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Leigh SJ, Lynch CMK, Bird BRH, Griffin BT, Cryan JF, Clarke G. Gut microbiota-drug interactions in cancer pharmacotherapies: implications for efficacy and adverse effects. Expert Opin Drug Metab Toxicol 2022; 18:5-26. [PMID: 35176217 DOI: 10.1080/17425255.2022.2043849] [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: 02/08/2023]
Abstract
INTRODUCTION The gut microbiota is involved in host physiology and health. Reciprocal microbiota-drug interactions are increasingly recognized as underlying some individual differences in therapy response and adverse events. Cancer pharmacotherapies are characterized by a high degree of interpatient variability in efficacy and side effect profile and recently, the microbiota has emerged as a factor that may underlie these differences. AREAS COVERED The effects of cancer pharmacotherapy on microbiota composition and function are reviewed with consideration of the relationship between baseline microbiota composition, microbiota modification, antibiotics exposure and cancer therapy efficacy. We assess the evidence implicating the microbiota in cancer therapy-related adverse events including impaired gut function, cognition and pain perception. Finally, potential mechanisms underlying microbiota-cancer drug interactions are described, including direct microbial metabolism, and microbial modulation of liver metabolism and immune function. This review focused on preclinical and clinical studies conducted in the last 5 years. EXPERT OPINION Preclinical and clinical research supports a role for baseline microbiota in cancer therapy efficacy, with emerging evidence that the microbiota modification may assist in side effect management. Future efforts should focus on exploiting this knowledge towards the development of microbiota-targeted therapies. Finally, a focus on specific drug-microbiota-cancer interactions is warranted.
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Affiliation(s)
| | | | | | | | - John F Cryan
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Gerard Clarke
- APC Microbiome Ireland, University College Cork, Cork, Ireland
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Lawrence NJ, Martin A, Davis ID, Troon S, Sengupta S, Hovey E, Coskinas X, Kaplan R, Smith B, Ritchie A, Meade A, Eisen T, Blinman P, Stockler MR. What Survival Benefits are Needed to Make Adjuvant Sorafenib Worthwhile After Resection of Intermediate- or High-Risk Renal Cell Carcinoma? Clinical Investigators' Preferences in the SORCE Trial. KIDNEY CANCER 2018; 2:123-131. [PMID: 30740581 PMCID: PMC6364092 DOI: 10.3233/kca-180038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Decisions about adjuvant therapy involve trade-offs between possible benefits and harms. Objective We sought to determine the survival benefits that clinical investigators would judge as sufficient to warrant treatment with adjuvant sorafenib in the SORCE trial after nephrectomy for apparently localised renal cell carcinoma (RCC). Methods A subset of clinical investigators in the SORCE trial completed a validated questionnaire that elicited the minimum survival benefits they judged sufficient to warrant one year of adjuvant sorafenib in scenarios with hypothetical baseline survival times of 5 years and 15 years, and baseline survival rates at 5 years of 65% and 85%. Results The 100 participating SORCE investigators had a median age of 42 years, and 74 were male. For one year of sorafenib versus no therapy, the median benefits in survival times the investigators judged sufficient to warrant treatment were an extra nine months beyond five years and an extra 12 months beyond 15 years; the median benefits in survival rates were an extra 5% beyond baseline survival rates of both 65% and 85% at five years. The patients recruited in the SORCE trial by these investigators judged smaller benefits sufficient to warrant adjuvant sorafenib for both survival rate scenarios (p≤0.0001). The survival benefits the investigators judged sufficient to warrant one year of adjuvant therapy with sorafenib for RCC were similar to those of other clinicians considering three months of adjuvant chemotherapy for lung cancer, but smaller than those of clinicians considering six months of adjuvant chemotherapy for breast cancer. Conclusion SORCE investigators judged larger benefits necessary to warrant adjuvant sorafenib than their patients. The benefits required by the investigators were similar or smaller than those other clinicians considered sufficient to warrant adjuvant chemotherapy for other cancers. Clinicians should recognise that their patients and colleagues may have preferences that differ from their own when considering the potential benefits and harms of adjuvant treatment.
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Affiliation(s)
- Nicola J Lawrence
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia
| | - Andrew Martin
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia
| | - Ian D Davis
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Oncology, Eastern Health, Box Hill, VIC, Australia
| | - Simon Troon
- Fiona Stanley Hospital, Perth, WA, Australia
| | - Shomik Sengupta
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Elizabeth Hovey
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia.,Nelune Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Xanthi Coskinas
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Richard Kaplan
- MRC Clinical Trials Unit, University College London, London, UK
| | - Benjamin Smith
- MRC Clinical Trials Unit, University College London, London, UK
| | | | - Angela Meade
- MRC Clinical Trials Unit, University College London, London, UK
| | - Tim Eisen
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Prunella Blinman
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia.,Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Martin R Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia.,Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, NSW, Australia.,Chris O'Brien Lifehouse, Sydney, NSW, Australia
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Lainez N, García-Donas J, Esteban E, Puente J, Sáez MI, Gallardo E, Pinto-Marín Á, Vázquez-Estévez S, León L, García-Carbonero I, Suárez-Rodríguez C, Molins C, Climent-Duran MA, Lázaro-Quintela M, González Del Alba A, Méndez-Vidal MJ, Chirivella I, Afonso FJ, López-Brea M, Sala-González N, Domenech M, Basterretxea L, Santander-Lobera C, Gil-Arnáiz I, Fernández O, Caballero-Díaz C, Mellado B, Marrupe D, García-Sánchez J, Sánchez-Escribano R, Fernández Parra E, Villa Guzmán JC, Martínez-Ortega E, Belén González M, Morán M, Suarez-Paniagua B, Lecumberri MJ, Castellano D. Impact on clinical practice of the implementation of guidelines for the toxicity management of targeted therapies in kidney cancer. The protect-2 study. BMC Cancer 2016; 16:135. [PMID: 26906039 PMCID: PMC4763443 DOI: 10.1186/s12885-016-2084-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/25/2016] [Indexed: 12/21/2022] Open
Abstract
Background The impact of such recommendations after their implementation of guidelines has not usually been evaluated. Herein, we assessed the impact and compliance with the Spanish Oncology Genitourinary Group (SOGUG) Guidelines for toxicity management of targeted therapies in metastatic renal cell carcinoma (mRCC) in daily clinical practice. Methods Data on 407 mRCC patients who initiated first-line targeted therapy during the year before and the year after publication and implementation of the SOGUG guideline program were available from 34 Spanish Hospitals. Adherence to SOGUG Guidelines was assessed in every cycle. Results Adverse event (AE) management was consistent with the Guidelines as a whole for 28.7 % out of 966 post-implementation cycles compared with 23.1 % out of 892 pre-implementation cycles (p = 0.006). Analysis of adherence by AE in non-compliant cycles showed significant changes in appropriate management of hypertension (33 % pre-implementation vs. 44.5 % post-implementation cycles; p < 0.0001), diarrhea (74.0 % vs. 80.5 %; p = 0.011) and dyslipemia (25.0 % vs. 44.6 %; p < 0.001). Conclusions Slight but significant improvements in AE management were detected following the implementation of SOGUG recommendations. However, room for improvement in the management of AEs due to targeted agents still remains and could be the focus for further programs in this direction.
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Affiliation(s)
- Nuria Lainez
- Department of oncology, Complejo Hospitalario de Navarra, Servicio Oncología Médica. Pabellón B 2ª planta. Hospital de día, C/ Irunlarrea, 3, 31008, Pamplona, Navarra, Spain.
| | - Jesús García-Donas
- Department of oncology, Hospital Sanchinarro, C/ Oña, 10, 28050, Madrid, Spain.
| | - Emilio Esteban
- Department of oncology, Hospital Universitario Central de Asturias, Julián Clavería s/n, 33006, Oviedo, Spain.
| | - Javier Puente
- Department of oncology, Hospital Clínico de Madrid, C/ Doctor Martín Lagos s/n, 28040, Madrid, Spain.
| | - M Isabel Sáez
- Department of oncology, Hospital Universitario Clínico Virgen de la Victoria, Campus Universitario de Teatinos, s/n, 29010, Málaga, Spain.
| | - Enrique Gallardo
- Department of oncology, Parc Taulí Sabadell Hospital Universitari, Parc Taulí 1, 08208, Sabadell, Spain.
| | - Álvaro Pinto-Marín
- Department of oncology, Hospital Universitario La Paz, P de la Castellana 261, 28046, Madrid, Spain.
| | - Sergio Vázquez-Estévez
- Department of oncology, Hospital Universitario Lucus Augusti, Lugar San Cibrao, S/N, 27003, Lugo, Spain.
| | - Luis León
- Department of oncology, Hospital Santiago de Compostela, Travesía da Choupana, s/n, 15706, Santiago de Compostela, Spain.
| | - Icíar García-Carbonero
- Department of oncology, Hospital Virgen de la Salud, Adva. De Barber, 30, 45004, Toledo, Spain.
| | | | - Carmen Molins
- Department of oncology, Hospital Universitario Dr. Peset, Avda. Gaspar Aguilar 90, 46017, Valencia, Spain.
| | - Miguel A Climent-Duran
- Department of oncology, Instituto Valenciano de Oncología, Gregorio Gea, 31-1° Planta, 46009, Valencia, Spain.
| | - Martín Lázaro-Quintela
- Department of oncology, Complexo Hospitalario Universitario de Vigo, Pizarro 22, 36204, Vigo, Spain.
| | - Aranzazu González Del Alba
- Department of oncology, Hospital Universitario Son Espases, Ctra Valldemossa, 79, 07010, Palma de Mallorca, Spain.
| | - María José Méndez-Vidal
- Department of oncology, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal, s/n, 14004, Córdoba, Spain.
| | - Isabel Chirivella
- Department of oncology, Hospital Clínico de Valencia, Avda Blasco Ibáñez, 17, 46010, Valencia, Spain.
| | - Francisco J Afonso
- Department of oncology, Complejo Hospitalario Arquitecto Marcide, Rúa da residencia s/n. San pedro de Leixa, 15405, Ferrol, Spain.
| | - Marta López-Brea
- Department of oncology, Hospital Marqués de Valdecilla, Avda. Valdecila s/n, 39008, Santander, Spain.
| | | | - Montserrat Domenech
- Department of oncology, Hospital de Althaia Xarxa Asistencial Manresa, Dr. Joan Soler, 1-3, 08243, Barcelona, Spain.
| | - Laura Basterretxea
- Department of oncology, Hospital de Donostia, P° Dr. Beguiristain 109, 20014, San Sebastian, Spain.
| | - Carmen Santander-Lobera
- Department of oncology, Hospital Miguel Servet, Avda Gómez Laguna 25, 50009, Zaragoza, Spain.
| | - Irene Gil-Arnáiz
- Department of oncology, Hospital Reina Sofía, Carretera Tarazona, KM 3, 31500, Tudela, Spain.
| | - Ovidio Fernández
- Department of oncology, Complejo Hospitalario Ourense. Hospital Santa María Nai, Ramón Puga, 52-54, 32005, Orense, Spain.
| | - Cristina Caballero-Díaz
- Department of oncology, Hospital General Universitario de Valencia, Avda Tres Cruces, s/n, 46014, Valencia, Spain.
| | - Begoña Mellado
- Department of oncology, IDIBAPS, Hospital Clinic i Provincial de Barcelona, Villarroel, 170, 08036, Barcelona, Spain.
| | - David Marrupe
- Department of oncology, Hospital Universitario de Móstoles, Río Júcar s/n, 28935, Móstoles, Madrid, Spain.
| | - José García-Sánchez
- Department of oncology, Hospital Arnau de Vilanova, C/ San Clemente n 12, 46015, Valencia, Spain.
| | - Ricardo Sánchez-Escribano
- Department of oncology, Hospital Universitario de Burgos, Avenida Cid Campeador, 96, 09005, Burgos, Spain.
| | - Eva Fernández Parra
- Department of oncology, H.U. Hospital de Valme, Ctra. de Cádiz Km. 548.9, 41014, Sevilla, Spain.
| | - José C Villa Guzmán
- Department of oncology, Hospital de Ciudad Real, Obispo Rafael Torija, 13005, Ciudad Real, Spain.
| | - Esther Martínez-Ortega
- Department of oncology, Hospital Ciudad de Jaén, Avenida Ejercito Español 10, 23007, Jaén, Spain.
| | - María Belén González
- Department of oncology, Hospital Son Llatzer, Ctra. Manacor, km.4, Sont Frriol, 07198, Palma de Mallorca, Spain.
| | - Marina Morán
- Pfizer Madrid, Avda. de Europa, 20B, 28108, Alcobendas, Madrid, Spain.
| | | | - María J Lecumberri
- Department of oncology, Complejo Hospitalario de Navarra, Servicio Oncología Médica. Pabellón B 2ª planta. Hospital de día, C/ Irunlarrea, 3, 31008, Pamplona, Navarra, Spain.
| | - Daniel Castellano
- Department of oncology, Hospital 12 de Octubre, Av. de Córdoba s/n, 28041, Madrid, Spain.
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