Neurological Adverse Effects in Patients of Advanced Colorectal Carcinoma Treated with Different Schedules of FOLFOX

Development of a prediction models for chemotherapy-induced adverse drug reactions: A retrospective observational study using electronic health records

PURPOSE

Chemotherapy-induced adverse drug reactions (ADRs) are common and diverse, and not only affect changes or interruptions to treatment schedules, but also negatively affect the patient's quality of life. This study aimed to predict eight chemotherapy-induced ADRs based on electronic health records (EHR) data using machine-learning algorithms.

METHODS

We used EHR data of 6812 chemotherapy cycles for 935 adult patients receiving four different chemotherapy regimens (FOLFOX, 5-fluorouracil + oxaliplatin + leucovorin; FOLFIRI, 5-fluorouracil + irinotecan + leucovorin; paclitaxel; and GP, gemcitabine + cisplatin) at a tertiary teaching hospital between January 2015 and June 2016. The predicted ADRs included nausea-vomiting, fatigue-anorexia, diarrhea, peripheral neuropathy, hypersensitivity, stomatitis, hand-foot syndrome, and constipation. Three machine learning algorithms were used to developed prediction models: logistic regression, decision tree, and artificial neural network. We compared the performance of the models with area of under the ROC (Receiver Operating Characteristic) curve (AUC) and accuracy.

RESULTS

The AUCs of the logistic regression, decision tree, and artificial neural network models were 0.62-0.83, 0.61-0.83, and 0.62-0.83, respectively, and the accuracies were 0.59-0.84, 0.55-0.88, and 0.57-0.88, respectively. Among the algorithms, the logistic regression models performed best and had the highest AUC for six ADRs (range 0.67-0.83). The nausea-vomiting prediction models performed best with an AUC of 0.83 for the three algorithms.

CONCLUSIONS

The prediction models for chemotherapy-induced ADRs were able to predict eight ADRs using EHR data. The logistic regression models were best suited to predict ADRs. The models developed in this study can be used to predict the risk of ADRs in patients receiving chemotherapy.

Synthesis of Bis(Isoxazol-4-Ylmethylsulfanyl)Alkanes and Some Metal Complexes as a Hepatoprotective Agents

Purpose: This research is devoted to designing the synthesis of sulfanyl-substituted 3,5-dimethylisoxazoles, which contain structural analogues of the SAM drug in the molecule. SAM (S-adenosyl-L-methionine), formed in the biosynthetic process, is used as an effective hepatoprotective drug. Complexation and hepatoprotective properties of the combinatorial series of bis(isoxazolylsulfanyl)ethane have been studied. Methods: Bis(isoxazol-4-ylmethylsulfanyl)alkanes were synthesized using the one-pot method. The structures of compounds were established by one-dimensional (1H,13C) and two-dimensional (COSY, HCQS, HMBC) NMR spectroscopy, mass-spectrometry and X-ray diffraction. The biological activity of the combinatorial series of sulfanyl derivatives of diketones, azoles and their metal complexes has been studied by in vivo method. Simulation of the animal associated processes was carried out in accordance with the principles of bioethics. Screening studies of hepatoprotective activity were carried out in a model of acute CC14 intoxication after a single injection intraperitoneally as a 50% solution in olive oil. The pharmacologically known hepatoprotective drug SAM served as a control. Results: Two-step synthesis of novel α,ω-bis(isoxazol-4-ylmethylsulfanyl)alkanes was carried out via the multicomponent reaction between 2,4-pentandione, CH2O and α,ω-dithiols, then the resulting α,ω-bis(1,3-diketone-2-ylmethylsulfanyl)alkanes were transformed by hydroxyl amine to obtain bis-isoxasole derivatives. Promising precursor 1,2-bis(isoxazol-4-ylmethylsulfanyl)ethane was converted to metal complexes by interaction with PdCl2 or CuCl. The obtained compounds were found to be practically non-toxic compounds (1001 - 3000 mg/kg) according to the classification of K.K. Sidorov, but copper complex refers to low-toxic compounds substances (165 mg/kg). Compounds of sulfanyl ethane series demonstrate hepatoprotective activity. Conclusion: Palladium(II) complex being almost non-toxic possesses hepatoprotective activity comparable to the drug like SAM.

Preventive effect of oral goshajinkigan on chronic oxaliplatin-induced hypoesthesia in rats

Oxaliplatin, a widely used chemotherapeutic agent, induces peripheral neuropathy that manifests itself as two distinct phases: acute cold hyperesthesia and chronic peripheral hypoesthesia/dysesthesia. The latter is a serious dose-limiting side effect that can often lead to withdrawal of treatment. We have developed a rat model expressing both phases and used the model to investigate the action of goshajinkigan (GJG), a traditional Japanese herbal medicine, which was reported to ameliorate oxaliplatin-induced neuropathy in a placebo-controlled double-blind randomized phase II study. In this study, neuropathy was induced by injection of oxaliplatin twice weekly for 8 wks. The maximum level of cold hyperesthesia was observed at 4 wks with heat hypoesthesia developing later. Microscopy studies revealed atrophy of axons of myelinated sciatic nerve fibers in oxaliplatin-treated rats at 8 wks. Co-administration of GJG ameliorated both abnormal sensations as well as histological damage to the sciatic nerve. A pharmacokinetic study revealed numerous neuroprotective components of GJG that are rapidly absorbed into the blood. GJG and some of its components attenuated the generation of oxaliplatin-induced reactive oxygen species, which is a possible mechanism of oxaliplatin-induced neurotoxicity. The present study provides a useful animal model for oxaliplatin-induced neurotoxicity as well as a promising prophylactic agent.