. Currently, the majority of individuals diagnosed with this disease are immunocompetent although immune deficiency related to HIV or immunosuppressive therapy remains an important risk factor. Improvements in both frontline therapy and consolidation options, including the use of hematopoietic stem-cell transplantation, have translated to improved survival. Unfortunately, patients experiencing relapsed or refractory disease often fare poorly. Here, we review key clinical, pathologic, and therapeutic aspects of PCNSL and highlight challenging clinical scenarios that may be encountered by the treating oncologist.
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Heinly B, Allenzara A, Helm M, Foulke GT. Cutaneous Lupus Erythematosus: Review and Considerations for Older Populations. Drugs Aging 2024; 41:31-43. [PMID: 37991658 DOI: 10.1007/s40266-023-01079-5] [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: 10/09/2023] [Indexed: 11/23/2023]
Abstract
Though more common earlier in life, increasing attention is being focused on the development of cutaneous lupus erythematosus (CLE) in patients with advancing age. Studies show that CLE is more common in older populations than previously thought, and all CLE subtypes are possible in this group. Just like patients in the third or fourth decade of life, CLE may appear alongside or independent of systemic lupus erythematosus. Older populations manifesting CLE for the first time seem to have a lower risk of progression to systemic disease than younger peers, and are more commonly White. CLE must be carefully distinguished from other skin conditions that have a predilection for presentation in older populations, including rosacea, lichen planus, and other autoimmune conditions such as dermatomyositis or pemphigus/pemphigoid. It is thought that most CLE in older populations is drug-induced, with drug-induced subacute cutaneous lupus erythematosus being the most common subtype. Management of CLE in older patients focuses on eliminating unnecessary medications known to induce CLE, and otherwise treatment proceeds similarly to that in younger patients, with a few special considerations.
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Affiliation(s)
| | - Astia Allenzara
- Division of Rheumatology, Allergy and Immunology and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew Helm
- Department of Dermatology, Penn State College of Medicine, Hershey, PA, USA
| | - Galen T Foulke
- Department of Dermatology, Penn State College of Medicine, Hershey, PA, USA.
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
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Wang B, Zhang S, Shen ZT, Hou T, Zhao YH, Huang MS, Li J, Chen H, Hu PH, Luo ZJ, Yuan S, Wang FM, Li W, Shu C, Xia XH, Ding Y. Core-Shell Reactor Partitioning Enzyme and Prodrug by ZIF-8 for NADPH-Sensitive In Situ Prodrug Activation. Angew Chem Int Ed Engl 2023; 62:e202314025. [PMID: 37881154 DOI: 10.1002/anie.202314025] [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: 09/19/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 10/27/2023]
Abstract
Enzyme-prodrug therapies have shown unique advantages in efficiency, selectivity, and specificity of in vivo prodrug activation. However, precise spatiotemporal control of both the enzyme and its substrate at the target site, preservation of enzyme activity, and in situ substrate depletion due to low prodrug delivery efficiency continue to be great challenges. Here, we propose a novel core-shell reactor partitioning enzyme and prodrug by ZIF-8, which integrates an enzyme with its substrate and increases the drug loading capacity (DLC) using a prodrug as the building ligand to form a Zn-prodrug shell. Cytochrome P450 (CYP450) is immobilized in ZIF-8, and the antitumor drug dacarbazine (DTIC) is coordinated and deposited in its outer layer with a high DLC of 43.6±0.8 %. With this configuration, a much higher prodrug conversion efficiency of CYP450 (36.5±1.5 %) and lower IC50 value (26.3±2.6 μg/mL) are measured for B16-F10 cells with a higher NADPH concentration than those of L02 cells and HUVECs. With the tumor targeting ability of hyaluronic acid, this core-shell enzyme reactor shows a high tumor suppression rate of 96.6±1.9 % and provides a simple and versatile strategy for enabling in vivo biocatalysis to be more efficient, selective, and safer.
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Affiliation(s)
- Bo Wang
- Key Laboratory of Drug Quality Control and Pharmacovigilance, Ministry of Education, China Pharmaceutical University, Nanjing, 210009, China
| | - Sheng Zhang
- Key Laboratory of Drug Quality Control and Pharmacovigilance, Ministry of Education, China Pharmaceutical University, Nanjing, 210009, China
| | - Zi-Tao Shen
- Key Laboratory of Drug Quality Control and Pharmacovigilance, Ministry of Education, China Pharmaceutical University, Nanjing, 210009, China
| | - Ting Hou
- Key Laboratory of Drug Quality Control and Pharmacovigilance, Ministry of Education, China Pharmaceutical University, Nanjing, 210009, China
| | - Yi-Han Zhao
- Key Laboratory of Drug Quality Control and Pharmacovigilance, Ministry of Education, China Pharmaceutical University, Nanjing, 210009, China
| | - Meng-Sheng Huang
- Department of Biochemistry, School of Life Science and Technology, China Pharmaceutical University, Nanjing, 210009, China
| | - Jian Li
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing, 210023, China
| | - Huan Chen
- Department of Biochemistry, School of Life Science and Technology, China Pharmaceutical University, Nanjing, 210009, China
| | - Peng-Hui Hu
- Key Laboratory of Drug Quality Control and Pharmacovigilance, Ministry of Education, China Pharmaceutical University, Nanjing, 210009, China
| | - Zi-Jiang Luo
- Key Laboratory of Drug Quality Control and Pharmacovigilance, Ministry of Education, China Pharmaceutical University, Nanjing, 210009, China
| | - Shuai Yuan
- State Key Laboratory of Coordination Chemistry, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing, 210023, China
| | - Feng-Min Wang
- Key Laboratory of Mesoscopic Chemistry of Ministry of Education, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing, 210023, China
| | - Wei Li
- Key Laboratory of Mesoscopic Chemistry of Ministry of Education, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing, 210023, China
| | - Chang Shu
- Key Laboratory of Drug Quality Control and Pharmacovigilance, Ministry of Education, China Pharmaceutical University, Nanjing, 210009, China
| | - Xing-Hua Xia
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing, 210023, China
| | - Ya Ding
- Key Laboratory of Drug Quality Control and Pharmacovigilance, Ministry of Education, China Pharmaceutical University, Nanjing, 210009, China
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Jali AM, Alam MF, Hanbashi A, Mawkili W, Abdlasaed BM, Alshahrani S, Qahl AM, Alrashah ASS, Shahi HA. Sesamin's Therapeutic Actions on Cyclophosphamide-Induced Hepatotoxicity, Molecular Mechanisms, and Histopathological Characteristics. Biomedicines 2023; 11:3238. [PMID: 38137459 PMCID: PMC10741447 DOI: 10.3390/biomedicines11123238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
Cyclophosphamide, an alkylating agent integral to specific cancer chemotherapy protocols, is often curtailed in application owing to its significant hepatotoxic side effects. Therefore, this study was conducted to assess the hepatoprotective potential of sesamin, a plant-originated antioxidant, using rat models. The rats were divided into five groups: a control group received only the vehicle for six days; a cyclophosphamide group received an intraperitoneal (i.p.) single injection of cyclophosphamide (150 mg/kg) on day four; a sesamin group received a daily high oral dose (20 mg/kg) of sesamin for six days; and two groups were pretreated with oral sesamin (10 and 20 mg/kg daily from day one to day six) followed by an i.p. injection of cyclophosphamide on day four. The final and last sesamin dose was administered 24 h before euthanasia. At the end of the experiment, blood and liver tissue were collected for biochemical and histopathological assessments. The results indicated significantly increased liver markers (AST, ALT, ALP, and BIL), cytokines (TNFα and IL-1β), caspase-3, and malondialdehyde (MDA) in the cyclophosphamide group as compared to the normal control. Additionally, there was a significant decline in antioxidants (GSH) and antioxidant enzymes (CAT and SOD), but the sesamin treatment reduced liver marker enzymes, cytokines, and caspase-3 and improved antioxidants and antioxidant enzymes. Thus, sesamin effectively countered these alterations and helped to normalize the histopathological alterations. In conclusion, sesamin demonstrated the potential for attenuating cyclophosphamide-induced hepatotoxicity by modulating cytokine networks, apoptotic pathways, and oxidative stress, suggesting its potential role as an adjunct in chemotherapy to reduce hepatotoxicity.
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Affiliation(s)
- Abdulmajeed M. Jali
- Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia; (A.M.J.); (A.H.); (W.M.); (S.A.); (A.M.Q.); (A.S.S.A.); (H.A.S.)
| | - Mohammad Firoz Alam
- Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia; (A.M.J.); (A.H.); (W.M.); (S.A.); (A.M.Q.); (A.S.S.A.); (H.A.S.)
| | - Ali Hanbashi
- Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia; (A.M.J.); (A.H.); (W.M.); (S.A.); (A.M.Q.); (A.S.S.A.); (H.A.S.)
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford OX1 3QT, UK
| | - Wedad Mawkili
- Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia; (A.M.J.); (A.H.); (W.M.); (S.A.); (A.M.Q.); (A.S.S.A.); (H.A.S.)
| | - Basher M. Abdlasaed
- Department of Biology, Faculty of Education, Alasmaray Islamic University, Zliten 218521, Libya;
| | - Saeed Alshahrani
- Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia; (A.M.J.); (A.H.); (W.M.); (S.A.); (A.M.Q.); (A.S.S.A.); (H.A.S.)
| | - Abdullah M. Qahl
- Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia; (A.M.J.); (A.H.); (W.M.); (S.A.); (A.M.Q.); (A.S.S.A.); (H.A.S.)
- Pharmacy Department, Jazan University Hospital, Jazan University, Jazan 45142, Saudi Arabia
| | - Ahmad S. S. Alrashah
- Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia; (A.M.J.); (A.H.); (W.M.); (S.A.); (A.M.Q.); (A.S.S.A.); (H.A.S.)
- Pharmacy Administration, Ministry of Health, Health Affairs General Directorate, Najran 66251, Saudi Arabia
| | - Hamad Al Shahi
- Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia; (A.M.J.); (A.H.); (W.M.); (S.A.); (A.M.Q.); (A.S.S.A.); (H.A.S.)
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Cornman HL, Deng J, Kambala A, Parthasarathy V, Reddy SV, Kwatra SG. Clinical utility of peripheral blood laboratory testing in the diagnostic workup of prurigo nodularis: A multicenter cohort study. JAAD Int 2023; 13:74-82. [PMID: 37711338 PMCID: PMC10497789 DOI: 10.1016/j.jdin.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/16/2023] Open
Abstract
Background Prurigo nodularis (PN) is a chronic inflammatory skin disease associated with several systemic comorbidities. However, there is lack of evidence supporting specific laboratory testing in the diagnostic workup of PN patients. Objective To characterize the frequency and severity of clinical laboratory abnormalities in PN patients compared to controls. Methods Cross-sectional study of adult patients between October, 2015 and August, 2021 using TriNetX, a global health records database encompassing over 74 million patients. Results A total of 12,157 PN patients were matched to 12,157 controls. Significantly, greater proportions of PN patients had moderate-to-severely decreased hemoglobin, elevated transaminases, decreased albumin, increased bilirubin, increased serum creatinine, decreased estimated glomerular filtration rate, higher hemoglobin A1c levels, and alterations in thyroid stimulating hormone. Limitations Our data identifies associated laboratory abnormalities in PN patients but is unable to support a causal relationship. Conclusion PN patients are more likely to have laboratory abnormalities on renal, hepatic, hematologic, endocrine, and metabolic laboratory testing, demonstrating a role for systemic testing in the diagnostic workup of PN patients.
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Affiliation(s)
- Hannah L. Cornman
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Junwen Deng
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anusha Kambala
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Varsha Parthasarathy
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sriya V. Reddy
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Datta S, Aggarwal D, Sehrawat N, Yadav M, Sharma V, Sharma A, Zghair AN, Dhama K, Sharma A, Kumar V, Sharma AK, Wang H. Hepatoprotective effects of natural drugs: Current trends, scope, relevance and future perspectives. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 121:155100. [PMID: 37801892 DOI: 10.1016/j.phymed.2023.155100] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/02/2023] [Accepted: 09/17/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND The liver is a well-known player in the metabolism and removal of drugs. Drug metabolizing enzymes in the liver detoxify drugs and xenobiotics, ultimately leading to the acquisition of homeostasis. However, liver toxicity and cell damage are not only related to the nature and dosage of a particular drug but are also influenced by other factors such as aging, immune status, environmental contaminants, microbial metabolites, gender, obesity, and expression of individual genes Furthermore, factors such as drugs, alcohol, and environmental contaminants could induce oxidative stress, thereby impairing the regenerative potential of the liver and causing several diseases. Persons suffering from other ailments and those with comorbidities are found to be more prone to drug-induced toxicities. Moreover, drug composition and drug-drug interactions could further aggravate the risk of drug-induced hepatotoxicity. A plethora of mechanisms are responsible for initiating liver cell damage and further aggravating liver cell injury, followed by impairment of homeostasis, ultimately leading to the generation of reactive oxygen species, immune-suppression, and oxidative stress. OBJECTIVE To summarize the potential of phytochemicals and natural bioactive compounds to treat hepatotoxicity and other liver diseases. STUDY DESIGN A deductive qualitative content analysis approach was employed to assess the overall outcomes of the research and review articles pertaining to hepatoprotection induced by natural drugs, along with analysis of the interventions. METHODS An extensive literature search of bibliographic databases, including Web of Science, PUBMED, SCOPUS, GOOGLE SCHOLAR, etc., was carried out to understand the role of hepatoprotective effects of natural drugs. RESULTS Bioactive natural products, including curcumin, resveratrol, etc., have been seen as neutralizing agents against the side effects induced by the drugs. Moreover, these natural products are dietary and are readily available; thus, could be supplemented along with drugs to reduce toxicity to cells. Probiotics, prebiotics, and synbiotics have shown promise of improving overall liver functioning, and these should be evaluated more extensively for their hepatoprotective potential. Therefore, selecting an appropriate natural product or a bioactive compound that is free of toxicity and offers a reliable solution for drug-induced liver toxicity is quintessential. CONCLUSIONS The current review highlights the role of natural bioactive products in neutralizing drug-induced hepatotoxicity. Efforts have been made to delineate the possible underlying mechanism associated with the neutralization process.
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Affiliation(s)
- Sonal Datta
- Department of Bio-Sciences and Technology, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana 133207, India
| | - Diwakar Aggarwal
- Department of Bio-Sciences and Technology, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana 133207, India
| | - Nirmala Sehrawat
- Department of Bio-Sciences and Technology, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana 133207, India
| | - Mukesh Yadav
- Department of Bio-Sciences and Technology, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana 133207, India
| | - Varruchi Sharma
- Department of Biotechnology & Bioinformatics, Sri Guru Gobind Singh College, Chandigarh 160019, India
| | - Ajay Sharma
- Department of Chemistry, Career Point University, Tikker - Kharwarian, Hamirpur, Himachal Pradesh 176041, India
| | - Abdulrazzaq N Zghair
- College of Health and Medical Techniques, Middle Technical University, Baghdad, Iraq
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, UP, India
| | - Aanchal Sharma
- University Centre for Research and Development, University Institute of Biotechnology Chandigarh University, Gharuan, Mohali, India
| | - Vikas Kumar
- Department of Bio-Sciences and Technology, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana 133207, India
| | - Anil K Sharma
- Department of Biotechnology, Amity University, Sector-82-A, IT City Road, Mohali, Punjab 140306, India.
| | - Hailian Wang
- Institute of Organ Transplantation, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
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Gao X, Wang B, Huang Y, Wu M, Li Y, Li Y, Zhu X, Wu M. Role of the Nrf2 Signaling Pathway in Ovarian Aging: Potential Mechanism and Protective Strategies. Int J Mol Sci 2023; 24:13327. [PMID: 37686132 PMCID: PMC10488162 DOI: 10.3390/ijms241713327] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
The ovary holds a significant role as a reproductive endocrine organ in women, and its aging process bears implications such as menopause, decreased fertility, and long-term health risks including osteoporosis, cardiovascular disorders, and cognitive decline. The phenomenon of oxidative stress is tightly linked to the aging metabolic processes. More and more studies have demonstrated that oxidative stress impacts both physiologic and pathologic ovarian aging, and the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway plays a crucial role in regulating the antioxidant response. Furthermore, various therapeutic approaches have been identified to ameliorate ovarian aging by modulating the Nrf2 pathway. This review summarizes the important role of the Nrf2/ Kelch-like ECH-associated protein 1 (Keap1) signaling pathway in regulating oxidative stress and influencing ovarian aging. Additionally, it highlights the therapeutic strategies aimed at targeting the Nrf2/Keap1 pathway.
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Affiliation(s)
- Xiaofan Gao
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (X.G.); (B.W.); (Y.H.); (M.W.); (Y.L.); (Y.L.); (X.Z.)
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan 430030, China
| | - Bo Wang
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (X.G.); (B.W.); (Y.H.); (M.W.); (Y.L.); (Y.L.); (X.Z.)
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan 430030, China
| | - Yibao Huang
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (X.G.); (B.W.); (Y.H.); (M.W.); (Y.L.); (Y.L.); (X.Z.)
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan 430030, China
| | - Meng Wu
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (X.G.); (B.W.); (Y.H.); (M.W.); (Y.L.); (Y.L.); (X.Z.)
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan 430030, China
| | - Yuting Li
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (X.G.); (B.W.); (Y.H.); (M.W.); (Y.L.); (Y.L.); (X.Z.)
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan 430030, China
| | - Yinuo Li
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (X.G.); (B.W.); (Y.H.); (M.W.); (Y.L.); (Y.L.); (X.Z.)
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan 430030, China
| | - Xiaoran Zhu
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (X.G.); (B.W.); (Y.H.); (M.W.); (Y.L.); (Y.L.); (X.Z.)
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan 430030, China
| | - Mingfu Wu
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (X.G.); (B.W.); (Y.H.); (M.W.); (Y.L.); (Y.L.); (X.Z.)
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan 430030, China
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Song A, Ding T, Wei N, Yang J, Ma M, Zheng S, Jin H. Schisandrin B induces HepG2 cells pyroptosis by activating NK cells mediated anti-tumor immunity. Toxicol Appl Pharmacol 2023; 472:116574. [PMID: 37271225 DOI: 10.1016/j.taap.2023.116574] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/07/2023] [Accepted: 05/29/2023] [Indexed: 06/06/2023]
Abstract
Pyroptosis, an inflammatory programmed cell death, has been suggested as a novel molecular mechanism for the treatment of hepatocellular carcinoma (HCC) with chemotherapeutic agents. Recent studies showed that natural killer (NK) cells could inhibit apoptosis and regulate the progression of pyroptosis in tumor cells. Schisandrin B (Sch B), a lignan isolated from Schisandrae chinensis (Turcz.) Baill. (Schisandraceae) Fructus, has various pharmacological activities including anti-cancer effects. The purpose of this study was to investigate the effect of NK cells on Sch B's regulation of pyroptosis in HCC cells and the molecular mechanisms implicated. The results showed that Sch B alone could decrease cell viability and induce apoptosis in HepG2 cells. However, Sch B induced apoptosis in HepG2 cells was transformed into pyroptosis in the presence of NK cells. The mechanisms underlying NK cell's effect on pyroptosis in Sch B-treated HepG2 cells was related to its activation of caspase 3-Gasdermin E (GSDME). Further studies revealed that NK cell induced caspase 3 activation was derived from its activation of perforin-granzyme B pathway. This study explored the effect of Sch B and NK cells on pyroptosis in HepG2 cells and revealed that perforin-granzyme B-caspase 3-GSDME pathway is involved in the process of pyroptosis. These results proposed an immunomodulatory mechanism of Sch B on HepG2 cells pyroptosis and suggested Sch B as a promising immunotherapy combination partner for the treatment of HCC.
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Affiliation(s)
- Anping Song
- Department of Pharmacology, School of Pharmacy, Wannan Medical College, Wuhu, Anhui, China
| | - Tingting Ding
- Department of Pharmacology, School of Pharmacy, Wannan Medical College, Wuhu, Anhui, China
| | - Na Wei
- Department of Pharmacology, School of Pharmacy, Wannan Medical College, Wuhu, Anhui, China
| | - Jieren Yang
- Department of Pharmacology, School of Pharmacy, Wannan Medical College, Wuhu, Anhui, China
| | - Mingyue Ma
- Department of Pharmacology, School of Pharmacy, Wannan Medical College, Wuhu, Anhui, China
| | - Shuguo Zheng
- Department of Pharmacology, School of Pharmacy, Wannan Medical College, Wuhu, Anhui, China; Laboratory of Pharmacology of Chinese Medicine, School of Pharmacy, Wannan Medical College, Wuhu, Anhui, China.
| | - Huanhuan Jin
- Department of Pharmacology, School of Pharmacy, Wannan Medical College, Wuhu, Anhui, China; Laboratory of Pharmacology of Chinese Medicine, School of Pharmacy, Wannan Medical College, Wuhu, Anhui, China.
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Green S, Schultz L. Rational Alternatives to Fludarabine and Cyclophosphamide-Based Pre-CAR Lymphodepleting Regimens in the Pediatric and Young Adult B-ALL Setting. Curr Oncol Rep 2023; 25:841-846. [PMID: 37099243 DOI: 10.1007/s11912-023-01404-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/27/2023]
Abstract
PURPOSE OF REVIEW Lymphodepleting chemotherapy (LD) has emerged as a key determinant of chimeric antigen receptor T cell (CAR) efficacy across pediatric/adult B cell malignancies. Clinical trials demonstrate the superiority of fludarabine/cyclophosphamide (Flu/Cy) regimens, resulting in the adoption of Flu/Cy as the pre-CAR LD standard. In the context of a global fludarabine shortage, consideration of alternative regimens is timely, yet limited clinical data exists, specifically in the pediatric B-ALL CAR setting. RECENT FINDINGS Bendamustine has been used as an effective LD prior to CD19-CAR in adult lymphoma. Although use in the pediatric CAR setting is limited, tolerability has been established in pediatric Hodgkin's lymphoma. Clofarabine is a purine nucleoside analog with mechanistic overlap with fludarabine; however, toxicity is high in the upfront leukemia setting, and thus use as an LD pre-CAR should be pursued with caution. We review the experience using bendamustine and clofarabine to serve as a resource when considering LD regimens as an alternative to fludarabine for pediatric B-ALL.
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Affiliation(s)
- Sean Green
- Department of Pediatrics, Stanford University, 1000 Welch Road, Suite #300, Palo Alto, CA, 94304, USA
- Department of Pharmacy, Stanford Medicine Children's Health, 725 Welch Road, Palo Alto, CA, 94304, USA
| | - Liora Schultz
- Department of Pediatrics, Stanford University, 1000 Welch Road, Suite #300, Palo Alto, CA, 94304, USA.
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Daley J, Halligan K, Howrie D, Salgado CM, Superdock A, Friehling E, Bailey KM. Successful Treatment of Patient With Ewing Sarcoma in the Setting of Inherited Cholestatic Liver Disease. J Pediatr Hematol Oncol 2023; 45:e621-e623. [PMID: 36728269 PMCID: PMC10284126 DOI: 10.1097/mph.0000000000002623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/11/2022] [Indexed: 02/03/2023]
Abstract
Progressive familial intrahepatic cholestasis type 1 (PFIC1) is an inherited, progressive cholestatic liver disease. Here, we present an approach to the treatment of Ewing sarcoma in a patient with PFIC1. The diagnosis of PFIC1 presents a unique challenge in the treatment of Ewing sarcoma, as the standard-of-care vincristine, doxorubicin, cyclophosphamide/ifosfamide and etoposide chemotherapy backbone for Ewing sarcoma therapy treatment relies heavily on intact hepatic metabolism. In addition, we report prolonged lymphopenia and severe infectious complications in this patient, both of which may be attributed to more severe immunosuppression in setting of poor hepatic metabolism of chemotherapeutic agents.
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Affiliation(s)
- Jessica Daley
- Division of Pediatric Oncology, Department of Pediatrics
| | | | - Denise Howrie
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy and Medicine, Pittsburgh, PA
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ACG Clinical Guideline: Diagnosis and Management of Biliary Strictures. Am J Gastroenterol 2023; 118:405-426. [PMID: 36863037 DOI: 10.14309/ajg.0000000000002190] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/13/2022] [Indexed: 03/04/2023]
Abstract
A biliary stricture is an abnormal narrowing in the ductal drainage system of the liver that can result in clinically and physiologically relevant obstruction to the flow of bile. The most common and ominous etiology is malignancy, underscoring the importance of a high index of suspicion in the evaluation of this condition. The goals of care in patients with a biliary stricture are confirming or excluding malignancy (diagnosis) and reestablishing flow of bile to the duodenum (drainage); the approach to diagnosis and drainage varies according to anatomic location (extrahepatic vs perihilar). For extrahepatic strictures, endoscopic ultrasound-guided tissue acquisition is highly accurate and has become the diagnostic mainstay. In contrast, the diagnosis of perihilar strictures remains a challenge. Similarly, the drainage of extrahepatic strictures tends to be more straightforward and safer and less controversial than that of perihilar strictures. Recent evidence has provided some clarity in multiple important areas pertaining to biliary strictures, whereas several remaining controversies require additional research. The goal of this guideline is to provide practicing clinicians with the most evidence-based guidance on the approach to patients with extrahepatic and perihilar strictures, focusing on diagnosis and drainage.
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17
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Menon J, Shanmugam N, Valamparampil J, Vij M, Kumar V, Munirathnam D, Hakeem A, Rammohan A, Rela M. Outcomes of liver transplantation in children with Langerhans cell histiocytosis: Experience from a quaternary care center. Pediatr Blood Cancer 2023; 70:e30024. [PMID: 36317422 DOI: 10.1002/pbc.30024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare but important cause of end-stage liver disease in children. Conventional chemotherapeutic agents that are otherwise the standard-of-care in LCH may be counterproductive in patients with hepatic decompensation. Furthermore, the precise role of liver transplantation (LT) in the management of LCH remains unclear. METHODS Review of a prospectively collected database (January 2014 to December 2020) of children with liver disease was performed. All clinical details of patients with LCH managed at our center were collected and data analyzed. Based on the outcomes, a management algorithm was proposed. RESULTS Of the eight (five male) patients referred to our unit, six (75%) underwent LT (four and two for compensated and decompensated cirrhosis, respectively). Median age at diagnosis of LCH was 25 (range: 9-48) months. Two patients, who had previously completed LCH-specific chemotherapy, underwent upfront LT for compensated cirrhosis. Other two patients with compensated cirrhosis showed evidence of active disease. They underwent LT following completion of chemotherapy. Two children with decompensated cirrhosis also had evidence of active disease and were started on modified chemotherapy Both of them had progression of liver disease while on chemotherapy. Hence, an urgent LT was performed which was followed by completion of chemotherapy in these patients. On a median follow-up of 30.5 (10.5-50) months, all post-LT patients were alive with stable graft function and showed no disease recurrence. CONCLUSION We demonstrate that an algorithmic approach, along with newer chemotherapeutic agents, results in excellent outcomes in LCH patients with liver involvement. Larger multicentric studies on this rare disease are, however, needed to validate our findings.
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Affiliation(s)
- Jagadeesh Menon
- Department of Pediatric Gastroenterology & Hepatology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Naresh Shanmugam
- Department of Pediatric Gastroenterology & Hepatology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Joseph Valamparampil
- Department of Pediatric Gastroenterology & Hepatology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Mukul Vij
- Department of Histopathology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Vimal Kumar
- Department of Pediatric Hematology & Oncology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Deenadayalan Munirathnam
- Department of Pediatric Hematology & Oncology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Abdul Hakeem
- Institute of Liver Disease & Transplantation, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Ashwin Rammohan
- Institute of Liver Disease & Transplantation, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Mohamed Rela
- Institute of Liver Disease & Transplantation, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
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Boeriu E, Boc AG, Borda A, Negrean RA, Feciche B, Boeriu AI, Horhat FG, Mot IC, Horhat ID, Ravulapalli M, Sabuni O, Adi A, Anjary A, Arghirescu ST. Insights on Lipomatosis after Platinum-Based Chemotherapy Use in Pediatric Oncology: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121715. [PMID: 36556917 PMCID: PMC9784424 DOI: 10.3390/medicina58121715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022]
Abstract
Agents of platinum-based chemotherapy, such as cisplatin or carboplatin, are used in the treatment of a wide range of malignancies that affect children, such as brain tumors, osteosarcoma, neuroblastoma, hepatoblastoma, and germ cell tumors (GCTs). The Cyclophosphamide Equivalent Dose (CED) calculator for reproductive risk does not take platinum-based chemotherapy into account, despite the fact that it accounts for the majority of chemotherapy medications that are typically administered for pediatric GCTs. As a result, exposure to platinum-based drugs throughout infancy can have predictable long-term effects such as infertility, as well as other rare encounters such as lipoma formation and lipomatosis. Lipomas are the most prevalent benign soft tissue tumor subtype. They may be either solitary entities or engaged in multiple lipomatosis, which may have a familial origin or be an acquired disorder. Chemotherapy is a possible cause of lipomatosis. Chemotherapy based on cisplatin has been linked to a variety of long-term consequences, including kidney damage, neurotoxicity, and pulmonary toxicity, and may even create secondary cancers. However, lipoma development is known to occur in fewer than 1 in 100 individuals, and only a few examples of multiple cutaneous lipomatosis triggered by this therapy have been documented. Here we present a very rare case of lipomatosis in a pediatric patient with GCT under cisplatin therapy, which might be the third report of this kind affecting children.
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Affiliation(s)
- Estera Boeriu
- Department of Pediatrics, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Department of Oncology and Haematology, “Louis Turcanu” Emergency Clinical Hospital for Children, Iosif Nemoianu Street 2, 300011 Timisoara, Romania
| | - Alexandra Georgiana Boc
- Department of Pediatrics, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Alexandra Borda
- Department of Oncology and Haematology, “Louis Turcanu” Emergency Clinical Hospital for Children, Iosif Nemoianu Street 2, 300011 Timisoara, Romania
| | | | - Bogdan Feciche
- Department of Urology, Satu-Mare County Emergency Hospital, Strada Ravensburg 2, 440192 Satu-Mare, Romania
| | - Amalia Iulia Boeriu
- Klinikum Landshut, Teaching Hospital of the LMU Munich, Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, Robert-Koch-Strasse, 184034 Landshut, Germany
| | - Florin George Horhat
- Multidisciplinary Research Center on Antimicrobial Resistance (MULTI-REZ), Microbiology Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence:
| | - Ion Cristian Mot
- Department of Ear-Nose-Throat, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ioana Delia Horhat
- Department of Ear-Nose-Throat, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | | | - Omar Sabuni
- Faculty of General Medicine, Altinbas University, Dilmenler Cd., 34217 Istanbul, Turkey
| | - Abduljabar Adi
- Faculty of General Medicine, Baskent University, Fatih Sultan, 06790 Ankara, Turkey
| | - Adnan Anjary
- Faculty of General Medicine, Yeditepe University, Kayısdagı Cd., 34755 Istanbul, Turkey
| | - Smaranda Teodora Arghirescu
- Department of Pediatrics, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Department of Oncology and Haematology, “Louis Turcanu” Emergency Clinical Hospital for Children, Iosif Nemoianu Street 2, 300011 Timisoara, Romania
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Wong AK, Grobler A, Le B. ENhANCE trial protocol: A multi-centre, randomised, phase IV trial comparing the efficacy of oxycodone/naloxone prolonged release (OXN PR) versus oxycodone prolonged release (Oxy PR) tablets in patients with advanced cancer. Contemp Clin Trials Commun 2022; 30:101036. [PMID: 36407843 PMCID: PMC9672918 DOI: 10.1016/j.conctc.2022.101036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/01/2022] [Accepted: 11/07/2022] [Indexed: 11/14/2022] Open
Abstract
Background Oxycodone is a frequently used opioid in cancer. Opioid-induced constipation (OIC) is common. Oxycodone/Naloxone Prolonged Release (OXN PR) contains naloxone, which mitigates OIC. Trials have either focused on non-cancer pain, or conducted before significant experience of using OXN PR. This trial aims to: demonstrate (1) analgesic equivalence between OXN PR and Oxycodone Prolonged Release (Oxy PR), and (2) superiority of constipation outcomes in OXN PR compared to Oxy PR in cancer pain. Unlike other trials, it will only include patients with at least moderate pain scores (≥4/10), allow usual laxatives, and exclude potential liver dysfunction. Methods This is a multi-centre, open-label, randomised, phase IV study of OXN PR vs Oxy PR in patients with cancer-related pain. The primary outcome is pain difference on Brief Pain Inventory-Short Form (BPI-SF) at 5 weeks. Secondary outcomes are comparison of other pain outcomes (BPI-SF) and neuropathic pain measures (Leeds Assessment of Neuropathic Symptoms & Signs (S-LANNS)), constipation (Bowel Function Index (BFI)), quality of life (EORTC-QLQ-C30), rescue analgesia use, total opioid dose, and total laxative dose over 5 weeks. Conclusion The comparison of analgesic efficacy between both arms, and superiority of constipation in the OXN PR arm will add new knowledge on the comparisons of both agents, and oxycodone independently. This trial will extend knowledge of the effectiveness, safety, and adverse effect profiles of both drugs in terms of pain, constipation, quality of life outcomes for patients with cancer pain, and provide clinicians with high quality data to guide decision making. Trial registration Name of the registry: ANZCTR Trial registration number ACTRN12619001282178 Date of registration 17/09/2019 URL of trial registry record https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377673&isReview=true Protocol version 2.1_28 August 2020 Opioid-induced constipation is the commonest side effect in cancer pain management. Oxycodone/naloxone prolonged release aims to reduce opioid-induced constipation. Trials have little focus on cancer pain, concurrent liver impairment, and laxatives. This trial evaluates these key problems practically to guide decision making.
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Guarin JR, Fatherree JP, Oudin MJ. Chemotherapy treatment induces pro-invasive changes in liver ECM composition. Matrix Biol 2022; 112:20-38. [PMID: 35940338 PMCID: PMC10690958 DOI: 10.1016/j.matbio.2022.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 07/08/2022] [Accepted: 08/04/2022] [Indexed: 10/16/2022]
Abstract
Metastasis accounts for 90% of cancer-related deaths, yet the mechanisms by which cancer cells colonize secondary organs remain poorly understood. For breast cancer patients, metastasis to the liver is associated with poor prognosis and a median survival of 6 months. Standard of care is chemotherapy, but recurrence occurs in 30% of patients. Systemic chemotherapy has been shown to induce hepatotoxicity and fibrosis, but how chemotherapy impacts the composition of the liver extracellular matrix (ECM) remains unknown. Individual ECM proteins drive tumor cell proliferation and invasion, features that are essential for metastatic outgrowth in the liver. First, we find that the ECM of livers isolated from chemotherapy-treated MMTV-PyMT mice increases the invasion, but not proliferation, of metastatic breast cancer cells. Proteomic analysis of the liver ECM identified Collagen V to be more abundant in paclitaxel-treated livers. We show that Collagen V increases cancer cell invasion via α1β1 integrins and MAPK signaling, while also increasing the alignment of Collagen I, which has been associated with increased invasion. Treatment with obtustatin, an inhibitor specific to α1β1 integrins, inhibits tumor cell invasion in decellularized ECM from paclitaxel-treated livers. Overall, we show chemotherapy treatment alters the liver microenvironment, priming it as a pro-metastatic niche for cancer metastasis.
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Affiliation(s)
- Justinne R Guarin
- Department of Biomedical Engineering, Tufts University, Room 134, 200 College Ave, Medford, MA 20155, United States
| | - Jackson P Fatherree
- Department of Biomedical Engineering, Tufts University, Room 134, 200 College Ave, Medford, MA 20155, United States
| | - Madeleine J Oudin
- Department of Biomedical Engineering, Tufts University, Room 134, 200 College Ave, Medford, MA 20155, United States.
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21
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Menon J, Rammohan A, Vij M, Shanmugam N, Rela M. Current perspectives on the role of liver transplantation for Langerhans cell histiocytosis: A narrative review. World J Gastroenterol 2022; 28:4044-4052. [PMID: 36157108 PMCID: PMC9403430 DOI: 10.3748/wjg.v28.i30.4044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/30/2022] [Accepted: 07/22/2022] [Indexed: 02/06/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a malignant disease of the histiocytes involving various organ systems. The spectrum of liver involvement in LCH ranges from mild transaminitis to end-stage liver disease. The hallmark of hepatic LCH is secondary sclerosing cholangitis, which manifests due to a progressive destruction of the biliary tree by malignant histiocytes. Chemotherapy remains the mainstay of treatment for active LCH. Early recognition, diagnosis and a systematic approach to the management of LCH can ameliorate the disease process. Nonetheless, the liver involvement in these patients may progress despite the LCH being in remission. Liver transplantation (LT) remains central in the management of such patients. Various facets of the management of LCH, especially those with liver involvement remain unclear. Furthermore, aspects of LT in LCH with regards to the indication, timing and post-LT management, including immunosuppression and adjuvant therapy, remain undefined. This review summarises the current evidence and discusses the practical aspects of the role of LT in the management of LCH.
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Affiliation(s)
- Jagadeesh Menon
- Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai 600044, India
| | - Ashwin Rammohan
- Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai 600044, India
| | - Mukul Vij
- Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai 600044, India
| | - Naresh Shanmugam
- Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai 600044, India
| | - Mohamed Rela
- Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai 600044, India
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22
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Patauner F, Stanzione M, Stornaiuolo G, Martone V, Palladino R, Coppola N, Durante-Mangoni E, Zampino R. Safety and Efficacy of Direct Antiviral Agents for Hepatitis C in Patients with Malignancies Other Than Liver Cancer: A Case Series. Pathogens 2022; 11:pathogens11080860. [PMID: 36014981 PMCID: PMC9414735 DOI: 10.3390/pathogens11080860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background: direct-acting antivirals (DAA) are the current standard of care for chronic hepatitis C. Oncologic patients remain among the most difficult-to-treat subgroups of hepatitis C virus (HCV)-infected patients due to their clinical frailty and complex therapeutic protocols received. (2) Methods: we retrospectively collected and analysed clinical data of 30 consecutive patients treated with DAA, between 2015 and 2022, for chronic HCV infection in the context of oncologic disease. (3) Results: most patients were females (63.3%), median age was 67 years, HCV genotype 1 was prevalent (60%), and median HCV RNA levels were 2.2 × 106 IU/mL. The most common malignancy was breast cancer (37%), and the chief oncologic drugs co-administered with DAAs were tamoxifen, platinum derivatives, cyclophosphamide, paclitaxel, rituximab and doxorubicin. Overall, 50% of patients had chronic hepatitis. A total of 76.7% underwent a sofosbuvir-based treatment. Sustained virological response 12 weeks after the end of therapy (SVR12) was reached in all patients. After SVR12, two patients died. DAA treatment was well tolerated; no patients had to stop DAA treatment or showed any adverse event or drug-drug interaction specifically attributable to DAAs. (4) Conclusions: DAA treatment should be promptly offered to oncologic patients with chronic hepatitis C in order to achieve aminotransferase normalization and viremia control, making antineoplastic therapy feasible and safe.
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Affiliation(s)
- Fabian Patauner
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Napoli, Italy; (F.P.); (V.M.); (R.Z.)
| | - Maria Stanzione
- Department of Mental Health and Public Medicine, Infectious Diseases Unit, University of Campania Luigi Vanvitelli, 80138 Napoli, Italy; (M.S.); (G.S.); (R.P.); (N.C.)
| | - Gianfranca Stornaiuolo
- Department of Mental Health and Public Medicine, Infectious Diseases Unit, University of Campania Luigi Vanvitelli, 80138 Napoli, Italy; (M.S.); (G.S.); (R.P.); (N.C.)
| | - Veronica Martone
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Napoli, Italy; (F.P.); (V.M.); (R.Z.)
| | - Roberta Palladino
- Department of Mental Health and Public Medicine, Infectious Diseases Unit, University of Campania Luigi Vanvitelli, 80138 Napoli, Italy; (M.S.); (G.S.); (R.P.); (N.C.)
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Infectious Diseases Unit, University of Campania Luigi Vanvitelli, 80138 Napoli, Italy; (M.S.); (G.S.); (R.P.); (N.C.)
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80138 Napoli, Italy
- Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-7062475; Fax: +39-081-7062686
| | - Rosa Zampino
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Napoli, Italy; (F.P.); (V.M.); (R.Z.)
- Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, 80131 Naples, Italy
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Miura K, Takahashi H, Nakagawa M, Hamada T, Uchino Y, Iizuka K, Ohtake S, Iriyama N, Hatta Y, Nakamura H. Ideal dose intensity of R-CHOP in diffuse large B-cell lymphoma. Expert Rev Anticancer Ther 2022; 22:583-595. [PMID: 35472312 DOI: 10.1080/14737140.2022.2071262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The standard of care for diffuse large B-cell lymphoma (DLBCL) is rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). However, its ideal dose intensity varies among cases. AREAS COVERED This review provides the latest insights on the dose intensity of R-CHOP for DLBCL patients. Specifically, we discussed the optimal dose intensity for elderly patients, the optimal number of treatment cycles for limited or advanced-stage diseases, and the role of dose-intensified therapies or adding targeted inhibitors. EXPERT OPINION Performing a comprehensive or simplified geriatric assessment can distinguish elderly DLBCL patients who will likely benefit from curative R-CHOP. Very elderly or medically unfit patients may need dose reduction in R-CHOP; the Age, Comorbidities, and Albumin index may aid decision-making. Four cycles of R-CHOP followed by two rituximab cycles comprise a new standard for low-risk, limited-stage DLBCL patients. Compared to eight cycles, six cycles of R-CHOP have similar efficacy and fewer toxicities for advanced-stage DLBCL. Dose-intensified therapy is not recommended in most DLBCL cases but may be considered for patients with double (or triple)-hit lymphoma. Applying targeted inhibitors and not merely escalating R-CHOP dose intensity through molecular subtyping will improve the treatment outcome for DLBCL.
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Affiliation(s)
- Katsuhiro Miura
- Tumor Center, Nihon University Itabashi Hospital (Director); 2Department of Hematology and Rheumatology, Nihon University School of Medicine (Associate Professor), Tokyo, Japan.,Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hiromichi Takahashi
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine (Assistant Professor), Tokyo, Japan
| | - Masaru Nakagawa
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine (Assistant Professor), Tokyo, Japan
| | - Takashi Hamada
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshihito Uchino
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Kazuhide Iizuka
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine (Assistant Professor), Tokyo, Japan
| | - Shimon Ohtake
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Noriyoshi Iriyama
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshihiro Hatta
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hideki Nakamura
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
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Jaiswar SP, Agrawal M, Deo S, Saad S. Cervical gestational trophoblastic neoplasia: A rare form of gestational trophoblastic disease. J Cancer Res Ther 2022; 18:827-830. [PMID: 35900567 DOI: 10.4103/jcrt.jcrt_959_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Gestational trophoblastic neoplasia (GTN) is a rare disease and is characterized by an abnormal proliferation of trophoblastic cells of placenta. Since majority of them are chemotherapy sensitive, they are one of the highly curable cancers. However, due to its varied presentation, clinicians still face many challenges in its diagnosis and management. We present a case of 26-year-old woman, P0 + 3 (previous 3 abortions) who presented to us with a history of vaginal bleeding postuterine evacuation after 2 months of incomplete abortion. After clinical, radiological assessment and high human chorionic gonadotropin (hCG) titers, the patient was diagnosed as a case of cervical GTN. Risk assessment by the WHO prognostic scoring system was done and "Low Risk" was assigned to her. She was given total nine cycles of single agent chemotherapy including two consolidation cycles after normalization of hCG titers which patient tolerated well and remained asymptomatic.
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Affiliation(s)
- Shyam Pyari Jaiswar
- Department of Obstetrics and Gynaecology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Monica Agrawal
- Department of Obstetrics and Gynaecology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Sujata Deo
- Department of Obstetrics and Gynaecology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Sumaiya Saad
- Department of Obstetrics and Gynaecology, King George Medical University, Lucknow, Uttar Pradesh, India
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25
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van den Boogaard WMC, Komninos DSJ, Vermeij WP. Chemotherapy Side-Effects: Not All DNA Damage Is Equal. Cancers (Basel) 2022; 14:cancers14030627. [PMID: 35158895 PMCID: PMC8833520 DOI: 10.3390/cancers14030627] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023] Open
Abstract
Recent advances have increased survival rates of children and adults suffering from cancer thanks to effective anti-cancer therapy, such as chemotherapy. However, during treatment and later in life they are frequently confronted with the severe negative side-effects of their life-saving treatment. The occurrence of numerous features of accelerated aging, seriously affecting quality of life, has now become one of the most pressing problems associated with (pediatric) cancer treatment. Chemotherapies frequently target and damage the DNA, causing mutations or genome instability, a major hallmark of both cancer and aging. However, there are numerous types of chemotherapeutic drugs that are genotoxic and interfere with DNA metabolism in different ways, each with their own biodistribution, kinetics, and biological fate. Depending on the type of DNA lesion produced (e.g., interference with DNA replication or RNA transcription), the organ or cell type inflicted (e.g., cell cycle or differentiation status, metabolic state, activity of clearance and detoxification mechanisms, the cellular condition or micro-environment), and the degree of exposure, outcomes of cancer treatment can largely differ. These considerations provide a conceptual framework in which different classes of chemotherapeutics contribute to the development of toxicities and accelerated aging of different organ systems. Here, we summarize frequently observed side-effects in (pediatric) ex-cancer patients and discuss which types of DNA damage might be responsible.
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Affiliation(s)
- Winnie M. C. van den Boogaard
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (W.M.C.v.d.B.); (D.S.J.K.)
- Oncode Institute, Jaarbeursplein 6, 3521 AL Utrecht, The Netherlands
| | - Daphne S. J. Komninos
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (W.M.C.v.d.B.); (D.S.J.K.)
- Oncode Institute, Jaarbeursplein 6, 3521 AL Utrecht, The Netherlands
| | - Wilbert P. Vermeij
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (W.M.C.v.d.B.); (D.S.J.K.)
- Oncode Institute, Jaarbeursplein 6, 3521 AL Utrecht, The Netherlands
- Correspondence: ; Tel.: +31-88-972-5266
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Functionalized niosomes as a smart delivery device in cancer and fungal infection. Eur J Pharm Sci 2021; 168:106052. [PMID: 34740786 DOI: 10.1016/j.ejps.2021.106052] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 12/17/2022]
Abstract
Various diseases remain untreated due to lack of suitable therapeutic moiety or a suitable drug delivery device, especially where toxicities and side effects are the primary reason for concern. Cancer and fungal infections are diseases where treatment schedules are not completed due to severe side effects or lengthy treatment protocols. Advanced treatment approaches such as active targeting and inhibition of angiogenesis may be preferred method for the treatment for malignancy over the conventional method. Niosomes may be a better alternative drug delivery carrier for various therapeutic moieties (either hydrophilic or hydrophobic) and also due to ease of surface modification, non-immunogenicity and economical. Active targeting approach may be done by targeting the receptors through coupling of suitable ligand on niosomal surface. Moreover, various receptors (CD44, folate, epidermal growth factor receptor (EGFR) & Vascular growth factor receptor (VGFR)) expressed by malignant cells have also been reviewed. The preparation of suitable niosomal formulation also requires considerable attention, and its formulation depends upon various factors such as selection of non-ionic surfactant, method of fabrication, and fabrication parameters. A combination therapy (dual drug and immunotherapy) has been proposed for the treatment of fungal infection with special consideration for surface modification with suitable ligand on niosomal surface to sensitize the receptors (C-type lectin receptors, Toll-like receptors & Nucleotide-binding oligomerization domain-like receptors) present on immune cells involved in fungal immunity. Certain gene silencing concept has also been discussed as an advanced alternative treatment for cancer by silencing the mRNA at molecular level using short interfering RNA (si-RNA).
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27
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Ustyuzhanina NE, Anisimova NY, Bilan MI, Donenko FV, Morozevich GE, Yashunskiy DV, Usov AI, Siminyan NG, Kirgisov KI, Varfolomeeva SR, Kiselevskiy MV, Nifantiev NE. Chondroitin Sulfate and Fucosylated Chondroitin Sulfate as Stimulators of Hematopoiesis in Cyclophosphamide-Induced Mice. Pharmaceuticals (Basel) 2021; 14:1074. [PMID: 34832856 PMCID: PMC8623974 DOI: 10.3390/ph14111074] [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: 08/19/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 12/14/2022] Open
Abstract
The immunosuppression and inhibition of hematopoiesis are considered to be reasons for the development of complications after intensive chemotherapy and allogeneic hematopoietic stem cell transplantation. Chondroitin sulfate (CS), isolated from the fish Salmo salar, and fucosylated chondroitin sulfate (FCS), isolated from the sea cucumber Apostichopus japonicus, were studied for their roles as stimulators of hematopoiesis in a model of cyclophosphamide-induced immunosuppression in mice. The recombinant protein r G-CSF was applied as a reference. The studied polysaccharides were shown to stimulate the release of white and red blood cells, as well as platelets from bone marrow in immunosuppressed mice, while r G-CSF was only responsible for the significant increase in the level of leucocytes. The analysis of different populations of leucocytes in blood indicated that r G-CSF mainly stimulated the production of neutrophils, whereas in the cases of the studied saccharides, increases in the levels of monocytes, lymphocytes and neutrophils were observed. The normalization of the level of the pro-inflammatory cytokine IL-6 in the serum and the recovery of cell populations in the spleen were observed in immunosuppressed mice following treatment with the polysaccharides. An increase in the proliferative activity of hematopoietic cells CD34(+)CD45(+) was observed following ex vivo polysaccharide exposure. Further study on related oligosaccharides regarding their potential as promising drugs in the complex prophylaxis and therapy of hematopoiesis inhibition after intensive chemotherapy and allogeneic hematopoietic stem cell transplantation seems to be warranted.
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Affiliation(s)
- Nadezhda E. Ustyuzhanina
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Prospect 47, 119991 Moscow, Russia; (M.I.B.); (A.I.U.)
| | - Natalia Yu. Anisimova
- N.N. Blokhin National Medical Research Center of Oncology, Kashirskoe Shosse 24, 115478 Moscow, Russia; (N.Y.A.); (F.V.D.); (N.G.S.); (K.I.K.); (S.R.V.)
| | - Maria I. Bilan
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Prospect 47, 119991 Moscow, Russia; (M.I.B.); (A.I.U.)
| | - Fedor V. Donenko
- N.N. Blokhin National Medical Research Center of Oncology, Kashirskoe Shosse 24, 115478 Moscow, Russia; (N.Y.A.); (F.V.D.); (N.G.S.); (K.I.K.); (S.R.V.)
| | - Galina E. Morozevich
- V.N. Orekhovich Research Institute of Biomedical Chemistry, Pogodinskaya Str. 10, 119121 Moscow, Russia; (G.E.M.); (D.V.Y.)
| | - Dmitriy V. Yashunskiy
- V.N. Orekhovich Research Institute of Biomedical Chemistry, Pogodinskaya Str. 10, 119121 Moscow, Russia; (G.E.M.); (D.V.Y.)
| | - Anatolii I. Usov
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Prospect 47, 119991 Moscow, Russia; (M.I.B.); (A.I.U.)
| | - Nara G. Siminyan
- N.N. Blokhin National Medical Research Center of Oncology, Kashirskoe Shosse 24, 115478 Moscow, Russia; (N.Y.A.); (F.V.D.); (N.G.S.); (K.I.K.); (S.R.V.)
| | - Kirill I. Kirgisov
- N.N. Blokhin National Medical Research Center of Oncology, Kashirskoe Shosse 24, 115478 Moscow, Russia; (N.Y.A.); (F.V.D.); (N.G.S.); (K.I.K.); (S.R.V.)
| | - Svetlana R. Varfolomeeva
- N.N. Blokhin National Medical Research Center of Oncology, Kashirskoe Shosse 24, 115478 Moscow, Russia; (N.Y.A.); (F.V.D.); (N.G.S.); (K.I.K.); (S.R.V.)
| | - Mikhail V. Kiselevskiy
- N.N. Blokhin National Medical Research Center of Oncology, Kashirskoe Shosse 24, 115478 Moscow, Russia; (N.Y.A.); (F.V.D.); (N.G.S.); (K.I.K.); (S.R.V.)
| | - Nikolay E. Nifantiev
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Prospect 47, 119991 Moscow, Russia; (M.I.B.); (A.I.U.)
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Taggar AS, Mann P, Folkert MR, Aliakbari S, Myrehaug SD, Dawson LA. A systematic review of intraluminal high dose rate brachytherapy in the management of malignant biliary tract obstruction and cholangiocarcinoma. Radiother Oncol 2021; 165:60-74. [PMID: 34695521 DOI: 10.1016/j.radonc.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/11/2021] [Accepted: 10/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To conduct a systematic review evaluating the impact of high dose rate (HDR) intraluminal brachytherapy (ILBT) in the management of malignant biliary obstruction and cholangiocarcinoma with specific focus on stent patency, clinical outcomes and toxicities. METHODS AND MATERIALS A review of published articles was conducted using Medline, Embase and Cochrane databases using the search terms "bile duct carcinoma" or "cholangiocarcinoma" or "bile duct neoplasms" in combination with "brachytherapy" or "high dose rate brachytherapy" or "HDR brachytherapy". Studies published in English and reporting outcomes of ≥10 patients were included in the review. Only the most recent experience was included if same patients were included in sequential publications. RESULTS Seventeen studies were identified that met the inclusion criteria. Significant heterogeneity was observed in treatment regimens, which included use of surgery, external beam radiation (EBRT), and/or intra-arterial and intravenous chemotherapy in conjunction with ILBT. Nevertheless, among the included studies, use of ILBT appeared to result in longer duration of stent patency: 10 months with ILBT compared to 4-6 months without ILBT. A trend was observed towards prolonged local control and improved complete and partial response rates in patients treated with ILBT with or without EBRT. Weighted mean overall survival of patients treated with ILBT alone was 11.8 months compared to 10.5 months for those that received EBRT +/- chemotherapy in addition to ILBT. The included studies reported low complication rates and toxicity related to ILBT. CONCLUSION Brachytherapy can be an effective and safe tool in the management of malignant biliary tract obstruction in combination with stenting. Both retrospective and prospective studies have suggested improved outcomes when HDR ILBT is combined with percutaneous stenting.
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Affiliation(s)
- Amandeep S Taggar
- Sunnybrook Odette Cancer Centre, Toronto, Canada; University of Toronto, Canada.
| | - Paveen Mann
- Sunnybrook Odette Cancer Centre, Toronto, Canada
| | | | | | - Sten D Myrehaug
- Sunnybrook Odette Cancer Centre, Toronto, Canada; University of Toronto, Canada
| | - Laura A Dawson
- Princess Margaret Cancer Centre, Toronto, Canada; University of Toronto, Canada
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29
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Lee C, Leventhal TM, Anugwom CM. L-Asparaginase-Induced Hepatotoxicity Treated Successfully With L-Carnitine and Vitamin B Infusion. Cureus 2021; 13:e16917. [PMID: 34513489 PMCID: PMC8412850 DOI: 10.7759/cureus.16917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 12/02/2022] Open
Abstract
Asparaginase plays an integral role in chemotherapy for acute lymphoblastic leukemia (ALL). We present a 69-year old woman with refractory ALL, who developed asparaginase-induced hepatotoxicity and cholangiopathy after starting intravenous PEG-L-asparaginase-based chemotherapy. The patient was ultimately treated with the combination of L-carnitine and vitamin B complex, resulting in normalization of liver enzymes levels. This case highlights the consideration of PEG-L asparaginase chemotherapy-induced liver steatosis, injury, and cholangiopathy as well as the role of L-carnitine and vitamin B complex as treatment.
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Affiliation(s)
- Christina Lee
- Internal Medicine, University of Minnesota Medical School, Minneapolis, USA
| | - Thomas M Leventhal
- Division of Gastroenterology, Hepatology, and Nutrition/Transplant Hepatology and Critical Care Medicine, University of Minnesota, Minneapolis, USA
| | - Chimaobi M Anugwom
- Gastroenterology and Hepatology, University of Minnesota, Minneapolis, USA
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30
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Kim J, Randhawa H, Sands D, Lambe S, Puglia M, Serrano PE, Pinthus JH. Muscle-Invasive Bladder Cancer in Patients with Liver Cirrhosis: A Review of Pertinent Considerations. Bladder Cancer 2021. [DOI: 10.3233/blc-211536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The incidence of liver cirrhosis is increasing worldwide. Patients with cirrhosis are generally at a higher risk of harbouring hepatic and non-hepatic malignancies, including bladder cancer, likely due to the presence of related risk factors such as smoking. Cirrhosis can complicate both the operative and non-surgical management of bladder cancer. For example, cirrhotic patients undergoing abdominal surgery generally demonstrate worse postoperative outcomes, and chemotherapy in patients with cirrhosis often requires dose reduction due to its direct hepatotoxic effects and reduced hepatic clearance. Multiple other considerations in the peri-operative management for cirrhosis patients with muscle-invasive bladder cancer must be taken into account to optimize outcomes in these patients. Unfortunately, the current literature specifically related to the treatment of cirrhotic bladder cancer patients remains sparse. We aim to review the literature on treatment considerations for this patient population with respect to perioperative, surgical, and adjuvant management.
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Affiliation(s)
- John Kim
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - David Sands
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Shahid Lambe
- Division of Urology, McMaster University, Hamilton, ON, Canada
- McMaster Institute of Urology, St. Joseph’s Hospital, Hamilton, ON, Canada
| | - Marco Puglia
- Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
| | | | - Jehonathan H. Pinthus
- Division of Urology, McMaster University, Hamilton, ON, Canada
- Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
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31
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Dunlap R, Golden S, Lyons GR. Portal Vein Aneurysm Treated With Trans-Jugular Intrahepatic Porto-Systemic Shunt. Vasc Endovascular Surg 2021; 55:885-888. [PMID: 34114524 DOI: 10.1177/15385744211023291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Portal vein aneurysm (PVA) is a rare entity that can lead to hemorrhage or thrombosis. Although there is no standard treatment, most cases can be managed conservatively; intervention is reserved for symptomatic or enlarging aneurysms. For patients who are not surgical candidates due to cirrhosis and portal hypertension, endovascular creation of a trans-jugular intrahepatic porto-systemic shunt (TIPS) is an option to reduce portal venous pressure. This report describes a case of an enlarging PVA successfully treated with TIPS in a patient with cryptogenic cirrhosis.
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Affiliation(s)
- Robert Dunlap
- Division of Vascular and Interventional Radiology, Department of Radiology, The 1466Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sean Golden
- Division of Vascular and Interventional Radiology, Department of Radiology, The 1466Johns Hopkins Hospital, Baltimore, MD, USA
| | - Gray R Lyons
- Division of Vascular and Interventional Radiology, Department of Radiology, The 1466Johns Hopkins Hospital, Baltimore, MD, USA
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32
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Rolvink J, Gerards ALE, Kater AP, Swart EL, Becker ML. The effect of a Clinical Decision Support System on the frequency of dose adjustments of anticancer drugs in case of renal or hepatic dysfunction. J Oncol Pharm Pract 2021:10781552211019453. [PMID: 34111993 DOI: 10.1177/10781552211019453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Dose adjustments in patients with renal or hepatic dysfunction using anticancer drugs are indicated according to guidelines. However, implementation depends on awareness of prescribing physicians. We implemented a Clinical Decision Support System (CDSS), recommending dose adjustments upon electronic prescriptions based on renal and hepatic function. The alert provides a dose adjustment proposal and recent laboratory results. Our objective was to determine the frequency of dose adjustments before and after implementation of this CDSS. METHODS We included all first orders for patients ≥18 years treated with parenteral antineoplastic agents, for whom dosage adjustment is necessary based on renal or hepatic function between February 2018 and January 2019. This study was performed at the department of Clinical Oncology and Hematology of the Amsterdam University Medical Center. We implemented the CDSS August first. All prescriptions were prescribed according to common practice. We analyzed the orders where a dose reduction based on renal or hepatic function was indicated. RESULTS We included 73 orders before implementation and 99 orders after implementation. Before implementation 21% of doses were reduced in line with the guidelines versus 34% after implementation (p = 0.048). For hepatic dysfunction the proportion changed from 11% to 46% p = 0.011, while there was no effect for renal dysfunction (24% vs. 26% p = 0.75). CONCLUSION Dosages are more frequently adjusted in concordance with guidelines in patients with hepatic dysfunction who are treated with parenteral antineoplastic agents after implementation of a CDSS. The change was not seen in patients with renal dysfunction.
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Affiliation(s)
- José Rolvink
- University of Amsterdam, Amsterdam, the Netherlands.,Pharmacy Foundation of Haarlem Hospitals, Haarlem, the Netherlands.,Spaarne Gasthuis, Haarlem/Hoofddorp, the Netherlands.,Northwest Clinics, Alkmaar, The Netherlands
| | | | | | | | - Matthijs L Becker
- Pharmacy Foundation of Haarlem Hospitals, Haarlem, the Netherlands.,Spaarne Gasthuis, Haarlem/Hoofddorp, the Netherlands
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33
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Weyand AC, Barbaro RP, Walkovich KJ, Frame DG. Adjustments to pharmacologic therapies for hemophagocytic lymphohistiocytosis while on extracorporeal support. Pediatr Blood Cancer 2021; 68:e29007. [PMID: 33751818 PMCID: PMC8068609 DOI: 10.1002/pbc.29007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/01/2021] [Accepted: 02/23/2021] [Indexed: 11/08/2022]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is an immune dysregulatory syndrome characterized by severe inflammation and end-organ damage. Due to significant organ dysfunction, patients often require extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). In this report, we describe consideration for adjusting treatment in the context of extracorporeal organ support. We describe agents commonly used and dosing adjustments made in light of extracorporeal organ support. We report six cases that illustrate the feasibility of initiating standard HLH therapies in patients requiring these modalities.
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Affiliation(s)
- Angela C. Weyand
- Department of Pediatrics, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Ryan P. Barbaro
- Department of Pediatrics, Division of Critical Care, University of Michigan, Ann Arbor, MI
| | - Kelly J. Walkovich
- Department of Pediatrics, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - David G. Frame
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI
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34
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Crimmin J, Fulop T, Battisti NML. Biological aspects of aging that influence response to anticancer treatments. Curr Opin Support Palliat Care 2021; 15:29-38. [PMID: 33399393 DOI: 10.1097/spc.0000000000000536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Cancer is a disease of older adults, where fitness and frailty are a continuum. This aspect poses unique challenges to the management of cancer in this population. In this article, we review the biological aspects influencing the efficacy and safety of systemic anticancer treatments. RECENT FINDINGS The organ function decline associated with the ageing process affects multiple systems, including liver, kidney, bone marrow, heart, muscles and central nervous system. These can have a significant impact on the pharmacokinetics and pharmacodynamics of systemic anticancer agents. Comorbidities also represent a key aspect to consider in decision-making. Renal disease, liver conditions and cardiovascular risk factors are prevalent in this age group and may impact the risk of adverse outcomes in this setting. SUMMARY The systematic integration of geriatrics principles in the routine management of older adults with cancer is a unique opportunity to address the complexity of this population and is standard of care based on a wide range of benefits. This approach should be multidisciplinary and involve careful discussion with hospital pharmacists.
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Affiliation(s)
- Jane Crimmin
- Pharmacy, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Tamas Fulop
- Department of Medicine, Division of Geriatrics, Research Center on Aging, University of Sherbrooke, Faculty of Medicine and Health Sciences, Québec, Quebec, Canada
| | - Nicolò Matteo Luca Battisti
- Department of Medicine - Breast Unit, The Royal Marsden NHS Foundation Trust, Breast Cancer Research Division, The Institute of Cancer Research, Sutton, Surrey, UK
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35
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Tavakkoli A, Elmunzer BJ, Waljee AK, Murphy CC, Pruitt SL, Zhu H, Rong R, Kwon RS, Scheiman JM, Rubenstein JH, Singal AG. Survival analysis among unresectable pancreatic adenocarcinoma patients undergoing endoscopic or percutaneous interventions. Gastrointest Endosc 2021; 93:154-162.e5. [PMID: 32531402 PMCID: PMC8786308 DOI: 10.1016/j.gie.2020.05.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/25/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Most patients with pancreatic cancer are diagnosed at a late stage and are not candidates for surgical resection. Many have jaundice requiring biliary drainage, which can be accomplished using ERCP or percutaneous transhepatic biliary drainage (PTBD). To date, no studies have evaluated the impact of ERCP or PTBD on survival among patients with unresectable pancreatic cancer. The aims of our study were to compare overall survival between patients with unresectable pancreatic cancer receiving ERCP with those receiving PTBD, to compare overall survival between patients who received a biliary intervention (ERCP or PTBD) versus those who received no biliary intervention, and to compare secondary outcomes, such as length of hospital stay and costs, between ERCP and PTBD. METHODS We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results-Medicare database. Patients with known pancreatic cancer were included if they had a pancreatic head mass and/or evidence of biliary obstruction. We used a time-varying Cox proportional hazards model to estimate overall survival of patients receiving ERCP versus PTBD and overall survival among patients who received a biliary intervention versus no biliary drainage. Secondary outcomes included length of hospital stay, costs, and admissions within 30 days. RESULTS Of 14,808 patients with unresectable pancreatic cancer, 8898 patients (60.0%) underwent biliary drainage and 5910 patients (39.9%) received no biliary intervention. ERCP accounted for most biliary interventions (8271, 93.0%), whereas 623 patients (7.0%) underwent PTBD. In multivariable analysis, ERCP was associated with reduced mortality compared with PTBD (adjusted hazard ratio [aHR], .67; 95% confidence interval [CI], .60-.75). When ERCP or PTBD was compared with no biliary intervention, both procedures were associated with a survival benefit (aHR, .51 [95% CI, .49-.54] and .53 [95% CI, .48-.59], respectively). Compared with patients receiving PTBD, those who underwent ERCP had shorter mean length of hospital stay (7.0 ± 5.7 days vs 9.6 ± 6.6 days, respectively; P < .001) and lower hospital charges ($54,899.25 vs $75,246.00, P < .001) but no significant difference in hospitalization or 30-day readmissions. CONCLUSIONS ERCP is associated with reduced mortality compared with PTBD in pancreatic cancer patients, highlighting the critical role of ERCP in the management of biliary obstruction from pancreatic cancer.
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Affiliation(s)
- Anna Tavakkoli
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Akbar K Waljee
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan, USA; Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA; Institute of Healthy Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA; Michigan Integrated Center for Health Analytics and Medical Prediction, Ann Arbor, Michigan, USA
| | - Caitlin C Murphy
- Department of Population and Data Sciences, University of Texas Southwestern, Dallas, Texas, USA; Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, Texas, USA
| | - Sandi L Pruitt
- Department of Population and Data Sciences, University of Texas Southwestern, Dallas, Texas, USA; Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, Texas, USA
| | - Hong Zhu
- Department of Population and Data Sciences, University of Texas Southwestern, Dallas, Texas, USA; Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, Texas, USA
| | - Rong Rong
- Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, Texas, USA; Department of Statistical Science, Southern Methodist University, Dallas, Texas, USA
| | - Richard S Kwon
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - James M Scheiman
- Division of Gastroenterology, Department of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Joel H Rubenstein
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan, USA; Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Amit G Singal
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Abstract
Childhood cancer survivors (CCSs) are at risk for renal and hepatic complications related to curative cancer treatments. Although acute renal and hepatic toxicities of cancer treatments are well described, data regarding long-term and late-occurring sequelae or their associations with acute sequelae are less robust. This article highlights the literature on the prevalence of and risk factors for late renal and hepatic toxicity in CCSs. Studies investigating these outcomes are needed to inform surveillance practices and the development of future frontline cancer treatment protocols.
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Mohammadian J, Mahmoudi S, Pourmohammad P, Pirouzpanah M, Salehnia F, Maroufi NF, Samadi N, Sabzichi M. Formulation of Stattic as STAT3 inhibitor in nanostructured lipid carriers (NLCs) enhances efficacy of doxorubicin in melanoma cancer cells. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2020; 393:2315-2323. [PMID: 32653978 DOI: 10.1007/s00210-020-01942-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/03/2020] [Indexed: 01/29/2023]
Abstract
Nowadays, nanoparticle-based combination therapy has been emerging as huge innovation in cancer treatment. Here, we studied the effect of Stattic (STAT3 inhibitor) loaded in nanostructured lipid carriers (NLCs) on enhancing the efficacy, cytotoxicity, and induction of apoptosis of doxorubicin in B16F10 mouse melanoma cancer cell. The evaluation of Stattic-loaded NLCs has been done in terms of zeta potential, particle size, scanning electron microscope (SEM), and cellular uptake. MTT assay was applied to evaluate the cell proliferation. Apoptotic cell death and identification of early and late apoptosis were assessed by DAPI staining and Annexin V/PI staining, respectively. Real-time RT-PCR was applied to measure the effects of doxorubicin and/or Stattic on key apoptotic genes such as Bad, Survivin, HIF1, and STAT3. The Stattic formulated into NLCs shown mean particle size of 56 ± 7 nm which was confirmed by SEM. The IC50 values for Stattic and doxorubicin were 2.95 ± 0.52 μM and 1.21 ± 0.36 μM, respectively. Stattic-loaded NLCs diminished percent of cell proliferation from 68 ± 6.8 to 54 ± 3.7% (p < 0.05). Combinational treatment of the cells with Stattic-loaded nanoparticles and doxorubicin give rise to a significant increase in the percentage of apoptosis (p < 0.05). The study of gene expression profile has shown a remarkable decrease in anti-apoptotic gene, Survivin, along with smooth decline in HIF1 as angiogenesis intermediator and increase in Bad mRNA levels. Our results recommend that NLCs as novel technology have potent strategy to augment efficacy of current chemotherapeutic agent in melanoma cancer cells.
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Affiliation(s)
- Jamal Mohammadian
- Drug Applied Research Center, and Department of Medical Biotechnology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shiva Mahmoudi
- Drug Applied Research Center, and Department of Medical Biotechnology, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Biochemistry, School of Medicine, Ardabil University of Medical Science, Ardabil, Iran
| | - Pirouz Pourmohammad
- Department of Clinical Biochemistry, School of Medicine, Ardabil University of Medical Science, Ardabil, Iran
| | - Mohammad Pirouzpanah
- Department of Genetic and Bioengineering, Faculty of Engineering and Architecture, Yeditepe University, 34755, Istanbul, Turkey
| | - Fatemeh Salehnia
- Drug Applied Research Center, and Department of Medical Biotechnology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nazila Fathi Maroufi
- Drug Applied Research Center, and Department of Medical Biotechnology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nasser Samadi
- Drug Applied Research Center, and Department of Medical Biotechnology, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mehdi Sabzichi
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
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38
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Implications of metabolism-driven myeloid dysfunctions in cancer therapy. Cell Mol Immunol 2020; 18:829-841. [PMID: 33077904 PMCID: PMC7570408 DOI: 10.1038/s41423-020-00556-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/10/2020] [Indexed: 02/07/2023] Open
Abstract
Immune homeostasis is maintained by an adequate balance of myeloid and lymphoid responses. In chronic inflammatory states, including cancer, this balance is lost due to dramatic expansion of myeloid progenitors that fail to mature to functional inflammatory neutrophils, macrophages, and dendritic cells (DCs), thus giving rise to a decline in the antitumor effector lymphoid response. Cancer-related inflammation orchestrates the production of hematopoietic growth factors and cytokines that perpetuate recruitment and activation of myeloid precursors, resulting in unresolved and chronic inflammation. This pathologic inflammation creates profound alterations in the intrinsic cellular metabolism of the myeloid progenitor pool, which is amplified by competition for essential nutrients and by hypoxia-induced metabolic rewiring at the tumor site. Therefore, persistent myelopoiesis and metabolic dysfunctions contribute to the development of cancer, as well as to the severity of a broad range of diseases, including metabolic syndrome and autoimmune and infectious diseases. The aims of this review are to (1) define the metabolic networks implicated in aberrant myelopoiesis observed in cancer patients, (2) discuss the mechanisms underlying these clinical manifestations and the impact of metabolic perturbations on clinical outcomes, and (3) explore new biomarkers and therapeutic strategies to restore immunometabolism and differentiation of myeloid cells towards an effector phenotype to increase host antitumor immunity. We propose that the profound metabolic alterations and associated transcriptional changes triggered by chronic and overactivated immune responses in myeloid cells represent critical factors influencing the balance between therapeutic efficacy and immune-related adverse effects (irAEs) for current therapeutic strategies, including immune checkpoint inhibitor (ICI) therapy.
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39
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An overview of acute gastrointestinal side effects of systemic anti-cancer therapy and their management. Best Pract Res Clin Gastroenterol 2020; 48-49:101691. [PMID: 33317796 DOI: 10.1016/j.bpg.2020.101691] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/06/2020] [Indexed: 01/31/2023]
Abstract
Treatment-related acute gastrointestinal toxicities are a common and often debilitating hurdle encountered in the treatment of cancer patients. While the introduction of targeted therapies such as tyrosine kinase inhibitors has led to improvements in survival outcomes, their use has also been complicated by a high frequency of clinically important adverse effects. Gastrointestinal toxicities such as nausea, vomiting, diarrhoea and hepatotoxicity represent potentially serious adverse events that may necessitate dose reductions, treatment interruptions and cessation of treatment. An improved knowledge of the incidence, pathophysiology, management and prophylaxis of these toxicities is crucial in order to reduce patient morbidity and mortality. In this review, we discuss the main gastrointestinal toxicities associated with chemotherapy and targeted therapies in oncology, outlining their incidence, pathophysiology and expert management guidelines.
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40
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Scattolin T, Bortolamiol E, Visentin F, Palazzolo S, Caligiuri I, Perin T, Canzonieri V, Demitri N, Rizzolio F, Togni A. Palladium(II)-η 3 -Allyl Complexes Bearing N-Trifluoromethyl N-Heterocyclic Carbenes: A New Generation of Anticancer Agents that Restrain the Growth of High-Grade Serous Ovarian Cancer Tumoroids. Chemistry 2020; 26:11868-11876. [PMID: 32368809 DOI: 10.1002/chem.202002199] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Indexed: 01/14/2023]
Abstract
The first palladium organometallic compounds bearing N-trifluoromethyl N-heterocyclic carbenes have been synthesized. These η3 -allyl complexes are potent antiproliferative agents against different cancer lines (for the most part, IC50 values fall in the range 0.02-0.5 μm). By choosing 1,3,5-triaza-7-phosphaadamantane (PTA) as co-ligand, we can improve the selectivity toward tumor cells, whereas the introduction of 2-methyl substituents generally reduces the antitumor activity slightly. A series of biochemical assays, aimed at defining the cellular targets of these palladium complexes, has shown that mitochondria are damaged before DNA, thus revealing a behavior substantially different from that of cisplatin and its derivatives. We assume that the specific mechanism of action of these organometallic compounds involves nucleophilic attack on the η3 -allyl fragment. The effectiveness of a representative complex, 4 c, was verified on ovarian cancer tumoroids derived from patients. The results are promising: unlike carboplatin, our compound turned out to be very active and showed a low toxicity toward normal liver organoids.
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Affiliation(s)
- Thomas Scattolin
- Department of Chemistry and Centre for Sustainable Chemistry, Ghent University, Krijgslaan 281,S-3, 9000, Ghent, Belgium
| | - Enrica Bortolamiol
- Department of Molecular Sciences and Nanosystems, Università Ca' Foscari, Campus Scientifico Via Torino 155, 30174, Venezia-Mestre, Italy
| | - Fabiano Visentin
- Department of Molecular Sciences and Nanosystems, Università Ca' Foscari, Campus Scientifico Via Torino 155, 30174, Venezia-Mestre, Italy
| | - Stefano Palazzolo
- Pathology Unit, Department of Molecular Biology and Translational Research, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081, Aviano, Italy
| | - Isabella Caligiuri
- Pathology Unit, Department of Molecular Biology and Translational Research, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081, Aviano, Italy
| | - Tiziana Perin
- Pathology Unit, Department of Molecular Biology and Translational Research, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081, Aviano, Italy
| | - Vincenzo Canzonieri
- Pathology Unit, Department of Molecular Biology and Translational Research, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081, Aviano, Italy.,Department of Medical, Surgical and Health Sciences, Università degli Studi di Trieste, Strada di Fiume 447, Trieste, Italy
| | - Nicola Demitri
- Elettra-Sincrotrone Trieste, S.S. 14 Km 163.5, Area Science Park Basovizza, 34149, Trieste, Italy
| | - Flavio Rizzolio
- Department of Molecular Sciences and Nanosystems, Università Ca' Foscari, Campus Scientifico Via Torino 155, 30174, Venezia-Mestre, Italy.,Pathology Unit, Department of Molecular Biology and Translational Research, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081, Aviano, Italy
| | - Antonio Togni
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology, ETH Zürich, Vladimir-Prelog-Weg 2, 8093, Zürich, Switzerland
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Venturini E, Iannuzzo G, D’Andrea A, Pacileo M, Tarantini L, Canale M, Gentile M, Vitale G, Sarullo F, Vastarella R, Di Lorenzo A, Testa C, Parlato A, Vigorito C, Giallauria F. Oncology and Cardiac Rehabilitation: An Underrated Relationship. J Clin Med 2020; 9:E1810. [PMID: 32532011 PMCID: PMC7356735 DOI: 10.3390/jcm9061810] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023] Open
Abstract
Cancer and cardiovascular diseases are globally the leading causes of mortality and morbidity. These conditions are closely related, beyond that of sharing many risk factors. The term bidirectional relationship indicates that cardiovascular diseases increase the likelihood of getting cancer and vice versa. The biological and biochemical pathways underlying this close relationship will be analyzed. In this new overlapping scenario, physical activity and exercise are proven protective behaviors against both cardiovascular diseases and cancer. Many observational studies link an increase in physical activity to a reduction in either the development or progression of cancer, as well as to a reduction in risk in cardiovascular diseases, a non-negligible cause of death for long-term cancer survivors. Exercise is an effective tool for improving cardio-respiratory fitness, quality of life, psychological wellbeing, reducing fatigue, anxiety and depression. Finally, it can counteract the toxic effects of cancer therapy. The protection obtained from physical activity and exercise will be discussed in the various stages of the cancer continuum, from diagnosis, to adjuvant therapy, and from the metastatic phase to long-term effects. Particular attention will be paid to the shelter against chemotherapy, radiotherapy, cardiovascular risk factors or new onset cardiovascular diseases. Cardio-Oncology Rehabilitation is an exercise-based multi-component intervention, starting from the model of Cardiac Rehabilitation, with few modifications, to improve care and the prognosis of a patient's cancer. The network of professionals dedicated to Cardiac Rehabilitation is a ready-to-use resource, for implementing Cardio-Oncology Rehabilitation.
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Affiliation(s)
- E. Venturini
- Cardiac Rehabilitation Unit, Azienda USL Toscana Nord-Ovest, Cecina Civil Hospital, 57023 LI Cecina, Italy
| | - G. Iannuzzo
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (G.I.); (M.G.)
| | - A. D’Andrea
- Unit of Cardiology and Intensive Care, “Umberto I” Hospital, Viale San Francesco, Nocera Inferiore, 84014 SA, Italy; (A.D.); (M.P.)
| | - M. Pacileo
- Unit of Cardiology and Intensive Care, “Umberto I” Hospital, Viale San Francesco, Nocera Inferiore, 84014 SA, Italy; (A.D.); (M.P.)
| | - L. Tarantini
- Division of Cardiology, Ospedale San Martino ULSS1 Dolomiti, 32100 Belluno, Italy;
| | - M.L. Canale
- Department of Cardiology, Azienda USL Toscana Nord-Ovest, Ospedale Versilia, Lido di Camaiore, 55041 LU, Italy;
| | - M. Gentile
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (G.I.); (M.G.)
| | - G. Vitale
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, 90123 Palermo, Italy; (G.V.); (F.M.S.)
| | - F.M. Sarullo
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, 90123 Palermo, Italy; (G.V.); (F.M.S.)
| | - R. Vastarella
- UOSD Scompenso Cardiaco e Cardiologia Riabilitativa, AORN Ospedale dei Colli-Monaldi, 80131 Naples, Italy;
| | - A. Di Lorenzo
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (A.D.L.); (C.T.); (A.P.); (C.V.); (F.G.)
| | - C. Testa
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (A.D.L.); (C.T.); (A.P.); (C.V.); (F.G.)
| | - A. Parlato
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (A.D.L.); (C.T.); (A.P.); (C.V.); (F.G.)
| | - C. Vigorito
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (A.D.L.); (C.T.); (A.P.); (C.V.); (F.G.)
| | - F. Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (A.D.L.); (C.T.); (A.P.); (C.V.); (F.G.)
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Qian J, Zhang X, Zhang B, Yan B, Wang L, Gu P, Wang W, Wang H, Han B. Tyrosine Kinase Inhibitor-Related Hepatotoxicity in Patients with Advanced Lung Adenocarcinoma: A Real-World Retrospective Study. Cancer Manag Res 2020; 12:3293-3299. [PMID: 32494193 PMCID: PMC7227784 DOI: 10.2147/cmar.s237968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 04/02/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose Hepatic injury is a common side effect following tyrosine kinase inhibitor (TKI) therapy and our understanding usually comes from clinical trials. In this retrospective study, we aimed to investigate the characteristics, risk factors and regimen-related differences of epidermal growth factor receptor (EGFR)-TKI-related hepatic toxicity in patients with advanced lung adenocarcinoma (LAD). Patients and Methods Liver function tests were documented in 424 patients admitted into the Shanghai Chest Hospital between January 2014 and December 2016 with advanced (IIIB/IV) LAD who received first-line gefitinib, erlotinib or icotinib. Hepatotoxicity was graded according to the Common Terminology Criteria for Adverse Events (CTCAE), version 4.0. The clinical spectrum and onset time of hepatic injury were evaluated. The risk factors of hepatic dysfunction were determined using a logistic regression analysis. Results A total of 87 (20.5%) patients experienced hepatotoxicity and 5.7% were of grade 3/4 liver dysfunction. The median onset time of hepatotoxicity was 7 weeks. Presence of hepatitis virus (HR: 2.593, 95% CI: 1.090–6.170, P=0.031) and pretreatment liver impairment (HR: 3.460, 95% CI: 1.746–6.855, P<0.001) were risk factors associated with increased risk of hepatotoxicity. Gefitinib (HR: 1.872, 95% CI: 1.028–3.412, P=0.040) and erlotinib (HR: 3.578, 95% CI: 1.683–7.609, P=0.001) had increased risk of hepatotoxicity compared to icotinib. Conclusion The different toxic profile of EGFR-TKIs should be taken into account in the choice of treatment based on the patients’ comorbidity.
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Affiliation(s)
- Jie Qian
- Department of Emergency Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xueyan Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Bo Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Bo Yan
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Lin Wang
- Department of Laboratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Ping Gu
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Weimin Wang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Huimin Wang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Baohui Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Mashni O, Qasem K, Sara AA, Awad W. Etoposide dosage adjustment in two patients with neuroendocrine tumors and severe liver impairment. J Oncol Pharm Pract 2020; 26:500-506. [DOI: 10.1177/1078155219859630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction Limited data are available on dosing etoposide in patients with liver impairment. Case report We report the dosing strategies for etoposide utilized in two patients with neuroendocrine tumors and severe liver impairment. Management and outcomes Treatment consisted of platinum-based chemotherapy regimens, with the decision of whether to administer etoposide and at what doses being based on the liver function before each chemotherapy cycle. By the end of treatment, total bilirubin was normal, and the performance status of both patients had improved, with stable computed tomography scan findings. Discussion The reported two cases suggest that the administration of etoposide at reduced doses with close monitoring in patients with neuroendocrine tumors and severe liver impairment may still be considered as an option and may improve outcomes.
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Affiliation(s)
- Ola Mashni
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Khlood Qasem
- Department of Hematology and Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Aseel Abu Sara
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Wedad Awad
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
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Rogers JE, Mizrahi JD, Shroff RT, Nelson DA, Tu J, Javle MM, Wolff RA, Pant S. Dose-modified gemcitabine plus nab-paclitaxel front-line in advanced pancreatic ductal adenocarcinoma with baseline hyperbilirubinemia. J Gastrointest Oncol 2020; 11:55-60. [PMID: 32175105 DOI: 10.21037/jgo.2019.10.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Von Hoff et al. demonstrated survival improvement with gemcitabine (GEM) + nab-paclitaxel (NabP) for metastatic pancreatic ductal adenocarcinoma (PDAC) compared to GEM alone. GEM + NabP resulted in a median overall survival (OS) and progression-free survival (PFS) of 8.5 and 5.5 months, respectively. Patients with baseline hyperbilirubinemia were excluded. Primary objective was OS. Secondary objectives included time on treatment (TOT), disease control rate, dosing practices, delays/admissions, and adverse effects. Methods Patients with borderline resectable, locally advanced, or metastatic PDAC who initiated front-line GEM-NabP during July 01, 2013-July 01, 2017 were reviewed. Patients with a baseline total bilirubin ≥2 mg/dL were included. Results Twelve patients total were included. Median age was 71 years old. Median baseline total bilirubin was 2.4 mg/dL (range, 2.1-5.2 mg/dL). 58% had metastatic disease. Median doses were NabP 100 mg/m2 + GEM 600 mg/m2 IV with a fixed-dose rate infusion (10 mg/m2/min). GEM-NabP was given biweekly or 3 weeks on 1 week off. Median OS, TOT, and disease control rate were 13.9, 5.2 months, and 58%, respectively. Fifty percent of patients required a dose delay. Metastatic patients only (n=7) had median OS and TOT of 6.9 and 2.1 months, respectively. No admissions related to toxicity were found. Conclusions Our analysis revealed safety with NabP (median dose =100 mg/m2) + GEM (median dose =600 mg/m2 at fixed-dose rate) given predominately biweekly in patients with a baseline elevated total bilirubin (≥2 mg/dL).
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Affiliation(s)
- Jane E Rogers
- U.T. M.D. Anderson Cancer Center Pharmacy Clinical Programs, Houston TX, USA
| | - Jonathan D Mizrahi
- U.T. M.D. Anderson Cancer Center Department of Cancer Medicine, Houston TX, USA
| | - Rachna T Shroff
- U.T. M.D. Anderson Cancer Center Department of Gastrointestinal Medical Oncology, Houston, TX, USA
| | - Douglas A Nelson
- U.T. M.D. Anderson Cancer Center Department of General Medical Oncology, Houston TX, USA
| | - Janet Tu
- U.T. M.D. Anderson Cancer Center Department of General Medical Oncology, Houston TX, USA
| | - Milind M Javle
- U.T. M.D. Anderson Cancer Center Department of Gastrointestinal Medical Oncology, Houston, TX, USA
| | - Robert A Wolff
- U.T. M.D. Anderson Cancer Center Department of Gastrointestinal Medical Oncology, Houston, TX, USA
| | - Shubham Pant
- U.T. M.D. Anderson Cancer Center Department of Investigation Cancer Therapeutics and Gastrointestinal Medical Oncology, Houston, TX, USA
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Affiliation(s)
- Brian K Alverson
- From the Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI (B.K.A.); and the Departments of Radiology (A.K.), Pediatrics (A.M.F.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Radiology (A.K.), Pediatrics (A.M.F.), and Pathology (A.R.S.), Harvard Medical School - both in Boston
| | - Aoife Kilcoyne
- From the Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI (B.K.A.); and the Departments of Radiology (A.K.), Pediatrics (A.M.F.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Radiology (A.K.), Pediatrics (A.M.F.), and Pathology (A.R.S.), Harvard Medical School - both in Boston
| | - Alison M Friedmann
- From the Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI (B.K.A.); and the Departments of Radiology (A.K.), Pediatrics (A.M.F.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Radiology (A.K.), Pediatrics (A.M.F.), and Pathology (A.R.S.), Harvard Medical School - both in Boston
| | - Aliyah R Sohani
- From the Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI (B.K.A.); and the Departments of Radiology (A.K.), Pediatrics (A.M.F.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Radiology (A.K.), Pediatrics (A.M.F.), and Pathology (A.R.S.), Harvard Medical School - both in Boston
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Urrutia-Maldonado E, Abril-Molina A, Alés-Palmer M, Gómez-Luque JM, Muñoz de Rueda P, Ocete-Hita E. Lesión hepática inducida por quimioterapia en niños. An Pediatr (Barc) 2019; 91:256-263. [DOI: 10.1016/j.anpedi.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/28/2018] [Accepted: 01/09/2019] [Indexed: 01/19/2023] Open
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Urrutia-Maldonado E, Abril-Molina A, Alés-Palmer M, Gómez-Luque JM, Muñoz de Rueda P, Ocete-Hita E. Chemotherapy-induced liver injury in children. An Pediatr (Barc) 2019. [DOI: 10.1016/j.anpede.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Smuder AJ. Exercise stimulates beneficial adaptations to diminish doxorubicin-induced cellular toxicity. Am J Physiol Regul Integr Comp Physiol 2019; 317:R662-R672. [PMID: 31461307 DOI: 10.1152/ajpregu.00161.2019] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Doxorubicin (DOX) is a highly effective antitumor agent used for the treatment of a wide range of cancers. Unfortunately, DOX treatment results in cytotoxic side effects due to its accumulation within off-target tissues. DOX-induced cellular toxicity occurs as a result of increased oxidative damage, resulting in apoptosis and cell death. While there is no standard-of-care practice to prevent DOX-induced toxicity to healthy organs, exercise has been shown to prevent cellular dysfunction when combined with DOX chemotherapy. Endurance exercise stimulates numerous biochemical adaptations that promote a healthy phenotype in several vulnerable tissues without affecting the antineoplastic properties of DOX. Therefore, for the development of an effective strategy to combat the pathological effects of DOX, it is important to determine the appropriate exercise regimen to prescribe to cancer patients receiving DOX therapy and to understand the mechanisms responsible for exercise-induced protection against DOX toxicity to noncancer cells. This review summarizes the cytotoxic effects of DOX on the heart, skeletal muscle, liver, and kidneys and discusses the current understanding of the clinical benefits of regular physical activity and the potential mechanisms mediating the positive effects of exercise on each organ system.
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Affiliation(s)
- Ashley J Smuder
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
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Clinical efficacy and safety of synthetic thymic peptides with chemotherapy for non-small cell lung cancer in China: A systematic review and meta-analysis of 27 randomized controlled trials following the PRISMA guidelines. Int Immunopharmacol 2019; 75:105747. [PMID: 31326719 DOI: 10.1016/j.intimp.2019.105747] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/27/2019] [Accepted: 07/08/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Synthetic thymic peptides (sTPs) are used with chemotherapy to treat non-small cell lung cancer (NSCLC). In this study, we have performed a systematic review and meta-analysis of published trials to confirm the clinical efficacy and safety of sTPs, and determine the optimal types, usages, and sTP/chemotherapy combinations to produce the desired responses. MATERIALS AND METHODS We collected all studies regarding combined sTP therapy and chemotherapy for NSCLC from the Chinese and English databases (up to October 2018). Bias risk was evaluated for each. Data for meta-analysis was extracted using a pre-designed form. Evidence quality was rated using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS We included 27 randomized controlled trials containing 1925 patients, most with unclear bias risk. Combining sTPs with chemotherapy significantly increased the objective response rate [1.28, (1.13 to 1.45)], disease control rate [1.10, (1.01 to 1.18)], quality of life (QOL) [2.05, (1.62, 2.60)], and 1-year overall survival rate [1.43, (1.15 to 1.78)], with decreased risks of neutropenia, thrombocytopenia, and gastrointestinal reactions. Optimal conditions included treatment in combination with gemcitabine or navelbine and cisplatin, twice a week, with one 3-week cycle. In these conditions, thymosin α1 improved both antitumor immunity and tumor response. Most results had good robustness, and their quality ranged from moderate to very low. CONCLUSIONS The results suggest that treatment with sTPs, especially thymosin α1, and concomitant chemotherapy is beneficial to the patient, and provide evidence for optimal treatment regimens that may increase patient QOL and survival.
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Lee S, Chang P, Chen P, Lu C, Hung Y, Tsang N, Hung C, Chen J, Hsu H, Chen Y, Chou W. Association of time interval between cancer diagnosis and initiation of palliative chemotherapy with overall survival in patients with unresectable pancreatic cancer. Cancer Med 2019; 8:3471-3478. [PMID: 31099160 PMCID: PMC6601580 DOI: 10.1002/cam4.2254] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/22/2019] [Accepted: 05/03/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Palliative chemotherapy is the standard treatment for patients with unresectable pancreatic cancer. Whether the early initiation of palliative chemotherapy is associated with a favorable survival outcome for these patients is not known. This study aimed to analyze the association of the time interval between cancer diagnosis and initiation of palliative chemotherapy with survival outcome in patients with pancreatic cancer. METHOD A total of 838 patients with unresectable pancreatic cancer who underwent palliative chemotherapy from 2010 to 2016 at 4 institutions in Taiwan were retrospectively enrolled. All patients were categorized according to time interval between cancer diagnosis and initiation of palliative chemotherapy for comparison of the survival outcome. RESULT The median time interval was 14 days (range, 0 to 163 days) in our patient cohort. Accordingly, 22%, 29%, and 49% of the patients underwent palliative chemotherapy within 1, 1 to 2, and >2 weeks after cancer diagnosis, respectively. The survival outcome had no statistical difference among these 3 patient groups. Subgroup analyses revealed that patients with the time interval ≤2 weeks exhibited poorer survival outcome than those with the time interval >2 weeks if they initially presented with jaundice (6.1 months vs 8.4 months, P = 0.029). In contrast, patients with the time interval ≤2 weeks revealed a better survival outcome than those with the time interval >2 weeks if they initially presented with pain (8.0 vs 6.3 months, P = 0.014). CONCLUSION In our study, time interval between cancer diagnosis and the initiation of palliative chemotherapy >2 weeks was not associated with a poorer survival outcome for patients with unresectable pancreatic cancer. Our result might help clinicians to clarify that early initiation of palliative chemotherapy might provide survival benefit for patients who present with tumor pain, but not for those who present with jaundice.
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Affiliation(s)
- Shu‐Hui Lee
- Department of Nursing, College of MedicineChang Gung Memorial Hospital at Linkou and Chang Gung UniversityTaoyuanTaiwan
| | - Pei‐Hung Chang
- Department of Hematology‐OncologyChang Gung Memorial Hospital at KeelungKeelungTaiwan
| | - Ping‐Tsung Chen
- Department of Hematology‐OncologyChang Gung Memorial HospitalChiayiTaiwan
| | - Chang‐Hsien Lu
- Department of Hematology‐OncologyChang Gung Memorial HospitalChiayiTaiwan
| | - Yu‐Shin Hung
- Department of Hematology‐Oncology, College of MedicineChang Gung Memorial Hospital at Linkou and Chang Gung UniversityTaoyuanTaiwan
| | - Ngan‐Ming Tsang
- Department of Radiation Oncology, College of MedicineChang Gung Memorial Hospital at Linkou and Chang Gung UniversityTaoyuanTaiwan
| | - Chia‐Yen Hung
- Department of Hematology‐Oncology, College of MedicineChang Gung Memorial Hospital at Linkou and Chang Gung UniversityTaoyuanTaiwan
- Department of Hematology‐OncologyMackay General HospitalTaipeiTaiwan
| | - Jen‐Shi Chen
- Department of Hematology‐Oncology, College of MedicineChang Gung Memorial Hospital at Linkou and Chang Gung UniversityTaoyuanTaiwan
| | - Hung‐Chih Hsu
- Department of Hematology‐Oncology, College of MedicineChang Gung Memorial Hospital at Linkou and Chang Gung UniversityTaoyuanTaiwan
| | - Yen‐Yang Chen
- Department of Hematology‐OncologyChang Gung Memorial Hospital at KaohsiungKaohsiungTaiwan
| | - Wen‐Chi Chou
- Department of Hematology‐Oncology, College of MedicineChang Gung Memorial Hospital at Linkou and Chang Gung UniversityTaoyuanTaiwan
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