Phase I/II Trial of Adjuvant Dose-Dense Docetaxel/Epirubicin/Cyclophosphamide (TEC) in Stage II and III Breast Cancer

Evaluation of chemotherapy infusion and phlebitis among cancer patients: A prospective observational single-center study

INTRODUCTION

Chemotherapy is an integral part of cancer management which is associated with phlebitis in around 70% of patients receiving intravenous chemotherapy infusion. Thus, we aimed to estimate the incidence, severity, and management of phlebitis associated with chemotherapy infusion among cancer patients.

METHODS

A prospective study was conducted among 145 patients receiving intravenous chemotherapy for the duration of six months in the oncology department. The relevant data for phlebitis was obtained and assessed using Phlebitis Grading Scale and Visual Analogue Scale for the assessment of severity and pain due to phlebitis, respectively.

RESULTS

Out of 145 patients, female (56.6%) patients predominated over male patients (43.5%) with a mean age of 53.5 ± 11.82 years. Phlebitis was encountered in 30.34% of patients among whom 22.8% (33) were females followed by 7.6% were males and the majority of patients (13.1%) were from the 46 to 60 years age group. Phlebitis was observed frequently among stage 2 (11%) and satge 4 (11%) patients. The highest incidence of phlebitis was seen among hypertensive (34.09%) and diabetic patients (27.27%) followed by those receiving chemotherapy through the 20-gauge intravenous cannula (22.8%) and 22-gauge (6.9%). Platinum compounds (56.8%) were commonly associated with phlebitis, followed by cyclophosphamide (20.5%). Heparin and benzyl nicotinate topical gel were used to treat phlebitis.

CONCLUSION

Platinum and cyclophosphamide are commonly associated with phlebitis which can be managed by topical heparin plus benzyl nicotinate. Phlebitis shouldn't be ignored as it has a high incidence, affects the quality of life, and increases the treatment burden.

Identifying Risk Factors for Anthracycline Chemotherapy-induced Phlebitis in Women with Breast Cancer: An Observational Study

AIMS

Anthracycline chemotherapy administered via a peripheral cannula results in severe anthracycline chemotherapy-induced phlebitis (ACIP) in about 20-30% of patients. Administering chemotherapy via a central venous catheter (CVC) prevents ACIP. However, CVCs are associated with an increased risk of thrombosis and sepsis. Our aim was to identify risk factors associated with severe ACIP and to provide evidence about the individual risk of developing symptoms.

MATERIALS AND METHODS

A prospective observational study of 263 women with breast cancer receiving peripheral administration of anthracycline chemotherapy at a UK cancer centre was conducted between May 2016 and January 2018. Data were collected at baseline and every 3 weeks following each chemotherapy treatment, using both healthcare professional- and participant-reported symptom assessments.

RESULTS

After three cycles of chemotherapy, 27% of participants experienced severe ACIP. Factors associated with symptom severity were identified as: arm used for chemotherapy administration, epirubicin dose, age, pre-existing hypertension, comorbidity, ethnic group and pain during chemotherapy administration. The sequence of arm used for chemotherapy administration was the single most significant factor (P < 0.001). When alternating arms were used no other risk factor was influential. Where alternating arms were not used, younger age and higher dose were associated with higher-grade symptoms, with age being more influential than dose. The cumulative effect of increasing symptom severity with repeated cycles was also identified (P < 0.001).

CONCLUSION

It is recommended that a CVC is not routinely required for women with breast cancer who have not undergone an axillary node clearance and receive chemotherapy in alternate arms. The need for a CVC for women who are planned to receive all anthracycline chemotherapy cycles in the same arm should be assessed in the light of peripheral venous access assessment and the key risk factors of age, dose and number of cycles.

Docetaxel Facilitates Endothelial Dysfunction through Oxidative Stress via Modulation of Protein Kinase C Beta: The Protective Effects of Sotrastaurin

Docetaxel (DTX), a taxane drug, has widely been used as an anticancer or antiangiogenesis drug. However, DTX caused side effects, such as vessel damage and phlebitis, which may reduce its clinical therapeutic efficacy. The molecular mechanisms of DTX that cause endothelial dysfunction remain unclear. The aim of this study as to validate the probable mechanisms of DTX-induced endothelial dysfunction in endothelial cells. Human umbilical vein endothelial cells (HUVECs) were stimulated with DTX (2.5, 5, and 10nM) for 24 h to induce endothelial dysfunction. Stimulation with DTX reduced cell viability in a concentration- and time-dependent manner. DTX upregulated caspase-3 activity and TUNEL-positive cells. DTX treatment also increased PKCβ phosphorylation levels and NADPH oxidase activity, which resulted in ROS formation. However, all of these findings were reversed by PKCβ inhibition and NADPH oxidase repression. Finally, we demonstrated that sotrastaurin (AEB-071), a new PKCβ inhibitor, mitigated DTX-induced oxidative injury in endothelial cells. Our findings from this study provide a probable molecular mechanism of DTX-induced oxidative injury in endothelial cells and a new clinical and therapeutic approach for preventing DTX-mediated vessel injury.

Efficacy of neo-adjuvant chemotherapy with TEC regimen on breast cancer

OBJECTIVE

This study aims to investigate the efficacy of neo-adjuvant chemotherapy with TEC regimen (taxotere-epirubicin-cyclophosphamide) in the treatment of breast cancer (BC) patients.

METHOD

Total of 118 BC patients were recruited from the Department of Breast Surgery in Shengjing Hospital of China Medical University from January 1, 2010 to December 31, 2012, in this study. The clinical data and serum samples were collected from each patient prior to the study. All patients were given four cycles of TEC chemotherapy before surgery.

RESULTS

The overall response rate of TEC regimen in the treatment of BC was 67.8% (80/118), clinical complete response rate was 3.4% (4/118), and clinical partial response rate was 64.4% (76/118). Furthermore, we found that age, tumor size, lymph node metastasis and clinical stages of patients had no statistically significant difference (all P > 0.05). Both negative ER status and negative PR status were statistically related to better response (P = 0.033 and P = 0.024, respectively) when compared with the positive ER status and positive PR status, while such association was not observed between the negative HER-2 status and positive HER-2 status (P > 0.05). In addition, the efficacy of triple-negative breast cancer was significantly better than that of luminal A, luminal B and HER-2+ cancers (all P < 0.05), but there was no significant difference among the HER-2+, luminal A, luminal B groups (all P > 0.05).

CONCLUSION

Our study support the view that BC cases under the TEC chemotherapy were related to higher overall response rates; and the chemotherapy with the TEC regimen could be served as an effective therapy in the treatment of BC.

Synergistic antitumoral effect of combination E gene therapy and Doxorubicin in MCF-7 breast cancer cells

The low effectiveness of conventional therapies to achieve the long-term survival of metastatic breast cancer patients calls for the development of novel options. Genes encoding cytotoxic proteins have been proposed as a new strategy to enhance the antiproliferative activity of drugs. Combined therapy using these genes and classical antitumoral drugs are under intensive study. The E gene from ϕX174 encodes a membrane protein with a toxic domain that leads to a decrease in the tumour cell growth rate. With the aim of improving the anti-tumour effect on breast cancer cells of the currently used chemotherapeutic drugs (Paclitaxel, Docetaxel and Doxorubicin), we investigated the association of E suicide gene with these drugs. The effect of the combined therapy (gene therapy and cytotoxic) was determined by treating transfected MCF-7 cells and multicellular tumour spheroids (MTS) with drugs gradient concentrations. Our results showed that E gene has a direct oncolytic effect inducing a significant decrease in the proliferation rate of the MCF-7 cells. The E gene antitumoral activity was mediated by the induction of apoptosis (mitochondrial pathway). In addition, a significant enhancement of proliferation inhibition was observed when E gene transfection was associated with cytotoxic drugs in comparison to single treatments. The use of the combined therapy E gene-Doxorubicin obtained the greatest effect on the MCF-7 growth arrest. This therapeutic association also induced a significant enhancement of the MTS volume growth inhibition. Anti-tumour activity of the chemotherapeutic drugs classically used in the treatment of breast cancer was enhanced by E gene. Our in vitro results indicate that experimental therapeutic strategy based in the combined therapy E gene and cytotoxic drugs may be of potential therapeutic value as a new strategy for patients with advanced breast cancer.

Intravenous administration of antineoplastic drugs: review of basics and what's new in 2009

Today, newer treatment regimens combine chemotherapy with targeted therapy, based on an improved understanding of cancer pathophysiology. New diagnostic testing with microarray technology is helping to identify mutational sequences in patient tumors, so individualized treatment of cancer will occur during our lifetime. The administration of IV antineoplastic drugs continues to be an important role of infusion nurses. In addition, this therapy has also found a niche in the treatment of nonmalignant conditions such as rheumatoid arthritis. This article reviews the fundamentals of administration of IV antineoplastic drugs and current issues and trends.

Gef gene therapy enhances the therapeutic efficacy of doxorubicin to combat growth of MCF-7 breast cancer cells

PURPOSE

The potential use of combined therapy is under intensive study including the association between classical cytotoxic and genes encoding toxic proteins which enhanced the antitumour activity. The main aim of this work was to evaluate whether the gef gene, a suicide gene which has a demonstrated antiproliferative activity in tumour cells, improved the antitumour effect of chemotherapeutic drugs used as first-line treatment in the management of advanced breast cancer.

METHODS

MCF-7 human breast cancer cells were transfected with gef gene using pcDNA3.1-TOPO expression vector. To determine the effect of the combined therapy, MCF-7 transfected and non-transfected cells were exposed to paclitaxel, docetaxel and doxorubicin at different concentrations. The growth-inhibitory effect of gef gene and/or drugs was assessed by MTT assay. Apoptosis modulation was determined by flow cytometric analysis, DNA fragmentation and morphological analysis. Multicellular tumour spheroids (MTS) from MCF-7 cells were used to confirm effectiveness of combined therapy (gef gene and drug).

RESULTS

Our results demonstrate that combined therapy gef gene/drugs (paclitaxel, docetaxel or doxurubicin) caused a decrease in cell viability. However, only the gef-doxorubicin (10 microM) combination induced a greater enhancement in the antitumour activity in MCF-7 cells. Most importantly, this combined strategy resulted in a significant synergistic effect, thus allowing lower doses of the drug to be used to achieve the same therapeutic effect. These results were confirmed using MTS in which volume decrease with combined therapy was greater than obtained using the gene therapy or chemotherapy alone, or the sum of both therapies.

CONCLUSIONS

The cytotoxic effect of gef gene in breast cancer cells enhances the chemotherapeutic effect of doxorubicin. This therapeutic approach has the potential to overcome some of the major limitations of conventional chemotherapy, and may therefore constitute a promising strategy for future applications in breast cancer therapy.

The role of doxorubicin and epirubicin in the treatment of patients with metastatic hormone-refractory prostate cancer

Advanced hormone-refractory prostate cancer (HRPC) is characterized by prevalently osteoblastic bone metastases which are what mostly affect these patients' quality of life and make the assessment of response to treatment particularly difficult by commonly used criteria. HRPC cannot be cured by any available therapeutic option, and chemotherapy has to be still considered as a palliative treatment. The anthracyclines doxorubicin (Dox) and epirubicin (Epi), alone or in combination with other agents, have been extensively used in the treatment of HRPC, but controversial results have been reported. The majority of reviewed studies reported a pain reduction in >50% of patients receiving Dox or Epi, suggesting a substantial palliative effect by their use in metastatic HRPC. The weekly schedule of anthracyclines seemed to achieve similar results to the 3-weekly schedule but with a better toxicity profile. Although the toxic adverse effects were usually manageable when anthracyclines were combined with other agents, toxicity was severe by a number of aggressive regimens. Docetaxel is today approved for the treatment of HRPC, and must be considered the standard platform on which new agents may be combined. Given that HRPC includes a heterogeneous group of patients with variable rates of tumour growth, the combination of docetaxel with active agents such as anthracyclines may deserve further clinical investigation.