1
|
Jiang Z, Xie Y, Zhang W, Du C, Zhong Y, Zhu Y, Jiang L, Dou L, Shao K, Sun Y, Xue Q, Tian Y, Gao S, Zhao D, Zhou A. Perioperative chemotherapy with docetaxel plus oxaliplatin and S-1 (DOS) versus oxaliplatin plus S-1 (SOX) for the treatment of locally advanced gastric or gastro-esophageal junction adenocarcinoma (MATCH): an open-label, randomized, phase 2 clinical trial. Gastric Cancer 2024; 27:571-579. [PMID: 38457083 PMCID: PMC11016518 DOI: 10.1007/s10120-024-01471-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/20/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND It remains unclear whether addition of docetaxel to the combination of a platinum and fluoropyrimidine could provide more clinical benefits than doublet chemotherapies in the perioperative treatment for locally advanced gastric/gastro-esophageal junction (LAG/GEJ) cancer in Asia. In this randomized, phase 2 study, we assessed the efficacy and safety of perioperative docetaxel plus oxaliplatin and S-1 (DOS) versus oxaliplatin plus S-1 (SOX) in LAG/GEJ adenocarcinoma patients. METHODS Patients with cT3-4 Nany M0 G/GEJ adenocarcinoma were randomized (1:1) to receive 4 cycles of preoperative DOS or SOX followed by D2 gastrectomy and another 4 cycles of postoperative chemotherapy. The primary endpoint was major pathological response (MPR). RESULTS From Aug, 2015 to Dec, 2019,154 patients were enrolled and 147 patients included in final analysis, with a median age of 60 (26-73) years. DOS resulted in significantly higher MPR (25.4 vs. 11.8%, P = 0.04). R0 resection rate, the 3-year PFS and 3-year OS rates were 78.9 vs. 61.8% (P = 0.02), 52.3 vs. 35% (HR 0.667, 95% CI: 0.432-1.029, Log rank P = 0.07) and 57.5 vs. 49.2% (HR 0.685, 95% CI: 0.429-1.095, Log rank P = 0.11) in the DOS and SOX groups, respectively. Patients who acquired MPR experienced significantly better survival. DOS had similar tolerance to SOX. CONCLUSIONS Perioperative DOS improved MPR significantly and tended to produce longer PFS compared to SOX in LAG/GEJ cancer in Asia, and might be considered as a preferred option for perioperative chemotherapy and worth further investigation.
Collapse
Affiliation(s)
- Zhichao Jiang
- Department of Medical Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, No. 17, Panjiayuannanli Street, Chaoyang District, Beijing, 100021, China
| | - Yibin Xie
- Department of Pancreatic and Gastric Surgery, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Wen Zhang
- Department of Medical Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, No. 17, Panjiayuannanli Street, Chaoyang District, Beijing, 100021, China
| | - Chunxia Du
- Department of Medical Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, No. 17, Panjiayuannanli Street, Chaoyang District, Beijing, 100021, China
| | - Yuxin Zhong
- Department of Pancreatic and Gastric Surgery, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yuelu Zhu
- Department of Pathology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Liming Jiang
- Department of Imaging Diagnosis, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lizhou Dou
- Department of Endoscopy, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Kang Shao
- Department of Thoracic Surgery, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yongkun Sun
- Department of Medical Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, No. 17, Panjiayuannanli Street, Chaoyang District, Beijing, 100021, China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yantao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Dongbing Zhao
- Department of Pancreatic and Gastric Surgery, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Aiping Zhou
- Department of Medical Oncology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, No. 17, Panjiayuannanli Street, Chaoyang District, Beijing, 100021, China.
| |
Collapse
|
2
|
Han R, He HC, Zhang WN, Pan ZT, Feng CY, Liang MJ, Wu MY, Zhong W, Lin WQ. Investigation of the correlation between platelet antibodies and peripheral blood cytopenia in patients with hepatocellular carcinoma. Sci Rep 2024; 14:9705. [PMID: 38678158 PMCID: PMC11055914 DOI: 10.1038/s41598-024-60603-8] [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: 10/29/2023] [Accepted: 04/25/2024] [Indexed: 04/29/2024] Open
Abstract
The primary triggers that stimulate the body to generate platelet antibodies via immune mechanisms encompass events such as pregnancy, transplantation, and blood transfusion. Interestingly, our findings revealed that a subset of male patients with hepatocellular carcinoma (HCC), despite having no history of transplantation or blood transfusion, has shown positive results in platelet antibody screenings. This hints at the possibility that certain factors, potentially related to the tumor itself or its treatment, may affect antibody production. To delve the causes we initiated this study. We employed a case-control study approach to analyze potential influential factors leading to the positive results via univariate and multivariate regression analysis. We utilized Kendall's tau-b correlation to examine the relationship between the strength of platelet antibodies and peripheral blood cytopenia. Antitumor medication emerged as an independent risk factor for positive results in HCC patients, and the strength of platelet antibodies positively correlated with the severity of anemia and thrombocytopenia. Without history of blood transfusion, transplantation, pregnancy, those HCC patients underwent recent tumor medication therapy are experiencing peripheral erythrocytopenia or thrombocytopenia, for them platelet antibody screenings holds potential clinical value for prevention and treatment of complications like drug-immune-related anemia and/or bleeding.
Collapse
Affiliation(s)
- Rui Han
- Laboratory of Oncology in South China, Department of Blood Transfusion, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060, People's Republic of China
| | - Hui-Chan He
- Laboratory of Oncology in South China, Department of Blood Transfusion, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060, People's Republic of China
| | - Wan-Ning Zhang
- Laboratory of Oncology in South China, Department of Blood Transfusion, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060, People's Republic of China
| | - Ze-Tao Pan
- Laboratory of Oncology in South China, Department of Blood Transfusion, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060, People's Republic of China
| | - Chen-Yang Feng
- Laboratory of Oncology in South China, Department of Blood Transfusion, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060, People's Republic of China
| | - Ming-Jian Liang
- Laboratory of Oncology in South China, Department of Blood Transfusion, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060, People's Republic of China
| | - Mei-Yi Wu
- Laboratory of Oncology in South China, Department of Blood Transfusion, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060, People's Republic of China
| | - Wei Zhong
- Department of Internal Medicine, Huangpu Hospital of Traditional Chinese Medicine, 3 Xieshan Road, Huangpu District, Guangzhou, 510700, People's Republic of China.
| | - Wen-Qian Lin
- Laboratory of Oncology in South China, Department of Blood Transfusion, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Yuexiu District, Guangzhou, 510060, People's Republic of China.
| |
Collapse
|
3
|
Zhao D, Song Q, Wu C, Wang S. Case report: A rare case of acute hemolysis in advanced rectal cancer after XELOX and nivolumab treatment: analysis of drug-dependent antibodies. Front Med (Lausanne) 2023; 10:1167759. [PMID: 37305130 PMCID: PMC10248394 DOI: 10.3389/fmed.2023.1167759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Objective To investigate the mechanism, in vitro differential test and clinical significance of hemolytic anemia after receiving oxaliplatin and nivolumab treatment. Methods We encountered a male patient with stage IV rectal cancer who experienced acute hemolysis during the ninth cycle of treatment with XELOX combined with nivolumab and cetuximab. The patient's blood samples were collected and tested for the presence of oxaliplatin or nivolumab antibodies on red blood cells. Results Direct antiglobulin testing of red blood cells incubated with oxaliplatin was strongly positive, whereas cells incubated with nivolumab were negative, which suggested that oxaliplatin was responsible for the hemolysis. After short-term highdose glucocorticoid treatment, human normal immunoglobulin infusion, and other symptomatic treatments, the patient's condition rapidly improved, and he continued to receive nivolumab treatment without further hemolysis. Conclusion Attention should be paid to the possibility of acute hemolysis when using oxaliplatin and nivolumab, and it is important to recognize and manage this adverse event early. We detected oxaliplatin-related antibodies on the surface of red blood cells in vitro, which provided evidence for the following treatments.
Collapse
Affiliation(s)
| | - Qiao Song
- Department of Medicine, Qingdao University, Qingdao, China
- Department of Hematology, Affiliated Hospital, Qingdao University, Qingdao, China
| | - Chunyan Wu
- Department of Medicine, Qingdao University, Qingdao, China
- Department of Hematology, Affiliated Hospital, Qingdao University, Qingdao, China
| | - Shuye Wang
- Harbin Medical University, Harbin, China
- Department of Hematology, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| |
Collapse
|
4
|
Gao A, Zhang L, Zhong D. Chemotherapy-induced thrombocytopenia: literature review. Discov Oncol 2023; 14:10. [PMID: 36695938 PMCID: PMC9877263 DOI: 10.1007/s12672-023-00616-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
Chemotherapy-induced thrombocytopenia (CIT) is a common condition that frequently results in reduced chemotherapy dosages, postponed treatment, bleeding, and unfavorable oncological outcomes. At present, there is no clear suggestions for preventing or treating CIT. Thrombopoietin (TPO) replacement therapy has been invented and used to treat CIT to promote the production of megakaryocytes and stimulate the formation of platelets. However, this treatment is limited to the risk of immunogenicity and cancer progression. Therefore, an unmet need exists for exploring alternatives to TPO to address the clinical issue of CIT. Application of appropriate therapeutic drugs may be due to understanding the potential mechanisms of CIT. Studies have shown that chemotherapy significantly affects various cells in bone marrow (BM) microenvironment, reduces their ability to support normal hematopoiesis, and may lead to BM damage, including CIT in cancer patients. This review focuses on the epidemiology and treatment of cancer patients with CIT. We also introduce some recent progress to understand the cellular and molecular mechanisms of chemotherapy inhibiting normal hematopoiesis and causing thrombocytopenia.
Collapse
Affiliation(s)
- Ai Gao
- Department of Medical Oncology, Tianjin Medical University General Hospital, No.154, Anshandao, Heping District, Tianjin, 300052, China.
| | - Linlin Zhang
- Department of Medical Oncology, Tianjin Medical University General Hospital, No.154, Anshandao, Heping District, Tianjin, 300052, China
| | - Diansheng Zhong
- Department of Medical Oncology, Tianjin Medical University General Hospital, No.154, Anshandao, Heping District, Tianjin, 300052, China
| |
Collapse
|
5
|
Oxaliplatin hypersensitivity complicated by thrombocytopenia during desensitization. Ann Allergy Asthma Immunol 2021; 127:267-269. [PMID: 33971363 DOI: 10.1016/j.anai.2021.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/02/2021] [Accepted: 04/28/2021] [Indexed: 11/21/2022]
|
6
|
Stack A, Khanal R, Denlinger CS. Oxaliplatin-induced Immune Thrombocytopenia: A Case Report and Literature Review. Clin Colorectal Cancer 2020; 20:e1-e4. [PMID: 33012678 DOI: 10.1016/j.clcc.2020.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/24/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Anthony Stack
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA
| | - Rashmi Khanal
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Crystal S Denlinger
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA.
| |
Collapse
|
7
|
Acute Immune-Mediated Thrombocytopenia due to Oxaliplatin and Irinotecan Therapy. Case Rep Oncol Med 2019; 2019:4314797. [PMID: 31781443 PMCID: PMC6875012 DOI: 10.1155/2019/4314797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/26/2019] [Accepted: 10/12/2019] [Indexed: 12/13/2022] Open
Abstract
We describe a case of a 63-year-old woman with advanced colon cancer and liver metastases who was treated with fluorouracil, leucovorin, and oxaliplatin (FOLFOX) and cetuximab chemotherapy. She tolerated 13 cycles of chemotherapy without any significant hematological side effects, but after the 14th cycle, she developed melena and was admitted for severe thrombocytopenia. After supportive care, the platelet counts rapidly improved to 76,000/μL. Upon initiation of FOLFIRI and cetuximab chemotherapy, she again developed rectal bleeding and severe thrombocytopenia with a platelet count of 6000/μL. Lab testing was positive for oxaliplatin and irinotecan drug-dependent platelet antibodies on flow cytometry assay. Drug-induced thrombocytopenia (DITP) is associated with several classes of drugs with several proposed underlying mechanisms. Prospective studies are needed to further address different mechanisms of drug-induced thrombocytopenia.
Collapse
|
8
|
Pan E, Hsieh E, Piatek C. Case Report: Oxaliplatin-Induced Immune-Mediated Thrombocytopenia. Case Rep Oncol 2019; 11:880-882. [PMID: 30687065 PMCID: PMC6341312 DOI: 10.1159/000495032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 10/30/2018] [Indexed: 11/26/2022] Open
Abstract
Thrombocytopenia is a frequent complication of cancer may be due to a variety of causes including malignancy itself, acute disease processes, or cancer therapy. Systemic cancer therapy is the most common cause of thrombocytopenia in cancer patients observed nearly two-thirds of patients with solid tumors. Thrombocytopenia with traditional chemotherapy agents is most frequently the result of megakaryocyte cytotoxicity. Oxaliplatin is a platinum derivative commonly used in gastrointestinal malignancies and is associated with drug-induced immune thrombocytopenia.
Collapse
Affiliation(s)
- Elizabeth Pan
- Department of Medicine, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Eric Hsieh
- Department of Medicine, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Caroline Piatek
- Division of Hematology, Department of Medicine, Keck School of Medicine of USC, Los Angeles, California, USA
| |
Collapse
|
9
|
Patients treated with oxaliplatin are at risk for thrombocytopenia caused by multiple drug-dependent antibodies. Blood 2018; 131:1486-1489. [PMID: 29439950 DOI: 10.1182/blood-2017-10-812461] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|
10
|
Pietrantonio F, Di Bartolomeo M, Buzzoni R, Bajetta E. Acute Immune-Mediated Thrombocytopenia Due to Oxaliplatin Administration: A Case Report. TUMORI JOURNAL 2018; 96:154-6. [DOI: 10.1177/030089161009600125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Drug-induced acute thrombocytopenia is an extremely rare side effect that may occur immediately after oxaliplatin infusion. This potentially fatal reaction is immune mediated and can be anticipated by mild hemorrhagic signs during previous administrations. This is the first report of acute thrombocytopenia occurring during adjuvant treatment of colorectal cancer with oxaliplatin. Clinicians should be aware of this adverse event in order to prevent possible serious consequences and stop further oxaliplatin administration.
Collapse
Affiliation(s)
- Filippo Pietrantonio
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maria Di Bartolomeo
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Roberto Buzzoni
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Emilio Bajetta
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| |
Collapse
|
11
|
Racca P, Spadi R, Fora G, Fanchini L, Ritorto G, Ferrari L, Pinta F, Lista P, Ciuffreda L. Hemolytic uremic syndrome induced by infusion of oxaliplatin: A case report. TUMORI JOURNAL 2018; 97:31e-3e. [DOI: 10.1177/030089161109700527] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction Oxaliplatin is a third-generation platinum compound with proven antitumor activity in the treatment of colorectal cancer. The occurrence of life-threating hemolitic uremic syndrome has been observed after oxaliplatin therapy. The kind of tumor and treatment modalities seem to influence the onset of hemolitic uremic syndrome. Methods The clinical course of the case is reviewed and compared with reports of other similar cases in the literature. Results We describe the development of hemolitic uremic syndrome as a result of prolonged oxaliplatin treatment of a colon cancer patient. Conclusions Although this rare event requires the concurrence of other unknown factors, it should be considered in a decision-making setting.
Collapse
Affiliation(s)
- Patrizia Racca
- SSCVD Colorectal Cancer Unit, AOU San Giovanni Battista, Turin, Italy
| | - Rosella Spadi
- SSCVD Colorectal Cancer Unit, AOU San Giovanni Battista, Turin, Italy
| | - Gianluca Fora
- SSCVD Colorectal Cancer Unit, AOU San Giovanni Battista, Turin, Italy
| | - Laura Fanchini
- SSCVD Colorectal Cancer Unit, AOU San Giovanni Battista, Turin, Italy
| | | | - Laura Ferrari
- SSCVD Colorectal Cancer Unit, AOU San Giovanni Battista, Turin, Italy
| | - Francesco Pinta
- SSCVD Colorectal Cancer Unit, AOU San Giovanni Battista, Turin, Italy
| | - Patrizia Lista
- SC Medical Oncology 1, AOU San Giovanni Battista, Turin, Italy
| | | |
Collapse
|
12
|
Ahmed AT, Gupta S. Acute drop of platelets in metastatic colon cancer. Clin Case Rep 2017; 5:1862-1864. [PMID: 29152287 PMCID: PMC5676258 DOI: 10.1002/ccr3.1210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/25/2017] [Indexed: 01/08/2023] Open
Abstract
Oxaliplatin is a platinum commonly used in the treatment of metastatic colon cancer. It can cause thrombocytopenia through different mechanism. Sudden isolated drop in platelets should raise the concern for oxaliplatin immune‐induced thrombocytopenia and abrupt discontinuation of the drug. Patients should not be rechallenged with oxaliplatin once diagnosis of OIIT is confirmed.
Collapse
Affiliation(s)
- Ahmed-Tarig Ahmed
- Division of Hematology-Oncology; John H. Stroger Hospital of Cook County; 1900 W. Polk St, Suite #750 Chicago 60612 Illinois
| | - Shweta Gupta
- Division of Hematology-Oncology; John H. Stroger Hospital of Cook County; 1900 W. Polk St, Suite #750 Chicago 60612 Illinois
| |
Collapse
|
13
|
Phull P, Quillen K, Hartshorn KL. Acute Oxaliplatin-induced Hemolytic Anemia, Thrombocytopenia, and Renal Failure: Case Report and a Literature Review. Clin Colorectal Cancer 2016; 16:S1533-0028(16)30259-6. [PMID: 27989485 DOI: 10.1016/j.clcc.2016.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/05/2016] [Accepted: 11/14/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Pooja Phull
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Karen Quillen
- Section of Hematology Oncology, Boston University School of Medicine, Boston, MA
| | - Kevan L Hartshorn
- Section of Hematology Oncology, Boston University School of Medicine, Boston, MA.
| |
Collapse
|
14
|
Bencardino K, Mauri G, Amatu A, Tosi F, Bonazzina E, Palmeri L, Querques M, Ravera F, Menegotto A, Boiani E, Sartore-Bianchi A, Siena S. Oxaliplatin Immune-Induced Syndrome Occurs With Cumulative Administration and Rechallenge: Single Institution Series and Systematic Review Study. Clin Colorectal Cancer 2016; 15:213-21. [DOI: 10.1016/j.clcc.2016.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/22/2015] [Accepted: 02/03/2016] [Indexed: 01/27/2023]
|
15
|
Bano N, Najam R, Qazi F, Mateen A. Clinical Features of Oxaliplatin Induced Hypersensitivity Reactions and Therapeutic Approaches. Asian Pac J Cancer Prev 2016; 17:1637-41. [DOI: 10.7314/apjcp.2016.17.4.1637] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
16
|
|
17
|
Meng L, Romano A, Smith E, Macik G, Grosh WW. Disseminated Intravascular Coagulation and Immune Hemolytic Anemia, Possibly Evans Syndrome, After Oxaliplatin and Bevacizumab Infusion for Metastatic Colon Adenocarcinoma: A Case Report and Literature Review. Clin Colorectal Cancer 2015; 14:e1-3. [DOI: 10.1016/j.clcc.2014.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
|
18
|
Malkhasyan K, Halene S, Lacy J. Oxaliplatin-Related Acute Disseminated Intravascular Coagulation Syndrome in a Patient With Metastatic Colon Cancer. Clin Colorectal Cancer 2015; 14:e9-e12. [DOI: 10.1016/j.clcc.2014.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 09/17/2014] [Indexed: 12/27/2022]
|
19
|
Woo HS, Lee KH, Yoon PH, Kim SJ, Park I, Kim YS, Ahn HK, Hong J, Shin DB, Sym SJ. Oxaliplatin-Induced Immune-Mediated Thrombocytopenia: A Case Report. Cancer Res Treat 2014; 47:949-53. [PMID: 25544580 PMCID: PMC4614196 DOI: 10.4143/crt.2014.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/15/2014] [Indexed: 11/21/2022] Open
Abstract
Oxaliplatin is a third-generation platinum derivative used for metastatic or advanced colorectal cancer treatment. Although myelosuppression is the most common cause of oxaliplatin-induced thrombocytopenia, rare cases of oxaliplatin-induced immune-mediated thrombocytopenia are reported. We report a case of a 57-year-old woman with colon cancer who developed gum bleeding and petechiae after oxaliplatin infusion. Laboratory tests revealed grade 4 thrombocytopenia and grade 4 neutropenia. She recovered from the thrombocytopenia and accompanying neutropenia within 4 days with no recurrence following discontinuation of oxaliplatin. Physicians need to be aware of the risk of severe acute thrombocytopenia following oxaliplatin administration.
Collapse
Affiliation(s)
- Hyun Sun Woo
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Kyoung Hwa Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Phill Hoon Yoon
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Su Ji Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Inkeun Park
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Young Saing Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Hee Kyung Ahn
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Junshik Hong
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Dong Bok Shin
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Sun Jin Sym
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| |
Collapse
|
20
|
Toki MI, Saif MW, Syrigos KN. Hypersensitivity reactions associated with oxaliplatin and their clinical management. Expert Opin Drug Saf 2014; 13:1545-54. [PMID: 25307143 DOI: 10.1517/14740338.2014.963551] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Oxaliplatin , has become an integral part of the medical treatment of colorectal cancer and other malignancies. Increased use of the drug during the last decade, has led to increased occurrence of oxaliplatin-induced hypersensitivity reactions (HSRs), posing a significant challenge for clinicians. This article aims to review the existing literature regarding the incidence, clinical presentation, pathophysiology, risk factors and current management of oxaliplatin-induced HSRs. AREAS COVERED A systematic review of the English literature published in PubMed and Medline was undertaken. The clinical manifestations of HSRs were found to be variable and unpredictable. These reactions should be an important concern, as their potential life-threatening risks can force doctors to stop treatment and seek alternatives, which may be less effective, not as well tolerated and/or more expensive. There are a few strategies to prevent these reactions so that patients can still benefit from oxaliplatin. Such strategies include the use of premedication (steroid and antagonists of type I and II histamine receptors), prolonged infusion time and desensitization. EXPERT OPINION The presented management strategies as well as novel diagnostic tools including skin/intradermal tests and specific IgE have shown promising results. However, future research and validation are warranted in bigger clinical trials.
Collapse
Affiliation(s)
- Maria I Toki
- National and Kapodistrian University of Athens, Sotiria General Hospital, Medical School, Third Department of Medicine, Oncology Unit , 152 Mesogeion Ave, 11527, Athens , Greece +30 210 770 0220 ; +30 210 778 1035 ;
| | | | | |
Collapse
|
21
|
Aroldi F, Prochilo T, Bertocchi P, Zaniboni A. Oxaliplatin-induced hypersensitivity reaction: underlying mechanisms and management. J Chemother 2014; 27:63-6. [PMID: 25096819 DOI: 10.1179/1973947814y.0000000204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Hypersensitivity reactions are rare but feared drugs adverse effect. These reactions are not uncommon with anticancer drugs, such as taxanes, monoclonal antibodies, and platinum compounds. Oxaliplatinum, a third-generation platinum compound, one of the mainstay drugs in the treatment of many gastrointestinal cancers, can give rise to hypersensitivity reactions, sometimes with fatal outcomes. In this paper, we reviewed the incidence and mechanisms underlying the occurrence of this event, highlighting the most recent advances concerning the pathogenesis of the reaction and also reporting possible risk factors identified and the most effective treatment in preventing the onset of this event.
Collapse
|
22
|
Suh SE, Jang MJ, Chong SY, Aster RH, Curtis BR, Oh D. A case of oxaliplatin-induced immune-mediated thrombocytopenia. Blood Res 2014; 49:61-4. [PMID: 24724069 PMCID: PMC3974961 DOI: 10.5045/br.2014.49.1.61] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 08/18/2012] [Accepted: 01/09/2014] [Indexed: 12/21/2022] Open
Abstract
Oxaliplatin is a platinum compound used in patients with gastrointestinal malignancies. It is known to evoke a drug-induced immune-mediated thrombocytopenia, which has not been reported in Korea. We describe a 53-year-old man who developed oxaliplatin-induced immune-mediated thrombocytopenia during chemotherapy for colon cancer. Oxaliplatin-dependent IgG platelet antibodies were detected in his serum on flow cytometry. He was treated with immunoglobulin and corticosteroids without any complications. Physicians should consider oxaliplatin-induced immune-mediated thrombocytopenia, when a sudden, isolated thrombocytopenia develops during chemotherapy with oxaliplatin.
Collapse
Affiliation(s)
- Seong Eun Suh
- Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea
| | - Moon Ju Jang
- Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea
| | - So Young Chong
- Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea
| | - Richard H Aster
- Platelet & Neutrophil Immunology Laboratory, Blood Center of Wisconsin, Milwaukee, WI, USA
| | - Brian R Curtis
- Platelet & Neutrophil Immunology Laboratory, Blood Center of Wisconsin, Milwaukee, WI, USA
| | - Doyeun Oh
- Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea
| |
Collapse
|
23
|
Forcello NP, Khubchandani S, Patel SJ, Brahaj D. Oxaliplatin-induced immune-mediated cytopenias: a case report and literature review. J Oncol Pharm Pract 2014; 21:148-56. [PMID: 24500808 DOI: 10.1177/1078155213520262] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Oxaliplatin is a third-generation platinum antineoplastic agent that commonly causes diarrhea, nausea, vomiting, myelosuppression, and peripheral neuropathy. Less common adverse effects that are increasingly being reported include acute immune-mediated thrombocytopenia, hemolytic anemia, and pancytopenia. Here, we report a patient case of suspected oxaliplatin-induced immune-mediated thrombocytopenia and a thorough literature evaluation of acute oxaliplatin-induced immune-mediated thrombocytopenia, hemolytic anemia, and pancytopenia that has yet to be reported until now. There have been 39 previously published reports of these cytopenic events with a median number of 16 treatment cycles prior to presentation. Patients experiencing unusual signs and symptoms such as chills, rigors, fever, back pain, abdominal pain, ecchymosis, hematemesis, hematuria, dark urine, hematochezia, petechiae, epistaxis, or mental status changes during or shortly after an oxaliplatin infusion should have complete blood counts ordered and evaluated promptly.
Collapse
Affiliation(s)
| | - Sapna Khubchandani
- Department of Hematology and Oncology, Bristol Hospital, Bristol, CT, USA
| | - Shrina J Patel
- School of Pharmacy, University of Saint Joseph, Hartford, CT, USA
| | - Driola Brahaj
- Department of Hematology and Oncology, Bristol Hospital, Bristol, CT, USA
| |
Collapse
|
24
|
Curtis BR. Drug-induced immune thrombocytopenia: incidence, clinical features, laboratory testing, and pathogenic mechanisms. Immunohematology 2014; 30:55-65. [PMID: 25247620 DOI: 10.21307/immunohematology-2019-099] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Drug-induced immune thrombocytopenia (DIIT) is a relatively uncommon adverse reaction caused by drug-dependent antibodies (DDAbs) that react with platelet membrane glycoproteins only when the implicated drug is present. Although more than 100 drugs have been associated with causing DIIT, recent reviews of available data show that carbamazepine, eptifibatide, ibuprofen, quinidine, quinine, oxaliplatin, rifampin, sulfamethoxazole, trimethoprim, and vancomycin are probably the most frequently implicated. Patients with DIIT typically present with petechiae, bruising, and epistaxis caused by an acute, severe drop in platelet count (often to <20,000 platelets/pL). Diagnosis of DIIT is complicated by its similarity to other non-drug-induced immune thrombocytopenias, including autoimmune thrombocytopenia, posttransfusion purpura, and platelet transfusion refractoriness, and must be differentiated by temporal association of exposure to a candidate drug with an acute, severe drop in platelet count. Treatment consists of immediate withdrawal of the implicated drug. Criteria for strong evidence of DIIT include (1) exposure to candidate drug-preceded thrombocytopenia; (2) sustained normal platelet levels after discontinuing candidate drug; (3) candidate drug was only drug used before onset of thrombocytopenia or other drugs were continued or reintroduced after resolution of thrombocytopenia, and other causes for thrombocytopenia were excluded; and (4) reexposure to the candidate drug resulted in recurrent thrombocytopenia. Flow cytometry testing for DDAbs can be useful in confirmation of a clinical diagnosis, and monoclonal antibody enzyme-linked immunosorbent assay testing can be used to determine the platelet glycoprotein target(s), usually GPIIb/IIIa or GPIb/IX/V, but testing is not widely available. Several pathogenic mechanisms for DIIT have been proposed, including hapten, autoantibody, neoepitope, drug-specific, and quinine-type drug mechanisms. A recent proposal suggests weakly reactive platelet autoantibodies that develop greatly increased affinity for platelet glycoprotein epitopes through bridging interactions facilitated by the drug is a possible mechanism for the formation and reactivity of quinine- type drug antibodies.
Collapse
Affiliation(s)
- Brian R Curtis
- PhD, D(ABMLI), MT(ASCP)SBB, Director, Platelet and Neutrophil Immunology Lab, Blood Research Institute, BloodCenter of Wisconsin, PO Box 2178, Milwaukee, WI 53201-2178
| |
Collapse
|
25
|
Arnold DM, Kukaswadia S, Nazi I, Esmail A, Dewar L, Smith JW, Warkentin TE, Kelton JG. A systematic evaluation of laboratory testing for drug-induced immune thrombocytopenia. J Thromb Haemost 2013; 11:169-76. [PMID: 23121994 PMCID: PMC4991941 DOI: 10.1111/jth.12052] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Drug-induced immune thrombocytopenia (DITP) can be confirmed by the demonstration of drug-dependent platelet antibodies in vitro; however, laboratory testing is not readily accessible and test methods are not standardized. OBJECTIVE To identify drugs with the strongest evidence for causing DITP based on clinical and laboratory criteria. PATIENTS/METHODS We developed a grading system to evaluate the quality of DITP laboratory testing. The 'DITP criteria' were: (i) Drug (or metabolite) was required for the reaction in vitro; (ii) Immunoglobulin binding was demonstrated; (iii) Two or more laboratories obtained positive results; and (iv) Platelets were the target of immunoglobulin binding. Laboratory diagnosis of DITP was considered definite when all criteria were met and probable when positive results were reported by only one laboratory. Two authors applied the DITP criteria to published reports of each drug identified by systematic review. Discrepancies were independently adjudicated. RESULTS Of 153 drugs that were clinically implicated in thrombocytopenic reactions, 72 (47%) were associated with positive laboratory testing. Of those, 16 drugs met criteria for a definite laboratory diagnosis of DITP and thus had the highest probability of causing DITP. Definite drugs were: quinine, quinidine, trimethoprim/sulfamethoxazole, vancomycin, penicillin, rifampin, carbamazepine, ceftriaxone, ibuprofen, mirtazapine, oxaliplatin and suramin; the glycoprotein IIbIIIa inhibitors abciximab, tirofiban and eptifibatide; and heparin. CONCLUSIONS We identified drugs with the strongest evidence for an association with immune thrombocytopenia. This list may be helpful for ranking potential causes of thrombocytopenia in a given patient.
Collapse
Affiliation(s)
- D M Arnold
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Suzuki K, Oda H, Sugawara Y, Masuya M, Nakase K, Fujioka M, Imai H, Katayama N. Oxaliplatin-induced acute thrombocytopenia: a case report and review of the literature. Intern Med 2013; 52:611-5. [PMID: 23448774 DOI: 10.2169/internalmedicine.52.8933] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report the case of a 77-year-old woman who developed acute thrombocytopenia during the 23rd cycle of modified FOLFOX therapy. She developed a hypersensitivity reaction with nasal bleeding. The chemotherapy infusion was immediately discontinued. The patient's symptoms resolved with discontinuation of chemotherapy and the administration of supportive therapy. A complete blood count showed severe thrombocytopenia, and oxaliplatin-induced thrombocytopenia was diagnosed. The patient was admitted to the hospital, and the thrombocytopenia was corrected with a platelet transfusion followed by prednisolone. She was discharged after one week without requiring additional platelet transfusions. With the widespread use of oxaliplatin, the risk of oxaliplatin-induced acute thrombocytopenia should be considered an acute onset hematological emergency.
Collapse
Affiliation(s)
- Kei Suzuki
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Hirata K, Matsuda H, Toyonaga T, Sonoda Y, Kiyonaga H, Tominaga Y, Mibu R, Miyazaki M, Kobayashi H. Successful Management with Splenectomy for Splenomegaly with Thrombocytopenia and Leukocytopenia Caused by Oxaliplatin-based Chemotherapy for Metastatic Colon Cancer. A Case Report. ACTA ACUST UNITED AC 2013. [DOI: 10.3862/jcoloproctology.66.422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
28
|
Schwartzman AD, Sethi R, Smith R. Multiorgan failure in a patient treated with the 5-fluorouracil, leucovorin, oxaliplatin, and irinotecan regimen. Clin Colorectal Cancer 2012; 12:136-9. [PMID: 23098664 DOI: 10.1016/j.clcc.2012.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 08/20/2012] [Accepted: 09/13/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Andrew D Schwartzman
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline, MA 02446, USA.
| | | | | |
Collapse
|
29
|
Jardim DL, Rodrigues CA, Novis YAS, Rocha VG, Hoff PM. Oxaliplatin-related thrombocytopenia. Ann Oncol 2012; 23:1937-1942. [PMID: 22534771 DOI: 10.1093/annonc/mds074] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
Oxaliplatin is a third generation platinum compound that inhibits DNA synthesis, mainly through intrastrandal cross-links in DNA. Most of the experience with the clinical use of this drug is derived from colorectal cancer but it is also used in other tumor types such as ovary, breast, liver and non-Hodgkin's lymphoma. Thrombocytopenia is a frequent toxicity seen during oxaliplatin treatment, occurring at any grade in up to 70% of patients and leading to delays or even discontinuation of the chemotherapy. Although myelossupression is recognized as the main cause of oxaliplatin-related thrombocytopenia, new mechanisms for this side-effect have emerged, including splenic sequestration of platelets related to oxaliplatin-induced liver damage and immune thrombocytopenia. These new pathophysiology pathways have different clinical presentations and evolution and may need specific therapeutic maneuvers. This article attempts to review this topic and provides useful clinical information for the management of oxaliplatin-related thrombocytopenia.
Collapse
Affiliation(s)
- D L Jardim
- Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo.
| | - C A Rodrigues
- Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo; Department of Clinical and Experimental Hematology, Universidade Federal do Estado de Sao Paulo, Sao Paulo
| | - Y A S Novis
- Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo
| | - V G Rocha
- Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo; Department of Radiology and Oncology, Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - P M Hoff
- Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo; Department of Radiology and Oncology, Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
30
|
Kurian S, Macintyre J, Mushtaq M, Rocha-Lima CM, Ahn Y. Oxaliplatin induced disseminated intravascular coagulation: A case report and review of literature. World J Gastrointest Oncol 2012; 4:181-3. [PMID: 22844549 PMCID: PMC3406283 DOI: 10.4251/wjgo.v4.i7.181] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 11/01/2011] [Accepted: 11/15/2011] [Indexed: 02/05/2023] Open
Abstract
Oxaliplatin in combination with a fluoropyrimide is a treatment option for colorectal cancer patients in the adjuvant and metastatic settings. Very few hematological emergencies have been reported associated with Oxaliplatin. These include autoimmune hemolytic anemia, thrombocytopenia and pancytopenia. We present a case report of a patient who developed hematuria and disseminated intravascular coagulation while receiving the second cycle of FOLFOX and bevacizumab for metastatic colon cancer.
Collapse
Affiliation(s)
- Shweta Kurian
- Shweta Kurian, Jessica Macintyre, Muzammil Mushtaq, Caio Max Rocha-Lima, Yeon Ahn, Division of Hematology Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, United States
| | | | | | | | | |
Collapse
|
31
|
Ohta S, Cho Y, Oshima S, Hosoya O, Juni K, Kojima H. Oxaliplatin-induced acute-onset thrombocytopenia and hemorrhage: Case report and review of the literature. Oncol Lett 2012; 3:1297-1300. [PMID: 22783437 DOI: 10.3892/ol.2012.653] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 03/19/2012] [Indexed: 11/06/2022] Open
Abstract
We report the case of a woman who developed acute thrombocytopenia with hemorrhagic diathesis during adjuvant treatment of colorectal adenocarcinoma with oxaliplatin, 5-fluorouracil and leucovorin. A 55-year-old woman started adjuvant chemotherapy with oxaliplatin, 5-fluorouracil and leucovorin (mFOLFOX6). Prior to starting the 12th course of chemotherapy, a complete blood cell count showed the following values: neutrophils 1800/mm(3), platelets 136,000/m(3) and hemoglobin 11.1 g/dl. A blood count revealed that the platelet levels had dropped to 35,000/mm(3), with no significant changes in hemoglobin levels following the course. The administration of corticosteroids was begun and the platelet number was recovered. Clinicians should be aware of the possibility of oxaliplatin-induced hematological emergencies during the treatment of colorectal cancer patients in order to optimize supportive treatment and avoid toxic mortality.
Collapse
Affiliation(s)
- Shoichiro Ohta
- Department of Oncology, Ibaraki Prefectural Central Hospital, Ibaraki
| | | | | | | | | | | |
Collapse
|
32
|
Di Cesare Mannelli L, Zanardelli M, Failli P, Ghelardini C. Oxaliplatin-Induced Neuropathy: Oxidative Stress as Pathological Mechanism. Protective Effect of Silibinin. THE JOURNAL OF PAIN 2012; 13:276-84. [DOI: 10.1016/j.jpain.2011.11.009] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 11/22/2011] [Accepted: 11/28/2011] [Indexed: 11/30/2022]
|
33
|
Leger RM, Garratty G. Antibodies to oxaliplatin, a chemotherapeutic, are found in plasma of healthy blood donors. Transfusion 2011; 51:1740-4. [DOI: 10.1111/j.1537-2995.2010.03040.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
34
|
Teng CJ, Hsieh YY, Chen KW, Chao TC, Tzeng CH, Wang WS. Sudden-onset pancytopenia with intracranial hemorrhage after oxaliplatin treatment: a case report and literature review. Jpn J Clin Oncol 2010; 41:125-9. [PMID: 20826449 DOI: 10.1093/jjco/hyq162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Oxaliplatin is a third-generation platinum compound and has been widely employed in the treatment of colorectal cancer. Despite its good efficacy, it is reported to induce immune-mediated cytopenia. We report the case of a 78-year-old male patient who experienced acute pancytopenia along with coagulopathy and intracranial hemorrhage after his 17th course of oxaliplatin. This condition appeared immediately after completion of oxaliplatin infusion, and was persistent despite aggressive transfusion and treatment with granulocyte colony-stimulating factor. The patient died 72 h after the administration of oxaliplatin. The only preceding symptom was chills 30 min after initiation of oxaliplatin, although steroid was given as premedication. We review the literature describing oxaliplatin-induced cytopenia, and discuss the manifestation, immune mechanism and treatment of this condition. We conclude that any symptoms that occur during infusion of oxaliplatin should not be overlooked but should be taken seriously as they may represent 'a little spark that kindles a great fire', and that steroids may provide an effective treatment for oxaliplatin-induced cytopenia. However, a major complication in our patient may still happen. Further studies for the mechanism and the predictive markers of oxaliplatin-induced cytopenia are worthy.
Collapse
Affiliation(s)
- Chung-Jen Teng
- Division of Oncology and Hematology, Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan
| | | | | | | | | | | |
Collapse
|
35
|
Abstract
We describe a patient who experienced immediate onset severe thrombocytopenia as part of a hypersensitivity reaction to oxaliplatin, following substantial relatively uncomplicated previous exposure to the drug. We review other reports of acute hematological toxicity from oxaliplatin. We draw attention to the important need for vigilance when patients develop unusual acute symptoms during or shortly after oxaliplatin infusion.
Collapse
Affiliation(s)
- Jessica M Mason
- Bristol Haematology and Oncology Centre, Horfield Road, Bristol, BS2 8ED, UK
| | - Gareth JG Rees
- Cancer Unit, Royal United Hospital, Combe Park, Bath, BA1 3NG, UK
| |
Collapse
|
36
|
Overman MJ, Maru DM, Charnsangavej C, Loyer EM, Wang H, Pathak P, Eng C, Hoff PM, Vauthey JN, Wolff RA, Kopetz S. Oxaliplatin-mediated increase in spleen size as a biomarker for the development of hepatic sinusoidal injury. J Clin Oncol 2010; 28:2549-55. [PMID: 20406923 DOI: 10.1200/jco.2009.27.5701] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Oxaliplatin-based chemotherapy can cause hepatic sinusoidal injury, with resultant sinusoidal damage and portal hypertension. We sought to explore the relationship between oxaliplatin induced hepatic sinusoidal injury, increases in spleen size, and the subsequent development of thrombocytopenia. PATIENTS AND METHODS We retrospectively assessed the relationship between chemotherapy exposure, changes in spleen size (determined by volumetric measurements), and platelet counts in 136 patients treated with adjuvant fluorouracil and oxaliplatin (FOLFOX) or fluoropyrimidine for stage II or III colorectal adenocarcinoma. Hepatic sinusoidal injury and changes in spleen size were graded in a separate population of 63 patients with metastatic colorectal cancer receiving fluoropyrimidine and oxaliplatin before liver resection. RESULTS Spleen size increased in 86% of patients treated with adjuvant FOLFOX (P < .001), with a > or = 50% increase in 24% of patients. Spleen size did not significantly increase in patients treated with adjuvant fluoropyrimidine. Increases in spleen size correlated with cumulative oxaliplatin dose (P = .003). Patients with splenic enlargement > or = 50% had higher rates of thrombocytopenia in the first year after completion of chemotherapy (27% v 5%; P = .003). In patients with hepatic metastases treated with preoperative fluoropyrimidine and oxaliplatin, increases in spleen size was a predictor of higher histologic grades of sinusoidal injury in both univariate (P = .03) and multivariate (P = .02) analyses. CONCLUSION Increases in spleen size correlate with increasing grade of hepatic sinusoidal injury and can serve as a simple method for identifying patients at risk for this toxicity. Oxaliplatin-induced increases in spleen size should be recognized as a potential etiology of persistent thrombocytopenia after oxaliplatin treatment.
Collapse
Affiliation(s)
- Michael J Overman
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Bautista MA, Stevens WT, Chen CS, Curtis BR, Aster RH, Hsueh CT. Hypersensitivity reaction and acute immune-mediated thrombocytopenia from oxaliplatin: two case reports and a review of the literature. J Hematol Oncol 2010; 3:12. [PMID: 20346128 PMCID: PMC2859393 DOI: 10.1186/1756-8722-3-12] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 03/26/2010] [Indexed: 11/18/2022] Open
Abstract
Background Oxaliplatin is a platinum compound used in the treatment of gastrointestinal malignancies, including colorectal cancer. The incidence of hypersensitivity reaction in patients receiving oxaliplatin is approximately 15%, with severe reaction (grade 3 and 4) occurring in 2% of patients. Case presentation We report two patients with metastatic colorectal cancer who developed de novo hypersensitivity reaction and acute thrombocytopenia after oxaliplatin infusion. Both patients had oxaliplatin treatment several years before and exhibited hypersensitivity on the third dose of oxaliplatin in recent treatment. Oxaliplatin was discontinued when clinical reaction was identified. Both patients were confirmed to have strong oxaliplatin-induced IgG platelet-reactive antibodies. Both patients' thrombocytopenia resolved within two weeks after discontinuation of oxaliplatin. One patient had disease stabilization lasting for three months without chemotherapy. Both patients subsequently received other chemotherapeutic agents without evidence of hypersensitivity reaction or immune-mediated thrombocytopenia. Conclusion We recommend vigilant monitoring of complete blood count and signs and symptoms of bleeding after the occurrence of oxaliplatin-induced hypersensitivity to avoid serious complications of immune-mediated thrombocytopenia.
Collapse
Affiliation(s)
- Marnelli A Bautista
- Department of Pathology and Laboratory Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
| | | | | | | | | | | |
Collapse
|
38
|
Fontão-Wendel R, Hoff PM, Lazar A, Freitas D, Novis Y, Patah P, Tsujita M, Balthazar A, Pierroti M, Wendel S. Immune-mediated pancytopenia induced by oxaliplatin: a case report. Transfusion 2010; 50:1453-9. [DOI: 10.1111/j.1537-2995.2010.02600.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
39
|
Slade JH, Alattar ML, Fogelman DR, Overman MJ, Agarwal A, Maru DM, Coulson RL, Charnsangavej C, Vauthey JN, Wolff RA, Kopetz S. Portal hypertension associated with oxaliplatin administration: clinical manifestations of hepatic sinusoidal injury. Clin Colorectal Cancer 2009; 8:225-30. [PMID: 19822514 DOI: 10.3816/ccc.2009.n.038] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Oxaliplatin-based chemotherapy regimens are currently a standard of care for the treatment of colorectal cancer (CRC) in both the adjuvant treatment and metastatic disease settings. Significant improvements in outcomes have been achieved with oxaliplatin-based combinations in these settings when compared with administration of 5-fluorouracil alone. Pathologic evaluation of normal liver from patients undergoing neoadjuvant oxaliplatin treatment has identified histologic evidence of sinusoidal injury, although the effect of this finding on patient outcomes after hepatic resection appears to be minimal. This article describes the use of oxaliplatin-based chemotherapy in 6 patients with stage III or IV CRC who developed evidence of noncirrhotic portal hypertension. These patients developed complications of portal hypertension including esophageal or hemorrhoidal varices with bleeding, splenomegaly with associated thrombocytopenia, and ascites. In each case, oxaliplatin-induced hepatic sinusoidal injury was identified as the most likely factor contributing to the development of noncirrhotic portal hypertension. The literature on hepatic sinusoidal injury after oxaliplatin is reviewed and the proposed pathophysiology is discussed.
Collapse
Affiliation(s)
- Julian H Slade
- Department of Pharmacy, The University of Texas M. D. Anderson Cancer Center, Houston, 77030, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
James E, Podoltsev N, Salehi E, Curtis BR, Saif MW. Oxaliplatin-Induced Immune Thrombocytopenia: Another Cumulative Dose-Dependent Side Effect? Clin Colorectal Cancer 2009; 8:220-4. [DOI: 10.3816/ccc.2009.n.037] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
41
|
Santodirocco M, Lombardi V, Fesce C, Palumbo G, Capalbo S, Landriscina M. Life-threatening oxaliplatin-induced acute thrombocytopenia, hemolysis and bleeding: a case report. Acta Oncol 2009; 47:1602-4. [PMID: 18607839 DOI: 10.1080/02841860801978913] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
42
|
Arndt P, Garratty G, Isaak E, Bolger M, Lu Q. Positive direct and indirect antiglobulin tests associated with oxaliplatin can be due to drug antibody and/or drug-induced nonimmunologic protein adsorption. Transfusion 2009; 49:711-8. [DOI: 10.1111/j.1537-2995.2008.02028.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
43
|
Oxaliplatin-induced immune mediated thrombocytopenia. Cancer Chemother Pharmacol 2008; 62:925-7. [PMID: 18204841 DOI: 10.1007/s00280-007-0675-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Accepted: 12/24/2007] [Indexed: 10/22/2022]
Abstract
Oxaliplatin is a third generation platinum compound used in patients with advanced colorectal carcinoma. Recently, the mechanism of a rare drug-induced immune thrombocytopenia in patients receiving oxaliplatin has been described. This complication is caused by oxaliplatin-dependent antibodies directed against platelet surface glycoproteins, and is unrelated to myelosuppression. In this report, we describe two patients who developed thrombocytopenia immediately soon after receiving oxaliplatin. Sensitization presumably had occurred after receiving oxaliplatin during preceding courses of multiagent chemotherapy that included oxaliplatin.
Collapse
|
44
|
Cobo F, De Celis G, Pereira A, Latorre X, Pujadas J, Albiol S. Oxaliplatin-induced immune hemolytic anemia: a case report and review of the literature. Anticancer Drugs 2007; 18:973-6. [PMID: 17667605 DOI: 10.1097/cad.0b013e3280e9496d] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a 59-year-old woman diagnosed with metastasic colorectal cancer who developed immune hemolytic anemia during FOLFOX chemotherapy (oxaliplatin/leucovorin/5-fluorouracil). Immunohematologic studies demonstrated that immune hemolysis was oxaliplatin-mediated. On the basis of this case and in a review of the literature in which 13 cases of previously reported oxaliplatin-induced immune cytopenia have been identified, we suggest some clinical clues regarding the use of oxaliplatin in cancer patients.
Collapse
Affiliation(s)
- Francesc Cobo
- Oncohematology Unit, Hospital Ntra. Sra. De Meritxell, Escaldes-Engordany, Andorra.
| | | | | | | | | | | |
Collapse
|
45
|
van Meerten E, Eskens FALM, van Gameren EC, Doorn L, van der Gaast A. First-line treatment with oxaliplatin and capecitabine in patients with advanced or metastatic oesophageal cancer: a phase II study. Br J Cancer 2007; 96:1348-52. [PMID: 17437008 PMCID: PMC2360191 DOI: 10.1038/sj.bjc.6603750] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This phase II study assessed the safety and efficacy of oxaliplatin and capecitabine in patients with advanced oesophageal cancer. Fifty-one eligible patients received oxaliplatin 130 mg m−2 intravenously on day 1 and capecitabine 1000 mg m−2 orally twice daily on days 1 to 14 in a 21-day treatment cycle as first-line treatment for advanced oesophageal cancer. Grade 3 neutropenia was seen in one patient and anaemia in another patient. No grade 4 haematological toxicities were observed. Grade 4 non-haematological toxicity (lethargy) occurred in one patient (2%). Grade 3 non-haematological toxicity was seen in 14 (27%) patients (vomiting and polyneuropathy (8%); nausea (6%); lethargy and hand–foot syndrome (4%); and anorexia, diarrhoea, and hyperbilirubinaemia (each in one patient)). In 22% of the patients, toxicity was the reason for stopping the treatment. The overall response rate was 39%. The median overall survival was 8 months; the 1-year survival rate was 26%. In the quality of life (QoL) analysis, the emotional well-being improved during treatment, but the physical functioning scores declined. The fatigue score on the symptom scales increased. Overall, the global QoL score did not change during treatment. In conclusion, the activity of oxaliplatin and capecitabine is comparable with other chemotherapy regimens in advanced oesophageal cancer with a low frequency of grade 3/4 toxicity. Because this treatment can be given on an outpatient basis, it is probably less toxic than cisplatin-based therapy and preserves QoL during treatment, it is a viable treatment option in patients with advanced oesophageal cancer.
Collapse
Affiliation(s)
- E van Meerten
- Department of Medical Oncology, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
| | - F A L M Eskens
- Department of Medical Oncology, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
| | - E C van Gameren
- Department of Medical Oncology, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
| | - L Doorn
- Department of Medical Oncology, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
| | - A van der Gaast
- Department of Medical Oncology, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
- E-mail:
| |
Collapse
|
46
|
Dahabreh I, Tsoutsos G, Tseligas D, Janinis D. Hemolytic uremic syndrome following the infusion of oxaliplatin: case report. BMC CLINICAL PHARMACOLOGY 2006; 6:5. [PMID: 16968538 PMCID: PMC1574347 DOI: 10.1186/1472-6904-6-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Accepted: 09/12/2006] [Indexed: 12/27/2022]
Abstract
Background Oxaliplatin is a platinum derivative, which is used in the treatment of colorectal cancer. A small number of oxaliplatin-related hemolytic and/or thrombocytopenic reactions have been reported. We present a case of hemolytic-uremic syndrome that developed during the 4th cycle of combination chemotherapy with oxaliplatin, 5-fluorouracil and leucovorin. Case presentation A 52-year-old-male was administered chemotherapy with oxaliplatin, 5-fluorouracil and leucovorin for a Duke's stage C colorectal carcinoma. Three cycles of chemotherapy had been administered without complications when, at the beginning of the fourth cycle, the patient developed clinical and laboratory abnormalities consistent with the development of the hemolytic-uremic syndrome. Treatment was discontinued; the patient was managed with monitored IV hydration and loop diuretics, high dose corticosteroids and fresh frozen plasma infusions and recovered completely. Conclusion The hemolytic-uremic syndrome may be a rare complication of oxaliplatin-based chemotherapy. Clinicians need to maintain a high index of suspicion to diagnose and treat this life-threatening adverse event.
Collapse
Affiliation(s)
- Issa Dahabreh
- Department of Medical Oncology, Athens Medical Center, Marousi, Greece
| | - George Tsoutsos
- Department of Surgery, Athens Medical Center, Marousi, Greece
| | | | - Dimitrios Janinis
- Department of Medical Oncology, Athens Medical Center, Marousi, Greece
| |
Collapse
|
47
|
Pavic M, Moncharmont P, Sève P, Rigal D, Broussolle C. Oxaliplatin-induced immune thrombocytopenia. ACTA ACUST UNITED AC 2006; 30:797-8. [PMID: 16801909 DOI: 10.1016/s0399-8320(06)73320-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
48
|
Noronha V, Burtness B, Murren J, Duffy TP. Oxaliplatin Induces a Delayed Immune-Mediated Hemolytic Anemia: A Case Report and Review of the Literature. Clin Colorectal Cancer 2005; 5:283-6. [PMID: 16356307 DOI: 10.3816/ccc.2005.n.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report a case of a 59-year-old woman with metastatic carcinoma of the ileocecal region who received FOLFOX(oxaliplatin/leucovorin/5-fluorouracil) and bevacizumab therapy and exhibited a partial remission with minimal side effects. She developed a mild self-limited episode of immune-mediated hemolytic anemia during her 16th cycle of chemotherapy, which precluded her from receiving further oxaliplatin. We review the literature on oxaliplatin-induced immune-mediated hemolysis, including its mechanism, presenting symptoms, laboratory features, management, and implications for future therapy.
Collapse
Affiliation(s)
- Vanita Noronha
- Mid Valley Oncology/Hematology, P.C., 407 Gidney Avenue, Newburgh, NY 12550, USA.
| | | | | | | |
Collapse
|
49
|
Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2005. [DOI: 10.1002/pds.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|