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Joffe L, Shen W, Shadid G, Jin Z, Ladas EJ. Skeletal muscle and adipose tissue changes in the first phase of treatment of pediatric solid tumors. Cancer Med 2020; 10:15-22. [PMID: 33140912 PMCID: PMC7826460 DOI: 10.1002/cam4.3584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 01/06/2023] Open
Abstract
Body composition is increasingly recognized as an important factor in cancer outcomes. Use of computed tomography (CT) in cancer care provides the opportunity to accurately quantify whole‐body lean and adipose tissues from images at the third lumbar spine. We sought to substantiate the use of routinely captured, single‐slice chest CT images at the thoracic level for evaluation of skeletal muscle, residual lean tissue, and adiposity among pediatric solid tumor patients. We performed a retrospective analysis among children who underwent treatment for a solid tumor at Columbia University Irving Medical Center. Skeletal muscle (SM), residual lean tissue (RLT), and adipose tissue cross‐sectional areas (cm2) were analyzed at diagnosis and at first follow‐up for disease evaluation (6–14 weeks). Imaging analysis was performed utilizing slice‐O‐matic image analysis software. Of the 57 patients identified, 39 had chest CT imaging that included intervertebral level T12‐L1, and 22 also had concurrent imaging at L3. Correlation coefficients between body composition variables at T12‐L1 and L3 were strong (r = 0.93–0.98). Paired t‐test showed a significant decrease in SM (−4.2 ± 8.12, p = 0.003) and RLT (−10.7 ± 28.5, p = 0.025) as well as a trend toward a significant increase in visceral adipose tissue (3.10 ± 9.65, p = 0.052). Univariable analysis demonstrated a significant association between increasing age and increased SM loss (β = −0.496 with SE = 0.194, p = 0.011), and a lack of association between body mass index and body composition changes. We provide the first line of evidence that single‐slice images from routinely obtained chest CT scans provide a simple, readily available mechanism for assessing body composition in pediatric solid tumor patients. Adverse body composition changes were observed, particularly among adolescents and young adults. Precis: Changes in body composition can be detected via routine CT images in pediatric patients undergoing treatment for solid tumors.
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Affiliation(s)
- Lenat Joffe
- Department of Pediatrics, Division of Pediatric Hematology/ Oncology/ Stem Cell Transplant, Columbia University Irving Medical Center, New York, NY, USA
| | - Wei Shen
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Institute of Human Nutrition; and MR Research Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Grace Shadid
- Institute of Human Nutrition, Columbia University Irving Medical Center, New York, NY, USA
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Elena J Ladas
- Department of Pediatrics, Division of Pediatric Hematology/ Oncology/ Stem Cell Transplant, Columbia University Irving Medical Center, New York, NY, USA
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Joffe L, Ladas EJ. Nutrition during childhood cancer treatment: current understanding and a path for future research. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:465-475. [PMID: 32061318 DOI: 10.1016/s2352-4642(19)30407-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 12/18/2022]
Abstract
Proper nutritional status during cancer therapy has been recognised as being integral to a variety of health outcome measures, including overall survival, treatment tolerance, and quality of life. The prevalence of malnutrition, defined by WHO as either undernutrition or overnutrition, among children and adolescents with cancer is reported to be as high as 75%. Yet, over the past two decades there have been limited advances in elucidating the underlying pathophysiological drivers of malnutrition in this population. This effect has resulted in a paucity of research aimed at improving nutritional assessment and intervention among this group. This Review presents an in-depth discussion of the role of nutritional status in paediatric cancer care, as well as evolving avenues of investigation that might propel personalised nutrition into a viable reality. Thus, nutritional science might facilitate individualised intervention strategies, and thereby help to optimise clinical outcomes for patients and survivors of childhood cancer.
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Affiliation(s)
- Lenat Joffe
- Department of Pediatrics, Division of Pediatric Hematology, Oncology, and Stem Cell Transplant, Columbia University Irving Medical Center, New York, NY, USA
| | - Elena J Ladas
- Department of Pediatrics, Division of Pediatric Hematology, Oncology, and Stem Cell Transplant, Columbia University Irving Medical Center, New York, NY, USA.
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Gade C, Christensen HR, Dalhoff KP, Holm JC, Holst H. Inconsistencies in dosage practice in children with overweight or obesity: A retrospective cohort study. Pharmacol Res Perspect 2018; 6:e00398. [PMID: 29721323 PMCID: PMC5909170 DOI: 10.1002/prp2.398] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 03/12/2018] [Indexed: 01/21/2023] Open
Abstract
Obesity can affect the pharmacokinetics of most drugs, which may result in under- or overdosing if traditional pediatric dosing strategies are used. To investigate currently applied dosage strategies in children with overweight or obesity (overweight/obesity), in a clinical treatment facility. In particular, whether dosing guidelines were available and metrics of body size applied. A retrospective cohort study of 200 patients admitted to the Danish Children's Obesity Clinic. Data were collected from 2007 to 2015. Overweight/obese children 3-18 years were included if they had at least one drug prescription. Overall there were 658 prescriptions, primarily analgesics, psychotropics, asthma medications, and antibiotics. Except for one prescription, guidelines for dosage of overweight/obese children were not available in the clinic. In one prescription of gentamicin, the dose was adjusted by a metric body size. Otherwise dose was predominately prescribed either by total body weight or as fixed dose by age, in accordance with the recommendations of normal weight children. In drugs with a narrow therapeutic interval, we found large interindividual variations in dosing regimens, that is, for gentamicin, paracetamol, and prednisolone. Reduction of dose to the maximum recommended adult dose was common practice, when the dose calculated by total body weight (ie, mg/kg) exceeded this maximum. This study highlights the shortage of dosing guidelines in overweight/obese children. We found a large interindividual variability in dosage regimens, even in drugs with narrow therapeutic intervals. The clinicians rely on "best practice", as evidence-based dosage regimens are missing for many drugs prescribed during childhood.
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Affiliation(s)
- Christina Gade
- Department of Clinical PharmacologyCopenhagen University HospitalBispebjerg and FrederiksbergCopenhagen NVDenmark
| | - Hanne R. Christensen
- Department of Clinical PharmacologyCopenhagen University HospitalBispebjerg and FrederiksbergCopenhagen NVDenmark
| | - Kim P. Dalhoff
- Department of Clinical PharmacologyCopenhagen University HospitalBispebjerg and FrederiksbergCopenhagen NVDenmark
| | - Jens Christian Holm
- Children's Obesity ClinicEuropean Center of Management (EASO)Department of PaediatricsZealand University HospitalHolbaekDenmark
| | - Helle Holst
- Department of Clinical PharmacologyCopenhagen University HospitalBispebjerg and FrederiksbergCopenhagen NVDenmark
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Tolbert JA, Bai S, Abdel-Rahman SM, August KJ, Weir SJ, Kearns GL, Neville KA. Pharmacokinetics of two 6-mercaptopurine liquid formulations in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2017; 64. [PMID: 28295989 DOI: 10.1002/pbc.26465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 12/07/2016] [Accepted: 12/22/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND A liquid formulation of 6-mercaptopurine (6-MP) was recently approved by the Food and Drug Administration (Purixan®) based on bioavailability (BA) data from healthy adults. We examined the pharmacokinetics (PK) and BA of 6-MP in children with acute lymphoblastic leukemia (ALL) comparing a marketed tablet, two extemporaneously prepared liquid formulations, and data from the approved liquid formulation. METHODS Twenty-two children (6-17 years) participated in a randomized two-way, crossover study of two cohorts. Group 1 (n = 11; five males) received a 5 mg/ml liquid formulation and the marketed 50 mg 6-MP tablet on separate occasions, and Group 2 (n = 11; five males) received a 50 mg/ml liquid formulation and the marketed tablet. The usual prescribed 6-MP dose (25-115 mg/m2 ) was given after an 8-hr fast. Serial blood samples were collected over 8 hr postdose. Plasma 6-MP concentrations were determined using a good laboratory practice (GLP)-validated liquid chromatography-tandem mass spectrometry method. PK parameters were calculated using noncompartmental analysis and compared within and between cohorts, and thiopurine methyltransferase (TPMT) genotype was analyzed. RESULTS No patient had a TPMT genotype reflective of a poor metabolizer phenotype. Comparison of PK parameters between 5 and 50 mg/ml treatments revealed significant differences (P <0.05) in AUCN (where AUC is area under the curve), CmaxN , and Tmax . Comparisons within each group revealed significant differences in AUC0-∞ and Tmax in the 5 mg/ml group. CONCLUSIONS Pharmacokinetic profiles of 6-MP established in healthy adults with the approved liquid formulation may not reflect the PK profile in children with ALL. Formulation-specific differences in PK may significantly impact the dose-exposure profile in these children and must be considered.
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Affiliation(s)
- Jaszianne A Tolbert
- Divisions of Hematology/Oncology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.,Divisions of Clinical Pharmacology, Medical Toxicology, and Therapeutic Innovation, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri
| | - Shasha Bai
- Arkansas Children's Hospital Research Institute, Arkansas Children's Hospital, Little Rock, Arkansas.,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Susan M Abdel-Rahman
- Divisions of Clinical Pharmacology, Medical Toxicology, and Therapeutic Innovation, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri
| | - Keith J August
- Divisions of Hematology/Oncology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri
| | - Scott J Weir
- Department of Pharmacology, Toxicology and Therapeutics, University of Missouri-Kansas City, Kansas City, Missouri.,Institute for Advancing Medical Innovation, University of Kansas Medical Center, Kansas City, Kansas.,University of Kansas Cancer CenterKansas City, Kansas
| | - Gregory L Kearns
- Divisions of Clinical Pharmacology, Medical Toxicology, and Therapeutic Innovation, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri
| | - Kathleen A Neville
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Sections of Clinical Pharmacology and Toxicology, Arkansas Children's Hospital, Little Rock, Arkansas.,Sections of Pediatric Hematology Oncology, Arkansas Children's Hospital, Little Rock, Arkansas
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Constance JE, Campbell SC, Somani AA, Yellepeddi V, Owens KH, Sherwin CMT. Pharmacokinetics, pharmacodynamics and pharmacogenetics associated with nonsteroidal anti-inflammatory drugs and opioids in pediatric cancer patients. Expert Opin Drug Metab Toxicol 2017; 13:715-724. [PMID: 28490206 DOI: 10.1080/17425255.2017.1329415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Advancing appropriate and adequate analgesic pharmacotherapy in pediatric patients with cancer is an area of clinical need. Few studies have been performed to evaluate the selection of an analgesic and appropriate dosing corresponding to analgesic effect among pediatric cancer patients. This review describes information related to pharmacokinetic, pharmacodynamic, and pharmacogenomic (when applicable) considerations for analgesics that are commonly used to manage pain experienced by pediatric patients with cancer. Areas covered: Analgesics commonly used to treat pediatric patients with malignancy patterned after the World Health Organization's 'analgesic ladder' for cancer pain management. Expert opinion: Addressing pain management safely and effectively in pediatric patients with cancer will require advances in both drug development, to increase the armament of analgesics available for children, and our pharmacologic understanding of those analgesics in current use. However, performing the necessary types of studies to develop new analgesics, or gain knowledge of existing therapy, within a population that is relatively small, diverse, and who experience pain originating from a variety of sources, is a tremendous challenge.
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Affiliation(s)
- Jonathan E Constance
- a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah School of Medicine , Salt Lake City , Utah , USA
| | | | - Amit A Somani
- c Clinical Pharmacologist (independent) , Richmond , Virginia , USA
| | - Venkata Yellepeddi
- d College of Pharmacy , Roseman University of Health Sciences, Riverfront Parkway , South Jordan , Utah
| | - Katie H Owens
- e Department of Pharmaceutics, School of Pharmacy , University of Washington , Seattle , WA , USA
| | - Catherine M T Sherwin
- a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah School of Medicine , Salt Lake City , Utah , USA
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Mercier JC, Droz N, Bourgade C, Vizeneux A, Cotillon M, de Groc T. [Specificities of prescribing medicines for children]. SOINS. PEDIATRIE, PUERICULTURE 2016; 37:12-16. [PMID: 27177480 DOI: 10.1016/j.spp.2016.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The vast majority of medicines have been developed for adults. Consequently, the prescribing of medicines for children must take into account their pharmacodynamic characteristics and must be calculated individually according to the degree of prematurity, the age, the weight or body area and the clinical condition. Medication errors are the most common type of medical errors, notably in children, due to dosage errors or prescribtion of inappropriate medicines. The best way to avoid them lies in the use of prescribing software, the involvement of pharmacists in care units, and proper communication between prescribing doctors, caregivers, pharmacists and families.
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Affiliation(s)
- Jean-Christophe Mercier
- Service de pédiatrie générale et urgences, hôpital Louis-Mourier, AP-HP, 178 rue des Renouillers, 92700 Colombes, France; Université Paris Diderot, 5 rue Thomas-Mann, 75013 Paris, France.
| | - Nina Droz
- Service de pédiatrie générale et urgences, hôpital Louis-Mourier, AP-HP, 178 rue des Renouillers, 92700 Colombes, France
| | - Clara Bourgade
- Service de pédiatrie générale et urgences, hôpital Louis-Mourier, AP-HP, 178 rue des Renouillers, 92700 Colombes, France
| | - Audrey Vizeneux
- Service de pédiatrie générale et urgences, hôpital Louis-Mourier, AP-HP, 178 rue des Renouillers, 92700 Colombes, France
| | - Marie Cotillon
- Service de pédiatrie générale et urgences, hôpital Louis-Mourier, AP-HP, 178 rue des Renouillers, 92700 Colombes, France
| | - Thibault de Groc
- Service de pédiatrie générale et urgences, hôpital Louis-Mourier, AP-HP, 178 rue des Renouillers, 92700 Colombes, France
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Barr RD, Mosby TT. Nutritional status in children and adolescents with leukemia: An emphasis on clinical outcomes in low and middle income countries. Hematology 2016; 21:199-205. [DOI: 10.1080/10245332.2015.1101968] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Ronald D. Barr
- Departments of Pediatrics, Pathology and Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Terezie T. Mosby
- College of Agriculture and Human Ecology, Tennessee Technological University, Cookeville, USA
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Abstract
Appropriate pediatric dose selection remains one of the most vexing clinical problems faced by healthcare professionals who are charged to provide medical care to infants and children. While body size does reflect the ontogeny of processes that govern drug disposition, there are extremes of disease that perturb the expected relationships.
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Affiliation(s)
- G L Kearns
- Arkansas Children's Hospital Research Institute and the Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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