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Li S, Wang H. Research Progress on Mechanism and Management of Adverse Drug Reactions of Anlotinib. Drug Des Devel Ther 2023; 17:3429-3437. [PMID: 38024530 PMCID: PMC10657757 DOI: 10.2147/dddt.s426898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Anti-angiogenesis therapy plays a vital role in the treatment of tumors, with anlotinib as its representative targeted drug. Anlotinib is a novel oral tyrosine kinase inhibitor (TKI) with inhibitory effects on tumor growth tumor angiogenesis. In Phase III clinical trials, anlotinib demonstrated better overall survival and progression-free survival than placebo in patients with advanced non-small cell lung cancer (NSCLC), and was approved for the first time as a third-line treatment for refractory advanced NSCLC. Going far beyond that, anlotinib has shown encouraging results in a variety of malignancies, including medullary thyroid carcinoma, renal cell carcinoma, gastric cancer and esophageal squamous cell carcinoma. Nevertheless, anlotinib has been subject to some controversy in terms of adverse events due to its widespread use. In this review, the mechanism of action, pharmacokinetic characteristics, adverse reactions in clinical use and management of anlotinib were summarized.
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Affiliation(s)
- Shiting Li
- Department of Pharmacy, Inner Mongolia Baogang Hospital, Baotou City, Inner, Mongolia, People’s Republic of China
| | - Hongqin Wang
- Department of Pharmacy, Inner Mongolia Baogang Hospital, Baotou City, Inner, Mongolia, People’s Republic of China
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2
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Zhang L, Hu A, Wang Y, Yang Y, Liu Y, Xu L, Wang L, Cheng Z. Medication adjustment of afatinib and combination therapy with sitagliptin for alleviating afatinib-induced diarrhea in rats. Neoplasia 2023; 43:100922. [PMID: 37567055 PMCID: PMC10423691 DOI: 10.1016/j.neo.2023.100922] [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: 07/13/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023]
Abstract
Afatinib, as the first-line treatment for non-small cell lung cancer (NSCLC), causes severe gastrointestinal adverse reactions that greatly affect patients' quality of life and even potentially result in treatment discontinuation. Multiple dose adjustments and concomitant use of anti-diarrheal medications are commonly employed to manage diarrhea, also allowing for a recovery period between each adjustment. However, these approaches are based on empirical guidance and still have limitations. This study aims to explore reliable approaches to alleviate diarrhea by focusing on two strategies: adjusting the dosing regimen of afatinib itself and implementing combination therapy. In this study, we firstly revealed a dose-dependent relationship between afatinib-induced diarrhea and gastrointestinal epithelial damage, resulting in atrophy, reduced expression of tight junction proteins, and increased permeability. We further found that even after discontinuation of the medication, although the severity of diarrhea had improved to baseline, the tight junction proteins and permeability of the intestinal epithelium did not fully recover, and the pharmacokinetics studies showed that drug absorption significantly increased than normal. This indicated the recovery period was longer than expected and may accelerate the occurrence of subsequent episodes of diarrhea. Hence, it would be prudent to consider adjustments to the starting dose or the recovery interval. Furthermore, we initially investigated the relationship between DPP enzyme and afatinib-induced diarrhea and found a significant decrease in plasma DPP enzyme activity following afatinib-induced diarrhea. Subsequently, we conducted continuous treatment with sitagliptin and observed significant improvement in afatinib-induced diarrhea. We observed that sitagliptin can promote the production of anti-inflammatory factors, increase the expression of intestinal epithelial tight junction proteins, and improve intestinal microbiota, further validating the mechanism through the use of GLP-23-33 as GLP-2 receptor inhibitor. In conclusion, sitagliptin exhibits promising potential as a therapeutic option for managing afatinib-induced diarrhea. Taken together, our study provides valuable insights into alleviating afatinib-induced diarrhea through both afatinib medication adjustment and sitagliptin combination therapy.
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Affiliation(s)
- Li Zhang
- Division of Biopharmaceutics and Pharmacokinetics, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China
| | - Anna Hu
- Division of Biopharmaceutics and Pharmacokinetics, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China
| | - Yan Wang
- Division of Biopharmaceutics and Pharmacokinetics, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China
| | - Yuxin Yang
- Division of Biopharmaceutics and Pharmacokinetics, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China
| | - Yalan Liu
- Division of Biopharmaceutics and Pharmacokinetics, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China
| | - Lian Xu
- Division of Biopharmaceutics and Pharmacokinetics, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China
| | - Lei Wang
- Division of Biopharmaceutics and Pharmacokinetics, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China; Department of Rheumatology and Immunology, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, China; Integrated Chinese and Western Medicine Postdoctoral Research Station, Jinan University, Guangzhou 510632, China.
| | - Zeneng Cheng
- Division of Biopharmaceutics and Pharmacokinetics, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China.
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Lin Y, Liu PY. Case Report: Severe rash/desquamation induced by sorafenib in an uHCC patient and its clinical management. Front Pharmacol 2022; 13:994865. [PMID: 36176447 PMCID: PMC9514041 DOI: 10.3389/fphar.2022.994865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Sorafenib-related dermatological toxicity is a well-known adverse reaction that can severely affect therapeutic outcomes. Rash/desquamation with its variable manifestations is one of the common clinical presentations. Currently, no standard continuum of care for sorafenib-related rash/desquamation has been established. Case summary: A 75-year-old woman with colorectal cancer who developed unresectable hepatocellular carcinoma (uHCC) received, six years later, sorafenib 400 mg twice daily. She developed a Grade-3 Common Terminology Criteria for Adverse Events (CTCEA) rash and bullae bilaterally on her lower extremities after 2 weeks of sorafenib use. Rash and blisters began to appear on the left calf and then merged as large bullae full of liquid and spread to both lower extremities. The bullae then erupted and skin began to slough off, which affected the patient’s normal daily functioning. To lessen the condition, sorafenib was stopped permanently and dexamethasone intravenous (IV) infusion at 5 mg daily for 3 days and piperacillin/tazobactam were used. The skin dried without exudate or ulcerations after a month. Conclusion: For severe (CTCAE Grade 3 or above) sorafenib-related rash/desquamation, short-term corticosteroid pulse therapy at large doses is usually effective with routine skin care, and antibiotics can be considered if infection is present. Permanent cessation of sorafenib should be considered if severe manifestations such as erythema multiforme (EM) and Steven-Johnson syndrome (SJS) are suspected.
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Affiliation(s)
- Yan Lin
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Ping-Yu Liu
- Department of Pharmacy, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Ping-Yu Liu,
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Kelly D, Fernández-Ortega P, Arjona ET, Daniele B. The role of nursing in the management of patients with renal and hepatic cancers: A systematic literature review. Eur J Oncol Nurs 2021; 55:102043. [PMID: 34655916 DOI: 10.1016/j.ejon.2021.102043] [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] [Received: 04/28/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE This systematic literature review identified publications evaluating the role and benefits of nurse-led care in the management of patients with a diagnosis of renal cell carcinoma (RCC) or hepatocellular carcinoma (HCC). METHODS The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Structured searches of the PubMed database and the EMCare nursing and allied health database were conducted (August 11, 2021). Eligible publications were English-language, full-text, peer-reviewed journal articles featuring HCC and/or RCC populations, interventions involving nurses, any/no comparators, and reporting any related healthcare outcomes. Data on study design and size, patient characteristics and impact of nursing care were extracted. RESULTS Fifty-six relevant articles were identified (43 on HCC; 10 on RCC; 3 on HCC and RCC). The literature described the role and impact of oncology nurses across a variety of care functions, including in health promotion and screening, care coordination, holistic oversight, symptom and adverse event monitoring and management, and emotional support. Twenty-nine empirical studies/case reports were identified demonstrating benefit of nurse-led interventions in HCC/liver cancer (n = 28) and RCC (n = 1). Benefits were achieved through: improved patient participation in screening programs; reduced time to diagnosis; improved treatment adherence, reduced treatment complications, dose reductions and outpatient visits, and potential cost savings. CONCLUSIONS The oncology nurse plays a multifaceted role in the care of patients with HCC and RCC, but more evidence from nurse-led interventions is required to guide optimal multidisciplinary care of patients with these conditions.
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Affiliation(s)
- Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales, UK.
| | - Paz Fernández-Ortega
- Department of Nursing Research, Catalan Institute of Oncology, Hospital Duran i Reynals, Barcelona, Spain
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Xie L, Xu J, Guo W, Wang Z, Yao Y, Li J, Lin J, Xiao J, Yu X, Zhang W, Cai Z, Hua Y, Chen J, Shao Z, Wu D, Wu S, Tu Z, Zhang X. Management of Apatinib-Related Adverse Events in Patients With Advanced Osteosarcoma From Four Prospective Trials: Chinese Sarcoma Study Group Experience. Front Oncol 2021; 11:696865. [PMID: 34367981 PMCID: PMC8339966 DOI: 10.3389/fonc.2021.696865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/29/2021] [Indexed: 02/05/2023] Open
Abstract
Four prospective trials have reported apatinib-related efficacy in osteosarcoma, with a high response rate of 43.2%. Currently, Adverse Events (AEs) have increasingly gained attention, as treatment with multiple tyrosine kinase inhibitors (TKIs) is potentially lifelong. For this reason, a consensus meeting of the Chinese Sarcoma Study Group (CSSG), which is a multidisciplinary panel composed of pediatric, medical and surgical oncologists specializing in sarcoma, nurse specialists, oncological senior pharmacists and gastroenterologists, was held to develop comprehensive guidelines on AEs emerging due to apatinib treatment to better assist in the prevention, management, and understanding of AE development. We summarized all AEs that arose in ≥10% of the participants as well as rare AEs that required extra caution to prevent that were observed in these four published prospective trials and arranged these AEs into 14 disorder systems according to CTCAE 5.0. In this review, we discuss strategies for the management of AEs in patients with advanced osteosarcoma, with the aim of maximizing treatment benefits and minimizing the need for apatinib treatment discontinuation. We also focus on providing recommendations for the prophylaxis and treatment of advanced osteosarcoma using apatinib to achieve optimal outcomes.
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Affiliation(s)
- Lu Xie
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Jie Xu
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Zhen Wang
- Orthopedic Oncology, Xijing Hospital Air Force Medical University of PLA (The Fourth Military Medical University), Xi'an, China
| | - Yang Yao
- Medical Oncology, Shanghai Sixth People's Hospital, Shanghai, China
| | - Jianmin Li
- Orthopedic Oncology, Qilu Hospital of Shandong University, Jinan, China
| | - Jianhua Lin
- Musculoskeletal Tumor Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jianru Xiao
- Orthopedic Oncology, Shanghai Changzheng Hospital, Shanghai, China
| | - Xiuchun Yu
- Orthopedic Oncology, Jinan Military General Hospital, Jinan, China
| | - Weibin Zhang
- Orthopedic Oncology, Ruijin Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Zhendong Cai
- Orthopedic Oncology, Shanghai General Hospital, Shanghai, China
| | - Yingqi Hua
- Orthopedic Oncology, Shanghai General Hospital, Shanghai, China
| | - Jing Chen
- Orthopedic Oncology and Medical Oncology, Wuhan Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zengwu Shao
- Orthopedic Oncology and Medical Oncology, Wuhan Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Di Wu
- Medical Oncology, The First Affiliated Hospital of Jilin University, Changchun, China
| | - Sujia Wu
- Orthopedic Oncology, General Hospital of Eastern Theater Command, Nanjing, China
| | - Zhongqi Tu
- Orthopedic Oncology, Huaxi Hospital West China School of Medicine/West China Hospital of Sichuan University (WCSM/WCH), Chengdu, China
| | - Xiaojing Zhang
- Musculoskeletal Tumor Center, Liaoning Cancer Hospital & Institute, Shenyang, China
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6
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Moser M, Radu IP, Dufour JF. Effects of Home Care on patients with hepatocellular carcinoma treated with sorafenib. JGH OPEN 2021; 5:864-870. [PMID: 34386593 PMCID: PMC8341184 DOI: 10.1002/jgh3.12533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 11/12/2022]
Abstract
Background and Aim Treatment with sorafenib causes diverse side effects, which limits adherence. This work assesses whether Home Care, a psychosocial nursing intervention, prolongs the duration of treatment in patients with advanced hepatocellular carcinoma (HCC) and if it influences health-related quality of life (HRQL). Methods and Results This is a cohort study using data from patients receiving sorafenib in the prospective Bern HCC Cohort at the University Hospital. Duration of treatment, overall survival, and HRQL using the Functional Assessment of Cancer Therapy-Hepatobiliary questionnaire were compared in the two groups. A total of 173 patients were eligible for the analysis. Among them, 141 were in the Home Care program, and 32 were not. Patients with Home Care had a significantly longer duration of treatment (265 days vs 152 days, P = 0.003) and a better functional well-being (17.7 vs 12.5, P = 0.015). Conclusion Psychosocial interventions such as Home Care are a valid method in improving adherence to sorafenib and can therefore be recommended.
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Affiliation(s)
- Monika Moser
- Hepatology, Department of Clinical Research University of Bern Bern Switzerland.,University Clinic for Visceral Surgery and Medicine, Inselspital Bern Switzerland
| | - Iuliana-Pompilia Radu
- Hepatology, Department of Clinical Research University of Bern Bern Switzerland.,University Clinic for Visceral Surgery and Medicine, Inselspital Bern Switzerland
| | - Jean-François Dufour
- Hepatology, Department of Clinical Research University of Bern Bern Switzerland.,University Clinic for Visceral Surgery and Medicine, Inselspital Bern Switzerland
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7
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Lee N, Carlisle AE, Peppers A, Park SJ, Doshi MB, Spears ME, Kim D. xCT-Driven Expression of GPX4 Determines Sensitivity of Breast Cancer Cells to Ferroptosis Inducers. Antioxidants (Basel) 2021; 10:antiox10020317. [PMID: 33672555 PMCID: PMC7923775 DOI: 10.3390/antiox10020317] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 01/02/2023] Open
Abstract
Inducers of ferroptosis such as the glutathione depleting agent Erastin and the GPX4 inhibitor Rsl-3 are being actively explored as potential therapeutics in various cancers, but the factors that determine their sensitivity are poorly understood. Here, we show that expression levels of both subunits of the cystine/glutamate antiporter xCT determine the expression of GPX4 in breast cancer, and that upregulation of the xCT/selenocysteine biosynthesis/GPX4 production axis paradoxically renders the cancer cells more sensitive to certain types of ferroptotic stimuli. We find that GPX4 is strongly upregulated in a subset of breast cancer tissues compared to matched normal samples, and that this is tightly correlated with the increased expression of the xCT subunits SLC7A11 and SLC3A2. Erastin depletes levels of the antioxidant selenoproteins GPX4 and GPX1 in breast cancer cells by inhibiting xCT-dependent extracellular reduction which is required for selenium uptake and selenocysteine biosynthesis. Unexpectedly, while breast cancer cells are resistant compared to nontransformed cells against oxidative stress inducing drugs, at the same time they are hypersensitive to lipid peroxidation and ferroptosis induced by Erastin or Rsl-3, indicating that they are 'addicted' to the xCT/GPX4 axis. Our findings provide a strategic basis for targeting the anti-ferroptotic machinery of breast cancer cells depending on their xCT status, which can be further explored.
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Affiliation(s)
- Namgyu Lee
- Cell and Cancer Biology, Department of Molecular, University of Massachusetts Medical School, Worcester, MA 01604, USA; (N.L.); (A.E.C.); (A.P.); (M.B.D.); (M.E.S.)
| | - Anne E. Carlisle
- Cell and Cancer Biology, Department of Molecular, University of Massachusetts Medical School, Worcester, MA 01604, USA; (N.L.); (A.E.C.); (A.P.); (M.B.D.); (M.E.S.)
| | - Austin Peppers
- Cell and Cancer Biology, Department of Molecular, University of Massachusetts Medical School, Worcester, MA 01604, USA; (N.L.); (A.E.C.); (A.P.); (M.B.D.); (M.E.S.)
| | - Sung Jin Park
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA 01604, USA;
| | - Mihir B. Doshi
- Cell and Cancer Biology, Department of Molecular, University of Massachusetts Medical School, Worcester, MA 01604, USA; (N.L.); (A.E.C.); (A.P.); (M.B.D.); (M.E.S.)
| | - Meghan E. Spears
- Cell and Cancer Biology, Department of Molecular, University of Massachusetts Medical School, Worcester, MA 01604, USA; (N.L.); (A.E.C.); (A.P.); (M.B.D.); (M.E.S.)
| | - Dohoon Kim
- Cell and Cancer Biology, Department of Molecular, University of Massachusetts Medical School, Worcester, MA 01604, USA; (N.L.); (A.E.C.); (A.P.); (M.B.D.); (M.E.S.)
- Correspondence:
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8
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Darvishi N, Yousefinejad V, Akbari ME, Abdi M, Moradi N, Darvishi S, Mehrabi Y, Ghaderi E, Jamshidi-Naaeini Y, Ghaderi B, Davoodi SH. Antioxidant and anti-inflammatory effects of oral propolis in patients with breast cancer treated with chemotherapy: a Randomized controlled trial. J Herb Med 2020. [DOI: 10.1016/j.hermed.2020.100385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Gao Y, Liu P, Shi R. Anlotinib as a molecular targeted therapy for tumors. Oncol Lett 2020; 20:1001-1014. [PMID: 32724339 PMCID: PMC7377159 DOI: 10.3892/ol.2020.11685] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/30/2020] [Indexed: 12/24/2022] Open
Abstract
Angiogenesis has an essential role in tumor growth and metastasis, and blocking this pathway has been a successfully utilized strategy in the clinical treatment of cancer. Anlotinib (AL3818) is a novel oral receptor tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor 2 and 3, fibroblast growth factor 1-4, platelet-derived growth factor receptor α and β, c-Kit and Ret. Anlotinib exerts inhibitory effects on tumor growth and angiogenesis and received its first approval as a third-line treatment for refractory advanced non-small-cell lung cancer in May 2018 and its second approval as a second-line treatment for advanced soft-tissue sarcoma in June 2019 in the People's Republic of China. Anlotinib has encouraging efficacy and a manageable and tolerable safety profile in a broad range of malignancies, including medullary thyroid cancer, renal cell cancer, gastric cancer and esophageal squamous cell carcinoma. In the present review, the preclinical and clinical trials of anlotinib were summarized with a focus on safety evaluation and adverse event management.
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Affiliation(s)
- Yi Gao
- School of Medicine, Southeast University, Nanjing, Jiangsu 210009, P.R. China
- Department of Gastroenterology, The Jiangyin Clinical College of Xuzhou Medical University, Jiangyin, Jiangsu 214400, P.R. China
- Jiangsu Provincial Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, Jiangsu 215123, P.R. China
| | - Pengfei Liu
- Department of Gastroenterology, The Jiangyin Clinical College of Xuzhou Medical University, Jiangyin, Jiangsu 214400, P.R. China
- State Key Laboratory of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, Jiangsu 215123, P.R. China
| | - Ruihua Shi
- School of Medicine, Southeast University, Nanjing, Jiangsu 210009, P.R. China
- Department of Gastroenterology, Zhongda Hospital, Affiliated Hospital of Southeast University, Nanjing, Jiangsu 210009, P.R. China
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10
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Edwards RL, Andan C, Lalla RV, Lacouture ME, O'Brien D, Sequist LV. Afatinib Therapy: Practical Management of Adverse Events With an Oral Agent for Non-Small Cell Lung Cancer Treatment. Clin J Oncol Nurs 2019; 22:542-548. [PMID: 30239509 DOI: 10.1188/18.cjon.542-548] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Afatinib is an oral, irreversible ErbB family blocker indicated for first-line treatment of metastatic non-small cell lung cancer (NSCLC) in patients with non-resistant epidermal growth factor receptor (EGFR) mutations. Afatinib is also approved for the treatment of metastatic squamous NSCLC following progression on platinum-based chemotherapy. Common afatinib-associated toxicities include gastrointestinal and dermatologic events, which can be dose limiting. OBJECTIVES In this review, the authors describe clinical trial experiences with afatinib, as well as best practices and practical approaches to the management of afatinib-associated adverse events in EGFR mutation-positive NSCLC. METHODS Safety and tolerability data from phase 3 trials of afatinib were reviewed, together with real-life experiences from the authors' clinical practices. FINDINGS Patient education, combined with early assessment and effective management of afatinib-related adverse events as well as dose- reduction strategies, allows patients to continue treatment and maximize the clinical benefits of afatinib.
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11
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Rimassa L, Danesi R, Pressiani T, Merle P. Management of adverse events associated with tyrosine kinase inhibitors: Improving outcomes for patients with hepatocellular carcinoma. Cancer Treat Rev 2019; 77:20-28. [PMID: 31195212 DOI: 10.1016/j.ctrv.2019.05.004] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 12/24/2022]
Abstract
Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer. Sorafenib, regorafenib, lenvatinib and cabozantinib are tyrosine kinase inhibitors (TKIs) that target, in part, vascular endothelial growth factor receptors, and are approved in various regions of the world for the treatment of advanced HCC. All these agents are associated with a range of adverse events (AEs) that can have a substantial impact on patients' health-related quality of life. Fatigue, diarrhoea, hand-foot skin reaction, nausea, vomiting, decreased appetite, hypertension and weight loss are among the most common AEs experienced with these four TKIs. In this review, we discuss strategies for the management of these AEs in patients with advanced HCC, with the aim of maximizing treatment benefits and minimizing the need for TKI treatment discontinuation. We also consider potential TKI-drug interactions and discuss the use of TKIs in patients with liver dysfunction or who have experienced tumour recurrence after liver transplantation. Use of appropriate AE management strategies and avoidance of contraindicated drugs should help patients with advanced HCC to achieve optimal outcomes with TKIs.
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Affiliation(s)
- Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Romano Danesi
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa, Italy
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Philippe Merle
- Department of Hepatology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, 103 Grande rue de la Croix Rousse, Lyon, France.
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12
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Naganuma A, Hoshino T, Ohno N, Ogawa Y, Murakami T, Horiguchi S, Uehara D, Suzuki Y, Hatanaka T, Kudo T, Ishihara H, Sato K, Kakizaki S, Takagi H. β-Hydroxy-β-methyl Butyrate/L-Arginine/L-Glutamine Supplementation for Preventing Hand-Foot Skin Reaction in Sorafenib for Advanced Hepatocellular Carcinoma. In Vivo 2019; 33:155-161. [PMID: 30587616 DOI: 10.21873/invivo.11452] [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: 09/18/2018] [Revised: 10/06/2018] [Accepted: 10/12/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIM Sorafenib is standard treatment for advanced hepatocellular carcinoma (HCC). Hand-foot skin reaction (HFSR) is a notorious side-effect of this therapy. This study evaluated prophylactic benefits of an oral nutritional supplement (ONS) on sorafenib-associated HFSR in advanced HCC. PATIENTS AND METHODS This was a prospective, single-center, open-label trial arm using combined ONS and sorafenib in patients with unresectable HCC from August 2014 to February 2018. Control patients received sorafenib without ONS from 2011 to 2014. From September 2014, prophylactic ONS containing β-hydroxy-β-methylbutyrate (HMB), L-arginine, and L-glutamine was given. Sorafenib dosage was 400 mg/day for both groups. RESULTS Each group comprised 22 men and three women. Age, sex, Child-Pugh score, and clinical stage excluding IV-B did not significantly differ between the groups. HFSR occurred after 2 weeks: 15/25 patients in the control group (60%; HFSR grade 1: 6, grade 2: 7, grade 3: 2) vs. 8/25 in the ONS group (32%; HFSR grade 1: 4, grade 2: 4, grade 3: 0; p=0.047, Pearson's Chi-square test). CONCLUSION Prophylactic HMB, L-arginine and L-glutamine supplementation effectively prevented sorafenib-associated HFSR in patients with advanced HCC.
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Affiliation(s)
- Atsushi Naganuma
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan .,Nutrition Support Team, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan
| | - Takashi Hoshino
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan
| | - Nozomi Ohno
- Nursing Department, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan
| | - Yusuke Ogawa
- Nutrition Support Team, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan
| | - Tatsuma Murakami
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan
| | - Suguru Horiguchi
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan
| | - Daisuke Uehara
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan.,Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yuhei Suzuki
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan.,Department of Gastroenterology, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Takeshi Hatanaka
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan.,Department of Gastroenterology, Gunma ken Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Tomohiro Kudo
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan.,Nutrition Support Team, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan
| | - Hiroshi Ishihara
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan
| | - Ken Sato
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Satoru Kakizaki
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hitoshi Takagi
- Department of Gastroenterology, Kusunoki Hospital, Fujioka, Japan
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13
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Cheng KW, Tseng CH, Tzeng CC, Leu YL, Cheng TC, Wang JY, Chang JM, Lu YC, Cheng CM, Chen IJ, Cheng YA, Chen YL, Cheng TL. Pharmacological inhibition of bacterial β-glucuronidase prevents irinotecan-induced diarrhea without impairing its antitumor efficacy in vivo. Pharmacol Res 2019; 139:41-49. [DOI: 10.1016/j.phrs.2018.10.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/13/2018] [Accepted: 10/30/2018] [Indexed: 12/27/2022]
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14
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Grávalos C, Sanmartín O, Gúrpide A, España A, Majem M, Suh Oh HJ, Aragón I, Segura S, Beato C, Botella R. Clinical management of cutaneous adverse events in patients on targeted anticancer therapies and immunotherapies: a national consensus statement by the Spanish Academy of Dermatology and Venereology and the Spanish Society of Medical Oncology. Clin Transl Oncol 2018; 21:556-571. [PMID: 30284232 DOI: 10.1007/s12094-018-1953-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/11/2018] [Indexed: 12/17/2022]
Abstract
Progress in the understanding of many tumors has enabled the development of new therapies, such as those targeted at specific molecules involved in cell growth (targeted therapies) or intended to modulate the immune system (immunotherapy). However, along with the clinical benefit provided by these new treatments, new adverse effects have also appeared. Dermatological toxicities such as papulopustular eruptions, xerosis, and pruritus are common with EGFR inhibitors. Other adverse effects have also been described with PDGFR, BCR-ABL, and MAPK tyrosine kinase inhibitors, antiangiogenic drugs, and inhibitors at immune checkpoints such as CTLA-4 and PD-1/PD-L1. Onset of these adverse effects often causes dose reductions and/or delays in administering the prescribed therapy, which can affect patient survival and quality of life. It is, therefore, important to prevent the occurrence of these adverse effects, or to treat unavoidable ones as soon as possible. This requires cooperation between medical oncologists and dermatologists. This article reviews the various dermatological toxicities associated with targeted therapies and immunotherapies, along with their diagnosis and therapeutic management.
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Affiliation(s)
- C Grávalos
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Avenida de Córdoba km 5.4, 28041, Madrid, Spain.
| | - O Sanmartín
- Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | - A Gúrpide
- Medical Oncology Department, Clínica Universitaria de Navarra, Pamplona, Spain
| | - A España
- Dermatology Department, Clínica Universitaria de Navarra, Pamplona, Spain
| | - M Majem
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - H J Suh Oh
- Dermatology Department, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - I Aragón
- Medical Oncology Department, Complejo Hospitalario Universitario de Huelva, Huelva, Spain
| | - S Segura
- Dermatology Department, Hospital del Mar, Barcelona, Spain
| | - C Beato
- Medical Oncology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - R Botella
- Dermatology Service, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
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15
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Vaidya T, Kamta J, Chaar M, Ande A, Ait-Oudhia S. Systems pharmacological analysis of mitochondrial cardiotoxicity induced by selected tyrosine kinase inhibitors. J Pharmacokinet Pharmacodyn 2018; 45:401-418. [PMID: 29446053 DOI: 10.1007/s10928-018-9578-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 02/05/2018] [Indexed: 01/13/2023]
Abstract
Tyrosine kinase inhibitors (TKIs) are targeted therapies rapidly becoming favored over conventional cytotoxic chemotherapeutics. Our study investigates two FDA approved TKIs, DASATINIB; indicated for IMATINIB-refractory chronic myeloid leukemia, and SORAFENIB; indicated for hepatocellular carcinoma and advanced renal cell carcinoma. Limited but crucial evidence suggests that these agents can have cardiotoxic side effects ranging from hypertension to heart failure. A greater understanding of the underlying mechanisms of this cardiotoxicity are needed as concerns grow and the capacity to anticipate them is lacking. The objective of this study was to explore the mitochondrial-mediated cardiotoxic mechanisms of the two selected TKIs. This was achieved experimentally using immortalized human cardiomyocytes, AC16 cells, to investigate dose- and time-dependent cell killing, along with measurements of temporal changes in key signaling proteins involved in the intrinsic apoptotic and autophagy pathways upon exposure to these agents. Quantitative systems pharmacology (QSP) models were developed to capture the toxicological response in AC16 cells using protein dynamic data. The developed QSP models captured well all the various trends in protein signaling and cellular responses with good precision on the parameter estimates, and were successfully qualified using external data sets. An interplay between the apoptotic and autophagic pathways was identified to play a major role in determining toxicity associated with the investigated TKIs. The established modeling platform showed utility in elucidating the mechanisms of cardiotoxicity of SORAFENIB and DASATINIB. It may be useful for other small molecule targeted therapies demonstrating cardiac toxicities, and may aid in informing alternate dosing strategies to alleviate cardiotoxicity associated with these therapies.
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Affiliation(s)
- Tanaya Vaidya
- Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, 6550 Sanger Road, Office: 469, Orlando, FL, 32827, USA
| | - Jeff Kamta
- Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, 6550 Sanger Road, Office: 469, Orlando, FL, 32827, USA
| | - Maher Chaar
- Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, 6550 Sanger Road, Office: 469, Orlando, FL, 32827, USA
| | - Anusha Ande
- Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, 6550 Sanger Road, Office: 469, Orlando, FL, 32827, USA
| | - Sihem Ait-Oudhia
- Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, 6550 Sanger Road, Office: 469, Orlando, FL, 32827, USA.
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16
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Ren N, Atyah M, Chen WY, Zhou CH. The various aspects of genetic and epigenetic toxicology: testing methods and clinical applications. J Transl Med 2017; 15:110. [PMID: 28532423 PMCID: PMC5440915 DOI: 10.1186/s12967-017-1218-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/18/2017] [Indexed: 12/15/2022] Open
Abstract
Genotoxicity refers to the ability of harmful substances to damage genetic information in cells. Being exposed to chemical and biological agents can result in genomic instabilities and/or epigenetic alterations, which translate into a variety of diseases, cancer included. This concise review discusses, from both a genetic and epigenetic point of view, the current detection methods of different agents’ genotoxicity, along with their basic and clinical relation to human cancer, chemotherapy, germ cells and stem cells.
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Affiliation(s)
- Ning Ren
- Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China. .,Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, 200032, People's Republic of China.
| | - Manar Atyah
- Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.,Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, 200032, People's Republic of China
| | - Wan-Yong Chen
- Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.,Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, 200032, People's Republic of China
| | - Chen-Hao Zhou
- Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.,Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, 200032, People's Republic of China
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17
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Ancker OV, Wehland M, Bauer J, Infanger M, Grimm D. The Adverse Effect of Hypertension in the Treatment of Thyroid Cancer with Multi-Kinase Inhibitors. Int J Mol Sci 2017; 18:E625. [PMID: 28335429 PMCID: PMC5372639 DOI: 10.3390/ijms18030625] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/07/2017] [Accepted: 03/09/2017] [Indexed: 02/04/2023] Open
Abstract
The treatment of thyroid cancer has promising prospects, mostly through the use of surgical or radioactive iodine therapy. However, some thyroid cancers, such as progressive radioactive iodine-refractory differentiated thyroid carcinoma, are not remediable with conventional types of treatment. In these cases, a treatment regimen with multi-kinase inhibitors is advisable. Unfortunately, clinical trials have shown a large number of patients, treated with multi-kinase inhibitors, being adversely affected by hypertension. This means that treatment of thyroid cancer with multi-kinase inhibitors prolongs progression-free and overall survival of patients, but a large number of patients experience hypertension as an adverse effect of the treatment. Whether the prolonged lifetime is sufficient to develop sequelae from hypertension is unclear, but late-stage cancer patients often have additional diseases, which can be complicated by the presence of hypertension. Since the exact mechanisms of the rise of hypertension in these patients are still unknown, the only available strategy is treating the symptoms. More studies determining the pathogenesis of hypertension as a side effect to cancer treatment as well as outcomes of dose management of cancer drugs are necessary to improve future therapy options for hypertension as an adverse effect to cancer therapy with multi-kinase inhibitors.
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Affiliation(s)
- Ole Vincent Ancker
- Department of Biomedicine, Aarhus University, Wilhelm Meyers Allé 4, 8000 Aarhus C, Denmark.
| | - Markus Wehland
- Clinic and Policlinic for Plastic, Aesthetic and Hand Surgery, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany.
| | - Johann Bauer
- Max-Planck-Institute for Biochemistry, Am Klopferspitz 18, 82152 Martinsried, Germany.
| | - Manfred Infanger
- Clinic and Policlinic for Plastic, Aesthetic and Hand Surgery, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany.
| | - Daniela Grimm
- Department of Biomedicine, Aarhus University, Wilhelm Meyers Allé 4, 8000 Aarhus C, Denmark.
- Clinic and Policlinic for Plastic, Aesthetic and Hand Surgery, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany.
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18
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Schmidt A, Iglesias L, Klain M, Pitoia F, Schlumberger MJ. Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:81-89. [PMID: 28225999 PMCID: PMC10522117 DOI: 10.1590/2359-3997000000245] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/11/2016] [Indexed: 11/22/2022]
Abstract
Radioiodine (RAI)-refractory thyroid cancer is an uncommon entity, occurring with an estimated incidence of 4-5 cases/year/million people. RAI refractoriness is more frequent in older patients, in those with large metastases, in poorly differentiated thyroid cancer, and in those tumors with high 18-fluordeoxyglucose uptake on PET/CT. These patients have a 10-year survival rate of less than 10%. In recent years, new therapeutic agents with molecular targets have become available, with multikinase inhibitors (MKIs) being the most investigated drugs. Two of these compounds, sorafenib and lenvatinib, have shown significant objective response rates and have significantly improved the progression-free survival in the two largest published prospective trials on MKI use. However, no overall survival benefit has been achieved yet. This is probably related to the crossover that occurs in most patients who progress on placebo treatment to the open treatment of these studies. In consequence, the challenge is to correctly identify which patients will benefit from these treatments. It is also crucial to understand the appropriate timing to initiate MKI treatment and when to stop it. The purpose of this article is to define RAI refractoriness, to summarize which therapies are available for this condition, and to review how to select patients who are suitable for them.
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Affiliation(s)
- Angelica Schmidt
- Hospital de ClínicasUniversity of Buenos AiresBuenos AiresArgentina Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires Buenos Aires, Argentina
- Institut Gustave RoussyUniversité Paris-SaclayVillejuifFranceInstitut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Laura Iglesias
- Institut Gustave RoussyUniversité Paris-SaclayVillejuifFranceInstitut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Michele Klain
- Università Federico II di NapoliNapoliItaliaUniversità Federico II di Napoli, Napoli, Italia
| | - Fabián Pitoia
- Hospital de ClínicasUniversity of Buenos AiresBuenos AiresArgentina Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires Buenos Aires, Argentina
| | - Martin J. Schlumberger
- Institut Gustave RoussyUniversité Paris-SaclayVillejuifFranceInstitut Gustave Roussy, Université Paris-Saclay, Villejuif, France
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19
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Lieb V, Rink M, Sikic D, Keck B. [Side effect management of tyrosine kinase inhibitors in urology : Gastrointestinal side effects]. Urologe A 2016; 55:805-12. [PMID: 27146873 DOI: 10.1007/s00120-016-0090-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
For approximately one decade, tyrosinkinase inhibitors (TKIs, smart drugs) have dramatically changed and improved the treatment of patients suffering from metastasized renal cell carcinoma. However, the different drugs have substantial side effects. Especially gastrointestinal symptoms may be problematic for patients. These side effects represent a challenge for the physician. On the one hand, dosage modifications and treatment interruption should be avoided to minimize the risk for progression. On the other hand, only mild side effects are tolerable for the patient. Based on a literature review, a clear overview of the incidence of possible side effects for the drugs axitinib, cabozantinib, pazopanib, sorafenib, and sunitinib is provided. Furthermore, we give a practical guide on how to prevent and treat the different gastrointestinal side effects. Finally, it is pointed out when dosage modifications or interruption of treatment are necessary and how to expeditiously re-escalate the treatment after mitigation of side effects.
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Affiliation(s)
- V Lieb
- Urologische Universitätsklinik Erlangen, Universitätsklinikum Erlangen, Rathsberger Str. 57, 91054, Erlangen, Deutschland
| | - M Rink
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Deutschland
| | - D Sikic
- Urologische Universitätsklinik Erlangen, Universitätsklinikum Erlangen, Rathsberger Str. 57, 91054, Erlangen, Deutschland
| | - B Keck
- Urologische Universitätsklinik Erlangen, Universitätsklinikum Erlangen, Rathsberger Str. 57, 91054, Erlangen, Deutschland.
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20
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Gadaleta-Caldarola G, Infusino S, Divella R, Ferraro E, Mazzocca A, De Rose F, Filippelli G, Abbate I, Brandi M. Sorafenib: 10 years after the first pivotal trial. Future Oncol 2016; 11:1863-80. [PMID: 26161924 DOI: 10.2217/fon.15.85] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Sorafenib is an oral multikinase inhibitor with anticancer activity against a wide spectrum of cancers. It is currently approved for the treatment of patients with hepatocellular carcinoma, advanced renal cell carcinoma or progressive, locally advanced or metastatic differentiated thyroid carcinoma. In this review, we present a number of studies that investigated the efficacy and safety of sorafenib in these settings. We also discuss the perspectives on the use of this molecule, including the role of sorafenib as comparator for the development of new drugs, the combination of sorafenib with additional therapies (such as transarterial chemoembolization for hepatocellular carcinoma) and the use of this treatment in several other advanced refractory solid tumors.
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Affiliation(s)
- Gennaro Gadaleta-Caldarola
- Medical Oncology Unit, 'Mons. R Dimiccoli' Hospital, Viale Ippocrate, 15, 76121 Barletta, Asl BAT, Italy
| | - Stefania Infusino
- Medical Oncology Unit, 'S Francesco di Paola' Hospital, Via Promintesta, 87027 Paola, ASP, Cosenza, Italy
| | - Rosa Divella
- Laboratory of Clinical and Experimental Pathology - National Cancer Institute 'Giovanni Paolo II', Viale Orazio Flacco 65, 70124, Bari, Italy
| | - Emanuela Ferraro
- Department of Internal Medicine & Clinical Specialties, University of Rome 'La Sapienza', Policlinico Umberto I, Viale del Policlinico, 155, 00161 Roma, Italy
| | - Antonio Mazzocca
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G Cesare, 11,70124 Bari, Italy, National Institute for Digestive Diseases, IRCCS 'Saverio De Bellis', Via Turi 27, 70013, Castellana Grotte, Bari, Italy
| | | | - Gianfranco Filippelli
- Medical Oncology Unit, 'S Francesco di Paola' Hospital, Via Promintesta, 87027 Paola, ASP, Cosenza, Italy
| | - Ines Abbate
- Laboratory of Clinical and Experimental Pathology - National Cancer Institute 'Giovanni Paolo II', Viale Orazio Flacco 65, 70124, Bari, Italy
| | - Mario Brandi
- Medical Oncology Unit, 'Mons. R Dimiccoli' Hospital, Viale Ippocrate, 15, 76121 Barletta, Asl BAT, Italy
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21
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Kajizono M, Aoyagi M, Kitamura Y, Sendo T. Effectiveness of medical supportive team for outpatients treated with sorafenib: a retrospective study. J Pharm Health Care Sci 2016; 1:6. [PMID: 26819717 PMCID: PMC4677728 DOI: 10.1186/s40780-014-0005-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/30/2014] [Indexed: 12/19/2022] Open
Abstract
Background It is well known that molecular-targeted drugs, of which sorafenib (Nexavar®) is one, differ from previous anticancer drugs and cause various unusual adverse drug reactions. Treatment with sorafenib causes adverse drug reactions such as hand-foot skin reactions, hypertension, and diarrhea. Physicians spend a lot of time monitoring adverse drug reactions to sorafenib in outpatients. As such, at Okayama University Hospital, pharmacists and nurses have organized a medical supportive team to help physicians in this regard. However, the effectiveness of interventions for sorafenib-treated outpatients by this medical supportive team remains unclear. The purpose of this study was thus to clarify the effectiveness of interventions for sorafenib-treated outpatients by this medical supportive team. Methods We retrospectively studied 70 outpatients treated with sorafenib between May 2009 and December 2012 at Okayama University Hospital. These outpatients were classified into two groups, an intervention group (31 outpatients) and a non-intervention group (39 outpatients). We compared the duration of sorafenib treatment between these groups. Results The duration of treatment with sorafenib was significantly longer in the intervention group than in the non-intervention group. No outpatients in the intervention group discontinued sorafenib due to adverse drug reactions such as hand-foot skin reactions or diarrhea. Conclusion The duration of sorafenib treatment was significantly longer in the intervention group than in the non-intervention group. Our findings suggest that interventions by the medical supportive team consisting of health care professionals were effective in preventing the discontinuation of sorafenib.
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Affiliation(s)
- Makoto Kajizono
- Department of Pharmacy, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558 Japan
| | - Megumu Aoyagi
- Department of Pharmacy, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558 Japan
| | - Yoshihisa Kitamura
- Department of Pharmacy, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558 Japan
| | - Toshiaki Sendo
- Department of Pharmacy, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558 Japan
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22
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Kanbayashi Y, Hosokawa T, Yasui K, Hongo F, Yamaguchi K, Moriguchi M, Miki T, Itoh Y. Predictive factors for sorafenib-induced hand–foot skin reaction using ordered logistic regression analysis. Am J Health Syst Pharm 2016; 73:e18-23. [DOI: 10.2146/ajhp150129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Yuko Kanbayashi
- Department of Hospital Pharmacy and Pain Treatment and Palliative Care Unit, University Hospital
| | - Toyoshi Hosokawa
- Pain Treatment and Palliative Care Unit, University Hospital, and Professor, Department of Pain Management and Palliative Care Medicine, Graduate School of Medical Science (GSMS)
| | | | | | | | | | | | - Yoshito Itoh
- Departments of Gastroenterology and Hepatology and Urology, GSMS, Kyoto Prefectural University of Medicine, Kyoto, Japan
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23
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Worden F, Fassnacht M, Shi Y, Hadjieva T, Bonichon F, Gao M, Fugazzola L, Ando Y, Hasegawa Y, Park DJ, Shong YK, Smit JWA, Chung J, Kappeler C, Meinhardt G, Schlumberger M, Brose MS. Safety and tolerability of sorafenib in patients with radioiodine-refractory thyroid cancer. Endocr Relat Cancer 2015; 22:877-87. [PMID: 26370187 PMCID: PMC4570090 DOI: 10.1530/erc-15-0252] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Effective adverse event (AE) management is critical to maintaining patients on anticancer therapies. The DECISION trial was a multicenter, randomized, double-blind, placebo-controlled, Phase 3 trial which investigated sorafenib for treatment of progressive, advanced, or metastatic radioactive iodine-refractory, differentiated thyroid carcinoma. Four hundred and seventeen adult patients were randomized (1:1) to receive oral sorafenib (400 mg, twice daily) or placebo, until progression, unacceptable toxicity, noncompliance, or withdrawal. Progression-free survival, the primary endpoint of DECISION, was reported previously. To elucidate the patterns and management of AEs in sorafenib-treated patients in the DECISION trial, this report describes detailed, by-treatment-cycle analyses of the incidence, prevalence, and severity of hand-foot skin reaction (HFSR), rash/desquamation, hypertension, diarrhea, fatigue, weight loss, increased serum thyroid stimulating hormone, and hypocalcemia, as well as the interventions used to manage these AEs. By-cycle incidence of the above-selected AEs with sorafenib was generally highest in cycle 1 or 2 then decreased. AE prevalence generally increased over cycles 2-6 then stabilized or declined. Among these AEs, only weight loss tended to increase in severity (from grade 1 to 2) over time; severity of HFSR and rash/desquamation declined over time. AEs were mostly grade 1 or 2, and were generally managed with dose interruptions/reductions, and concomitant medications (e.g. antidiarrheals, antihypertensives, dermatologic preparations). Most dose interruptions/reductions occurred in early cycles. In conclusion, AEs with sorafenib in DECISION were typically grade 1 or 2, occurred early during the treatment course, and were manageable over time.
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MESH Headings
- Adenocarcinoma, Follicular/drug therapy
- Adenocarcinoma, Follicular/enzymology
- Adenocarcinoma, Follicular/radiotherapy
- Adenoma, Oxyphilic/drug therapy
- Adenoma, Oxyphilic/enzymology
- Adenoma, Oxyphilic/radiotherapy
- Aged
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Carcinoma, Papillary/drug therapy
- Carcinoma, Papillary/enzymology
- Carcinoma, Papillary/radiotherapy
- Diarrhea/chemically induced
- Diarrhea/drug therapy
- Diarrhea/epidemiology
- Disease-Free Survival
- Drug Eruptions/drug therapy
- Drug Eruptions/epidemiology
- Drug Eruptions/etiology
- Drug Resistance, Neoplasm
- Dyspnea/chemically induced
- Dyspnea/epidemiology
- Fatigue/chemically induced
- Fatigue/epidemiology
- Female
- Humans
- Hypertension/chemically induced
- Hypertension/drug therapy
- Hypertension/epidemiology
- Hypocalcemia/chemically induced
- Hypocalcemia/epidemiology
- Incidence
- Iodine Radioisotopes/therapeutic use
- Male
- Middle Aged
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/epidemiology
- Niacinamide/adverse effects
- Niacinamide/analogs & derivatives
- Niacinamide/therapeutic use
- Phenylurea Compounds/adverse effects
- Phenylurea Compounds/therapeutic use
- Prevalence
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/therapeutic use
- Radiopharmaceuticals/therapeutic use
- Sorafenib
- Thyroid Neoplasms/drug therapy
- Thyroid Neoplasms/enzymology
- Thyroid Neoplasms/radiotherapy
- Weight Loss/drug effects
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Affiliation(s)
- Francis Worden
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Martin Fassnacht
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadioth
| | - Yuankai Shi
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadioth
| | - Tatiana Hadjieva
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Françoise Bonichon
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ming Gao
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laura Fugazzola
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadioth
| | - Yuichi Ando
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yasuhisa Hasegawa
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Do Joon Park
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Young Kee Shong
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Johannes W A Smit
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Chung
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christian Kappeler
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gerold Meinhardt
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Martin Schlumberger
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marcia S Brose
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Serum Oxidative Stress Markers and Genotoxic Profile Induced by Chemotherapy in Patients with Breast Cancer: A Pilot Study. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2015:212964. [PMID: 26576218 PMCID: PMC4630415 DOI: 10.1155/2015/212964] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 03/02/2015] [Accepted: 03/02/2015] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate the oxidative parameters of erythrocytes and genotoxicity in leukocytes of patients with breast cancer. Oxidative parameters were detected by spectrophotometry and genotoxic damage by single cell gel electrophoresis. Twenty-eight women with breast cancer were monitored before chemotherapy and after the second and fourth cycles of therapy with cyclophosphamide and doxorubicin. After the fourth cycle, increases (P < 0.05) in the reactive substances to thiobarbituric acid levels, nitrite content, and superoxide dismutase activity and high rates of DNA damage in leukocytes were observed when compared with healthy women group and baseline levels. Similarly, after the second cycle, the same parameters were increased (P < 0.05) when compared with baseline levels. Increase in catalase activity was detected only after the fourth cycle and reduced glutathione levels and glutathione peroxidase activity were decreased in all cycles when compared with healthy women, as well as after the second and fourth chemotherapy cycles compared to baseline (P < 0.05). Patients with breast cancer presented an indicative of oxidative stress before, during, and after chemotherapy, as well as increased genotoxic damage in all stages of treatment, demonstrating the clinical applicability of this investigation.
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Di Cesare Mannelli L, Maresca M, Farina C, Scherz MW, Ghelardini C. A model of neuropathic pain induced by sorafenib in the rat: Effect of dimiracetam. Neurotoxicology 2015; 50:101-7. [PMID: 26254739 DOI: 10.1016/j.neuro.2015.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/28/2015] [Accepted: 08/03/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Sorafenib is a kinase inhibitor anticancer drug whose repeated administration causes the onset of a peripheral painful neuropathy. Notably, the efficacy of common analgesic drugs is not adequate and this often leads pre-mature discontinuation of anticancer therapy. The aim of this study was to establish a rat model of sorafenib-induced neuropathic pain, and to assess the effect of the new anti-neuropathic compound dimiracetam in comparison with gabapentin, pregabalin and duloxetine. METHODS Male Sprague-Dawley rats were treated i.v. (10 mg kg(-1)), i.p. (10 and 30 mg kg(-1)) or p.o. (80 and 160 mg kg(-1)) with sorafenib once daily for 21 days. Pain behaviour measurements (cold plate, paw pressure, electronic von Frey) were performed on days 0, 7, 14 and 21. RESULTS Sorafenib lowered the paw-licking threshold to non-noxious cold stimuli on day 14 of all protocols evaluated. The i.p. administration resulted in greater efficacy than the other administration routes. Sorafenib treatments did not affect paw-withdrawal responses to non-noxious or to noxious mechanical stimuli. On day 14, dimiracetam (300 mg kg(-1)), gabapentin (100 mg kg(-1)), pregabalin (30 mg kg(-1)) and duloxetine (30 mg kg(-1)) were acutely administered p.o. in sorafenib i.p.-treated rats. A single oral dose of dimiracetam induced a statistically significant increase of the pain threshold 15 min after administration. Pregabalin induced a comparable effect, whereas gabapentin and duloxetine were ineffective. Repeated twice-daily administration of dimiracetam (150 mg kg(-1) p.o.), starting on the first day of i.p sorafenib administration, significantly protected rats from sorafenib-induced decrease in the paw-licking threshold. CONCLUSIONS A rat model of sorafenib-induced hypersensitivity to cold stimulation has been established. Dimiracetam and pregabalin are effective in prevention of sorafenib-induced neuropathy in this model.
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Affiliation(s)
- Lorenzo Di Cesare Mannelli
- Department of Neuroscience, Psychology, Drug Research and Child Health, - Neurofarba - Pharmacology and Toxicology Section, University of Florence, Viale G. Pieraccini, 6, 50139 Firenze, Italy.
| | - Mario Maresca
- Department of Neuroscience, Psychology, Drug Research and Child Health, - Neurofarba - Pharmacology and Toxicology Section, University of Florence, Viale G. Pieraccini, 6, 50139 Firenze, Italy
| | - Carlo Farina
- Neurotune AG, Wagistrasse 27a, CH-8952 Schlieren, Switzerland; Metys Pharmaceuticals, Friedrichstrasse 6, CH-4055 Basel, Switzerland
| | - Michael W Scherz
- Metys Pharmaceuticals, Friedrichstrasse 6, CH-4055 Basel, Switzerland
| | - Carla Ghelardini
- Department of Neuroscience, Psychology, Drug Research and Child Health, - Neurofarba - Pharmacology and Toxicology Section, University of Florence, Viale G. Pieraccini, 6, 50139 Firenze, Italy
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Li Y, Gao ZH, Qu XJ. The adverse effects of sorafenib in patients with advanced cancers. Basic Clin Pharmacol Toxicol 2015; 116:216-21. [PMID: 25495944 DOI: 10.1111/bcpt.12365] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/01/2014] [Indexed: 12/21/2022]
Abstract
Sorafenib is the first multi-kinase inhibitor (TKI) approved for the treatment of advanced hepatocellular cancer (HCC) and metastatic renal cell cancer (RCC) and is increasingly being used to treat patients with well-differentiated radioiodine-resistant thyroid cancer (DTC). Sorafenib demonstrates targeted activity on several families of receptor and non-receptor tyrosine kinases that are involved in angiogenesis, tumour growth and metastatic progression of cancer. Sorafenib treatment results in long-term efficacy and low incidence of life-threatening toxicities. Although sorafenib has demonstrated many benefits in patients, the adverse effects cannot be ignored. The most common treatment-related toxicities include diarrhoea, fatigue, hand-foot skin reaction and hypertension. Most of these toxicities are considered mild to moderate and manageable to varying degrees; however, cardiovascular events might lead to death. In this MiniReview, we summarize the adverse effects of sorafenib that commonly occur in patients with advanced cancers.
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Affiliation(s)
- Ye Li
- Department of Pharmacology, School of Chemical Biology & Pharmaceutical Sciences, Capital Medical University, Beijing, China
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Worden F. Treatment strategies for radioactive iodine-refractory differentiated thyroid cancer. Ther Adv Med Oncol 2014; 6:267-79. [PMID: 25364392 PMCID: PMC4206652 DOI: 10.1177/1758834014548188] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Until recently, no truly effective treatment options have existed for patients with radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC), a serious disease with poor prognosis. In November 2013, the targeted multikinase inhibitor, sorafenib, was approved for use in these patients based on substantially improved progression-free survival compared with placebo. A number of other targeted agents, including lenvatinib, are being investigated in phase II and phase III trials. With the advent of these new treatment options, practitioners are faced with making important decisions in determining which patients are candidates for systemic treatment and the optimal timing for treatment initiation. Since patients may remain asymptomatic for a protracted period of time, tumor size and growth rate are the primary considerations for making these choices. Proactive management of side effects is also critical in optimizing the effectiveness of treatment. Here we review targeted systemic agents that are either in use or are under investigation for RAI-refractory DTC and provide recommendations on the rationale for initiating systemic treatment and on managing adverse events. Four illustrative case studies are provided.
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Affiliation(s)
- Francis Worden
- University of Michigan Health System, Departments of Internal Medicine and Oncology, 1500 E Medical Center Dr SPC 5912, Ann Arbor, MI 48109, USA
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