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Sokolova A, Chan O, Ullah W, Hamdani AA, Anwer F. Delayed rhabdomyolysis with paclitaxel, ifosfamide, carboplatin, and etoposide regimen: a case report. J Med Case Rep 2017; 11:100. [PMID: 28395668 PMCID: PMC5387351 DOI: 10.1186/s13256-017-1272-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/21/2017] [Indexed: 11/21/2022] Open
Abstract
Background High-dose chemotherapy with autologous stem cell rescue is commonly used for the treatment of relapsed germ cell tumors. We report the first case of delayed rhabdomyolysis with paclitaxel, ifosfamide, carboplatin, and etoposide regimen. Case presentation We report a case of a 21-year-old African-American man diagnosed with relapsed non-seminomatous germ cell tumor who received high-dose chemotherapy with carboplatin and etoposide following TIGER trial arm B off-protocol. His course was complicated by muscle pain and rhabdomyolysis after cycle 4 on day +12 after infusion of autologous stem cells. To the best of our knowledge, this complication has not been reported with this regimen. A differential diagnosis of sepsis and neutropenic fever along with side effects of high-dose chemotherapy were considered, but based on the timing of events, it was concluded that the etiology of rhabdomyolysis is high-dose chemotherapy. Rhabdomyolysis was successfully treated with hydration and did not recur during subsequent cycle 5. Conclusions Delayed rhabdomyolysis after high-dose chemotherapy with paclitaxel, ifosfamide, carboplatin, and etoposide regimen has not been previously reported and needs to be considered for preventive strategy and prompt diagnosis and treatment to avoid renal complications. Physicians should have a low threshold to check creatine kinase enzymes in patients with unexplained muscle pain or renal insufficiency after high-dose chemotherapy.
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Affiliation(s)
- Alexandra Sokolova
- Department of Medicine, Nassau University Medical Cite Center, 2201 Hempstead Turnpike, East Meadow, NY, 11554, USA
| | - Onyee Chan
- Department of Medicine, University of Arizona, Banner University Medical Center - Tucson, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA.
| | - Waqas Ullah
- Department of Medicine, University of Arizona, Banner University Medical Center - Tucson, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA
| | - Auon Abbas Hamdani
- Department of Medicine, University of Arizona, Banner University Medical Center - Tucson, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA
| | - Faiz Anwer
- Department of Medicine, University of Arizona, Banner University Medical Center - Tucson, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA.,Department of Hematology, Oncology, Blood & Marrow Transplantation, University of Arizona, Banner University Medical Center - Tucson, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA
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Selle F, Gligorov J, Richard S, Khalil A, Alexandre I, Avenin D, Provent S, Soares DG, Lotz JP. Intensive chemotherapy as salvage treatment for solid tumors: focus on germ cell cancer. ACTA ACUST UNITED AC 2014; 48:13-24. [PMID: 25493378 PMCID: PMC4288488 DOI: 10.1590/1414-431x20144214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/15/2014] [Indexed: 02/15/2023]
Abstract
Germ cell tumors present contrasting biological and molecular features compared to many solid tumors, which may partially explain their unusual sensitivity to chemotherapy. Reduced DNA repair capacity and enhanced induction of apoptosis appear to be key factors in the sensitivity of germ cell tumors to cisplatin. Despite substantial cure rates, some patients relapse and subsequently die of their disease. Intensive doses of chemotherapy are used to counter mechanisms of drug resistance. So far, high-dose chemotherapy with hematopoietic stem cell support for solid tumors is used only in the setting of testicular germ cell tumors. In that indication, high-dose chemotherapy is given as the first or late salvage treatment for patients with either relapsed or progressive tumors after initial conventional salvage chemotherapy. High-dose chemotherapy is usually given as two or three sequential cycles using carboplatin and etoposide with or without ifosfamide. The administration of intensive therapy carries significant side effects and can only be efficiently and safely conducted in specialized referral centers to assure optimum patient care outcomes. In breast and ovarian cancer, most studies have demonstrated improvement in progression-free survival (PFS), but overall survival remained unchanged. Therefore, most of these approaches have been dropped. In germ cell tumors, clinical trials are currently investigating novel therapeutic combinations and active treatments. In particular, the integration of targeted therapies constitutes an important area of research for patients with a poor prognosis.
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Affiliation(s)
- F Selle
- Medical Oncology and Cellular Therapy Department, Hospital Tenon, Public Assistance Hospitals of Paris, Alliance for Cancer Research (APREC), Paris, France
| | - J Gligorov
- Medical Oncology and Cellular Therapy Department, Hospital Tenon, Public Assistance Hospitals of Paris, Alliance for Cancer Research (APREC), Paris, France
| | - S Richard
- Medical Oncology and Cellular Therapy Department, Hospital Tenon, Public Assistance Hospitals of Paris, Alliance for Cancer Research (APREC), Paris, France
| | - A Khalil
- Medical Oncology and Cellular Therapy Department, Hospital Tenon, Public Assistance Hospitals of Paris, Alliance for Cancer Research (APREC), Paris, France
| | - I Alexandre
- Medical Oncology Department, Hospital Centre of Bligny, Briis-sous-Forges, France
| | - D Avenin
- Medical Oncology and Cellular Therapy Department, Hospital Tenon, Public Assistance Hospitals of Paris, Alliance for Cancer Research (APREC), Paris, France
| | - S Provent
- Medical Oncology and Cellular Therapy Department, Hospital Tenon, Public Assistance Hospitals of Paris, Alliance for Cancer Research (APREC), Paris, France
| | - D G Soares
- Medical Oncology and Cellular Therapy Department, Hospital Tenon, Public Assistance Hospitals of Paris, Alliance for Cancer Research (APREC), Paris, France
| | - J P Lotz
- Medical Oncology and Cellular Therapy Department, Hospital Tenon, Public Assistance Hospitals of Paris, Alliance for Cancer Research (APREC), Paris, France
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Balduzzi A, Castiglione-Gertsch M. Leukemia risk after adjuvant treatment of early breast cancer. WOMENS HEALTH 2012; 1:73-85. [PMID: 19803948 DOI: 10.2217/17455057.1.1.73] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Modern cancer treatment has substantially increased the survival and curability of patients with various malignancies. Therefore, favorable prognosis mandates for the evaluation of long-term complications of treatment. Since the late 1970s, adjuvant combination chemotherapy for operable breast cancer has come into widespread use. Several recent studies have estimated the risk of acute myeloid leukemia associated with these regimens. The purpose of this analysis is to discuss the risk of leukemia after early breast cancer therapy, the types of leukemia, and the relationship between the risk of leukemia and treatment with different cytotoxic agents (alkylating agents, antimetabolities, topoisomerase II inhibitors, dose-dense therapy, high-dose therapy and growth factor use) and radiotherapy.
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Affiliation(s)
- Alessandra Balduzzi
- International Breast Cancer Study Group Coordinating Center, Istituto Europeo di Oncologia, via Ripamonti 435, 20141 Milano, Italy.
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4
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Gianni L, Gelber S, Ravaioli A, Price KN, Panzini I, Fantini M, Castiglione-Gertsch M, Pagani O, Simoncini E, Gelber RD, Coates AS, Goldhirsch A. Second non-breast primary cancer following adjuvant therapy for early breast cancer: a report from the International Breast Cancer Study Group. Eur J Cancer 2008; 45:561-71. [PMID: 19062268 DOI: 10.1016/j.ejca.2008.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 07/29/2008] [Accepted: 10/16/2008] [Indexed: 11/24/2022]
Abstract
The incidence of second non-breast primary cancer following adjuvant treatment was evaluated using data from patients enrolled from 1978 to 1999 in four International Breast Cancer Study Group (IBCSG) trials. The occurrence of these tumours as sites of the first failure was assessed separately for two treatment comparisons: toremifene versus tamoxifen for 5 years in 1035 patients in IBCSG Trials 12-93 and 14-93 with a median follow-up of 8 years and endocrine therapy (toremifene or tamoxifen) versus chemo-endocrine therapy (CMF or AC plus toremifene or tamoxifen) in 1731 patients from IBCSG Trials III, VII and 12-93, with a combined median follow-up of 14 years. No significant differences in second non-breast primary tumours were observed in either comparison. In particular, the incidences of second primary uterine tumours with toremifene and tamoxifen were similar and no significant increase of secondary leukaemias was observed with chemo-endocrine therapy compared with endocrine therapy.
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Affiliation(s)
- Lorenzo Gianni
- Department of Oncology, Ospedale Infermi, Rimini and Istituto Scientifico Romagnolo per lo Studio e Cura dei Tumori, Meldola (FC), Italy.
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5
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Takahashi S, Aiba K, Ito Y, Hatake K, Nakane M, Kobayashi T, Minowa S, Shibata H, Mitsuhashi J, Tsukahara S, Ishikawa E, Suzuki R, Tsuruo T, Sugimoto Y. Pilot study of MDR1 gene transfer into hematopoietic stem cells and chemoprotection in metastatic breast cancer patients. Cancer Sci 2007; 98:1609-16. [PMID: 17683514 PMCID: PMC11158217 DOI: 10.1111/j.1349-7006.2007.00571.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A major problem in high-dose chemotherapy with autologous hematopoietic stem cell transplantation is insufficient function of reconstituted bone marrow that limits the efficacy of post-transplantation chemotherapy. Because transduction of hematopoietic stem cells with the multidrug resistance 1 (MDR1) gene might circumvent this problem, we conducted a pilot study of MDR1 gene therapy against metastatic breast cancer. Peripheral blood stem cells were harvested, and one-third of the cells were transduced with MDR1 retrovirus. After the reconstitution of bone marrow function, the patients received high-dose chemotherapy with transplantation of both MDR1-transduced and unprocessed peripheral blood stem cells. The patients then received docetaxel chemotherapy. Two patients received transplantation of the MDR1-transduced cells in 2001. Peripheral blood MDR1-transduced leukocytes were 3-5% of the total cells after transplantation, but decreased gradually. During docetaxel chemotherapy, an increase in the rate of MDR1-transduced leukocytes (up to 10%) was observed. Comparison of docetaxel-induced granulocytopenia in the two patients suggested a bone marrow-protective effect of the MDR1-transduced cells. No serious side-effect was observed, and the patients were in complete remission for more than 3 years. The MDR1-transduced cells gradually decreased and disappeared almost entirely by the end of 2004. Results of linear amplification-mediated polymerase chain reaction of the MDR1-transduced leukocytes suggested no sign of abnormal amplification of the transduced cells. A third patient received transplantation of the MDR1-transduced cells in 2004. These results suggest the feasibility of our MDR1 gene therapy against metastatic breast cancer, and follow-up is ongoing.
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Affiliation(s)
- Shunji Takahashi
- Division of Clinical Chemotherapy, Cancer Chemotherapy Center, Japanese Foundation for Cancer Research, Tokyo 135-8500, Japan
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6
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Nieboer P, de Vries EGE, Mulder NH, van der Graaf WTA. Relevance of high-dose chemotherapy in solid tumours. Cancer Treat Rev 2005; 31:210-25. [PMID: 15944050 DOI: 10.1016/j.ctrv.2005.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Drug resistance is a major problem in the treatment of solid tumours. Based on a steep dose-response relationship for especially alkylating agents on tumour cell survival, high-dose chemotherapy was considered of interest for the treatment of solid tumours. Results of phase 1 and 2 studies with high-dose chemotherapy in a variety of tumour types showed good response rates. Nowadays, several phase 3 studies are available especially in metastatic and high-risk breast cancer patients. The high expectations of high-dose chemotherapy did not come true. This review analyses results of randomised studies and comments on the discrepancy between findings in patients versus those in tissue culture. Potential factors involved are the presence of tumour stem cells with different characteristics from more mature tumour cells, limitations in drug escalation in the clinic, transplant mortality, trial design and tumour cell contamination of the haematopoietic stem cell transplant. Maturation of the results from recent studies indicating a more modest benefit in, e.g., adjuvant breast cancer balanced versus long-term side effects will ultimately determine the role of high-dose chemotherapy in certain solid tumours. In case of well-defined indications for high-dose chemotherapy, further selection of patients based on patient and tumour characteristics as well as the introduction of new agents will most likely play a role.
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Affiliation(s)
- P Nieboer
- Department of Medical Oncology, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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7
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Kröger N, Damon L, Zander AR, Wandt H, Derigs G, Ferrante P, Demirer T, Rosti G. Secondary acute leukemia following mitoxantrone-based high-dose chemotherapy for primary breast cancer patients. Bone Marrow Transplant 2004; 32:1153-7. [PMID: 14647269 DOI: 10.1038/sj.bmt.1704291] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The incidence of secondary myelodysplasia/acute myeloid leukemia (AML) was retrospectively assessed in an international joint study in 305 node-positive breast cancer patients, who received mitoxantrone-based high-dose chemotherapy (HDCT) followed by autologous stem cell support as adjuvant therapy. The median age of the patients was 57 years (range 22-67). In all, 268 patients received peripheral blood stem cells, and 47 patients received autologous bone marrow. After a median follow-up of 57 months (range 10-125), three cases of secondary AML (sAML) were observed, resulting in a cumulative incidence of 0.94%. One case of sAML developed 18 months after HDCT (FAB M3) The karyotype was translocation 15;17 and, after induction therapy, the patient underwent autologous stem cell transplantation, and is in complete remission (CR) of both breast cancer and AML. The second patient developed AML (FAB M4eo with inversion 16) 5 months after HDCT. This patient achieved CR after induction therapy, but died of infectious complication. A third patient developed AML (FAB M4) 6 months after HDCT. She achieved CR after induction therapy, but relapsed and expired 28 months after diagnosis of AML. sAML after mitoxantrone-based HDCT is a possible, but rare complication in breast cancer patients.
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MESH Headings
- Acute Disease
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bone Marrow Transplantation
- Breast Neoplasms/drug therapy
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/therapy
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Cytarabine/administration & dosage
- Daunorubicin/administration & dosage
- Doxorubicin/administration & dosage
- Epirubicin/administration & dosage
- Female
- Humans
- Incidence
- Leukemia, Myeloid/chemically induced
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/epidemiology
- Leukemia, Myeloid/etiology
- Leukemia, Myelomonocytic, Acute/chemically induced
- Leukemia, Promyelocytic, Acute/chemically induced
- Leukemia, Radiation-Induced/epidemiology
- Leukemia, Radiation-Induced/etiology
- Lymphatic Metastasis
- Melphalan/administration & dosage
- Middle Aged
- Mitoxantrone/administration & dosage
- Mitoxantrone/adverse effects
- Neoplasms, Second Primary/chemically induced
- Paclitaxel/administration & dosage
- Peripheral Blood Stem Cell Transplantation
- Radiotherapy, Adjuvant/adverse effects
- Thiotepa/administration & dosage
- Transplantation Conditioning
- Transplantation, Autologous
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Affiliation(s)
- N Kröger
- Department of Bone Marrow Transplantation, University of Hamburg, Hamburg, Germany
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Friedman DL, Leisenring W, Schwartz JL, Deeg HJ. Second malignant neoplasms following hematopoietic stem cell transplantation. Int J Hematol 2004; 79:229-34. [PMID: 15168589 DOI: 10.1532/ijh97.03178] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hematopoietic stem cell transplantation is being successfully used to treat a variety of malignant and nonmalignant disorders. This therapy has resulted in an increasing number of survivors who are at risk for adverse long-term outcomes, including the development of second and subsequent malignant neoplasms. We review the incidence and spectrum of posttransplantation malignancies and discuss risk factors and future directions for research.
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Affiliation(s)
- Debra L Friedman
- University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
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9
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Burdette-Radoux S, Muss HB. Optimizing the Use of Anthracyclines in the Adjuvant Treatment of Early-Stage Breast Cancer. Clin Breast Cancer 2003; 4:264-72. [PMID: 14651771 DOI: 10.3816/cbc.2003.n.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Anthracyclines have been incorporated into adjuvant chemotherapy regimens for breast cancer since the 1980s. A metaanalysis confirmed that regimens containing anthracyclines result in better disease-free and overall survival than standard CMF (cyclophosphamide/methotrexate/5-fluorouracil), with a proportional reduction of 11% in risk of death at 10 years with the addition of these agents. Dose escalation of doxorubicin results in outcome improvement up to a threshold dose beyond which no further improvement is seen. Epirubicin, with its better toxicity profile, can be escalated to higher doses than doxorubicin, with better outcomes associated with higher dose levels. Tumors expressing HER2/neu may respond better to anthracycline-containing regimens than to standard CMF, but this remains controversial. Newer regimens combining anthracyclines with taxanes may offer a slight additional advantage in terms of disease-free and overall survival in some patient populations. The scheduling of treatment is important, with recent results of dose-dense scheduling showing a greater survival benefit than conventional scheduling. Ongoing clinical trials should further define the best choice of anthracycline and the optimal dose and schedule of treatment.
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Affiliation(s)
- Susan Burdette-Radoux
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT 05401, USA.
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