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Amanati A, Van Manen R, Sajedianfard S, Shojaadini H, Boroughani M, Molavi Vardanjani H. Antineoplastic agents associated with neutropenic enterocolitis in patients with malignancy: A quantitative safety signal analysis. J Oncol Pharm Pract 2024:10781552241238195. [PMID: 38477542 DOI: 10.1177/10781552241238195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND The use of certain chemotherapy agents is associated with the development of a condition called "chemotherapy-associated neutropenic enterocolitis" (CANE). OBJECTIVE To determine the risk of CANE associated with the use of each antineoplastic agent. METHODS The FDA FAERS database of spontaneous adverse reactions was searched for the occurrence of the MedDRA preferred term "neutropenic colitis." RESULTS The search resulted in 1134 records of patients (535 [47.3%] females, 479 [42.2%] males, sex not specified in 120 [10.6%]) with neutropenic colitis receiving immunosuppressive chemotherapy. The mean age of patients was 47 (SD 22). 22 antineoplastic agents were found to have a strong association (reported odds ratio [ROR] > 100) with the occurrence of CANE; 9 had ROR < 2. CONCLUSION Drug databases have several limitations in providing updated information about newly approved pharmaceutical adverse events. Signal detection is a diagnostic method recognized as practical in pharmacovigilance. It may be utilized in the FDA's adverse event reporting database and has demonstrated a reasonable predictive performance in signaling adverse events. Our study emphasized the substantial knowledge gap between what we know about the potential risk of CANE caused by antineoplastic agents and the reports of the FDA on their new approved products.
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Affiliation(s)
- Ali Amanati
- Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Sarvin Sajedianfard
- Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hafez Shojaadini
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohadese Boroughani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Molavi Vardanjani
- Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Pétronille R, Bernard D, Guillaume LG, Victoire V, Thomas F, Jérôme C, Eloïse DC, Gérard P, Sylvie S, Audrey S, François L, Suzette D, Muriel P, Maxime A. Comparative analysis of docetaxel: physical and chemical characterisation of Taxotère® and generics. Eur J Cancer 2020; 135:183-191. [PMID: 32599408 DOI: 10.1016/j.ejca.2020.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/01/2020] [Indexed: 02/02/2023]
Abstract
Several cases of fatal enterocolitis have been described in association with the use of docetaxel (DTX), and this increase in adverse events has been concomitant with a change in formulation. Indeed in 2010, a new DTX-based presentation has been introduced in the form of a single ready-to-use vial by Sanofi-Aventis, presentation also used for generics. In this study, different available formulations were compared (Sanofi 2 vials, Sanofi 1 vial, Accord Healthcare, Kabi, Hospira) in terms of composition compliance with control specifications and simulated micelle behaviour to try to determine what could be the potential causes of this problem. This work had permitted to show that all the tested products complied with specifications in terms of dosage and purity. Variations in the composition of polysorbate 80 (PS80) have been observed but are probably too small to be responsible for the toxicity found in patients. However, we identified a difference in micelle size and release kinetics probably because of doubling concentration of ethanol in new formulation. As a result, we emphasised the importance in the case of DTX of conducting bioequivalence studies as expected in European Medicines Agency (EMA) guidance to ensure patient safety, even though these formulation changes might seem minor. Therefore, further studies are needed to explore the potential role of ethanol, PS80 and the unbound fraction of DTX in the development of enterocolitis in patients treated with DTX.
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Affiliation(s)
- Roy Pétronille
- Pharmacy Department, Gustave Roussy, Villejuif, F-94805, France.
| | - Do Bernard
- Pharmacy Department, Hôpital Henri Mondor, Créteil, F-94010, France; University of Paris-Sud, Department of Pharmacy, Laboratory "Matériaux et Santé" EA 401, 5 Rue Jean Baptiste Clément, 92296 Châtenay-Malabry, France
| | | | | | - Fleury Thomas
- Pharmacy Department, Gustave Roussy, Villejuif, F-94805, France
| | - Conq Jérôme
- Pharmacy Department, Gustave Roussy, Villejuif, F-94805, France
| | - Da Costa Eloïse
- Pharmacy Department, Gustave Roussy, Villejuif, F-94805, France
| | - Pierron Gérard
- Centre National de La Recherche Scientifique, UMR-8122, Institut Gustave Roussy, Villejuif 94805, France
| | - Souquere Sylvie
- Centre National de La Recherche Scientifique, UMR-8122, Institut Gustave Roussy, Villejuif 94805, France
| | - Solgadi Audrey
- University of Paris-Sud, Department of Pharmacy, Laboratory "Matériaux et Santé" EA 401, 5 Rue Jean Baptiste Clément, 92296 Châtenay-Malabry, France
| | - Lemare François
- Pharmacy Department, Gustave Roussy, Villejuif, F-94805, France
| | - Delaloge Suzette
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Paul Muriel
- Pharmacy Department, Hôpital Henri Mondor, Créteil, F-94010, France
| | - Annereau Maxime
- Pharmacy Department, Gustave Roussy, Villejuif, F-94805, France
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Duceau B, Picard M, Pirracchio R, Wanquet A, Pène F, Merceron S, Mokart D, Moreau AS, Lengliné E, Canet E, Lemiale V, Mariotte E, Azoulay E, Zafrani L. Neutropenic Enterocolitis in Critically Ill Patients: Spectrum of the Disease and Risk of Invasive Fungal Disease. Crit Care Med 2019; 47:668-676. [PMID: 30741755 DOI: 10.1097/ccm.0000000000003687] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Neutropenic enterocolitis occurs in about 5.3% of patients hospitalized for hematologic malignancies receiving chemotherapy. Data from critically ill patients with neutropenic enterocolitis are scarce. Our objectives were to describe the population of patients with neutropenic enterocolitis admitted to an ICU and to investigate the risk factors of invasive fungal disease. DESIGN A multicentric retrospective cohort study between January 2010 and August 2017. SETTING Six French ICUs members of the Groupe de Recherche Respiratoire en Onco-Hématologie research network. PATIENTS Adult neutropenic patients hospitalized in the ICU with a diagnosis of enteritis and/or colitis. Patients with differential diagnosis (Clostridium difficile colitis, viral colitis, inflammatory enterocolitis, mesenteric ischemia, radiation-induced gastrointestinal toxicity, and Graft vs Host Disease) were excluded. INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS We included 134 patients (median Sequential Organ Failure Assessment 10 [8-12]), with 38.8% hospital mortality and 32.1% ICU mortality rates. The main underlying malignancies were acute leukemia (n = 65, 48.5%), lymphoma (n = 49, 36.6%), solid tumor (n = 14, 10.4%), and myeloma (n = 4, 3.0%). Patients were neutropenic during a median of 14 days (9-22 d). Infection was documented in 81 patients (60.4%), including an isolated bacterial infection in 64 patients (47.8%), an isolated fungal infection in nine patients (6.7%), and a coinfection with both pathogens in eight patients (5.0%). Radiologically assessed enteritis (odds ratio, 2.60; 95% CI, 1.32-7.56; p = 0.015) and HIV infection (odds ratio, 2.03; 95% CI, 1.21-3.31; p = 0.016) were independently associated with invasive fungal disease. CONCLUSIONS The rate of invasive fungal disease reaches 20% in patients with neutropenic enterocolitis when enteritis is considered. To avoid treatment delay, antifungal therapy might be systematically discussed in ICU patients admitted for neutropenic enterocolitis with radiologically assessed enteritis.
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Affiliation(s)
- Baptiste Duceau
- Medical Intensive Care Unit, Hospital Saint Louis, Assistance Publique-Hôpitaux de Paris, France
- Paris Diderot University, Paris, France
| | - Muriel Picard
- Intensive Care Unit, CHU de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Romain Pirracchio
- Anesthesiology and Surgical Intensive Care Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Department of Biostatistics and Medical Informatics, INSERM U-1153, Paris, France
| | - Anne Wanquet
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Hospital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sybille Merceron
- Intensive Care Unit, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Djamel Mokart
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | | | - Etienne Lengliné
- Department of Hematology, Hospital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Canet
- Medical Intensive Care Unit, Hospital Saint Louis, Assistance Publique-Hôpitaux de Paris, France
- Paris Diderot University, Paris, France
| | - Virginie Lemiale
- Medical Intensive Care Unit, Hospital Saint Louis, Assistance Publique-Hôpitaux de Paris, France
- Paris Diderot University, Paris, France
| | - Eric Mariotte
- Medical Intensive Care Unit, Hospital Saint Louis, Assistance Publique-Hôpitaux de Paris, France
- Paris Diderot University, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Hospital Saint Louis, Assistance Publique-Hôpitaux de Paris, France
- Paris Diderot University, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Hospital Saint Louis, Assistance Publique-Hôpitaux de Paris, France
- Paris Diderot University, Paris, France
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Carrion AF, Hosein PJ, Cooper EM, Lopes G, Pelaez L, Rocha-Lima CM. Severe colitis associated with docetaxel use: A report of four cases. World J Gastrointest Oncol 2010; 2:390-4. [PMID: 21160890 PMCID: PMC2999675 DOI: 10.4251/wjgo.v2.i10.390] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Revised: 07/28/2010] [Accepted: 08/04/2010] [Indexed: 02/05/2023] Open
Abstract
Diarrhea is a common side effect of chemotherapy. Pseudomembranous colitis is a well known complication of antibiotic treatment that can also be observed, albeit rarely, with certain chemotherapeutic agents. We present four cases of severe colitis in patients undergoing treatment with taxane-based chemotherapy for pancreatic, lung and breast cancer. None of them had recently received antibiotics. One patient presented with a bowel perforation and three had endoscopic findings of pseudomembranous colitis. Two of these three patients had negative stool toxin assays for Clostridium difficile. In the patient presenting with perforation, an emergency left hemicolectomy was performed and the pathological findings in the colon were acute inflammation and ischemic necrosis; the other three patients were treated with oral vancomycin and/or oral or intravenous metronidazole leading to complete resolution of the symptoms. Apart from pseudomembranous colitis, we describe patients presenting with neutropenic enterocolitis as well as ischemic colitis after docetaxel use. These cases provide some insight into the spectrum and varied clinical presentations of severe colitis associated with taxane-based chemotherapy.
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Affiliation(s)
- Andres F Carrion
- Andres F Carrion, Peter J Hosein, Eugene M Cooper, Liset Pelaez, Caio M Rocha-Lima, Department of Medicine, Division of Gastroenterology, Hematology/Oncology, Pathology, University of Miami Miller School of Medicine, Miami, FL 33136, United States
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