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Hasik PN, Thomas C, Hazarika M, Undela K. Ocular adverse events associated with platins: a disproportionality analysis of pharmacovigilance data and extensive systematic review of case reports. Expert Opin Drug Saf 2024:1-14. [PMID: 39137273 DOI: 10.1080/14740338.2024.2392860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Anti-cancer drugs, particularly platinum-based chemotherapy drugs, have been showing ocular adverse events (OAEs) in patients undergoing chemotherapy, which is concerning due to the potential impact on patient's quality of life and the ability to continue effective cancer treatment. RESEARCH DESIGN AND METHODS A retrospective case/non-case study was conducted using spontaneous reports on OAEs by platins from the FDA Adverse Event Reporting System (FAERS) database. A disproportionality analysis was performed by calculating the Proportional Reporting Ratio (PRR), Reporting Odds Ratio (ROR), and the Information Component (IC) to identify OAE signals for platinum-based chemotherapy drugs. In parallel, a review of case reports for OAEs from platins was conducted by a systematic literature search in PubMed and Google Scholar. RESULTS Using disproportionality analysis, 69 signals were identified for platinum-based chemotherapy drugs and OAEs (carboplatin: 42, oxaliplatin: 16, cisplatin: 11). Choroidal infarction [PRR = 215.1; χ2 = 4527.1; lower bound (LB) ROR = 140.7; IC025 = 5.1] and orbital hemorrhage [PRR = 120.0; χ2 = 300.5; LB ROR = 35.1; IC025 = 1.3] were the strong signals identified for carboplatin. Optic disc hyperemia [PRR = 208.2; χ2 = 742.5; LB ROR = 74.1; IC025 = 2.2] and blindness cortical [PRR = 23.7; χ2 = 382.5; LB ROR = 14.8; IC025 = 3.1] were the signals identified for oxaliplatin and cisplatin, respectively. A total of 32 case reports of OAEs from platinum-based chemotherapy drugs were identified through a systematic search in PubMed and Google Scholar, strengthening the association. CONCLUSION The study revealed a potential risk of OAEs when using platinum-based chemotherapy drugs as an anticancer medication.
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Affiliation(s)
- P N Hasik
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER) Guwahati, Kamrup, India
| | - Christy Thomas
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER) Guwahati, Kamrup, India
| | - Munlima Hazarika
- Department of Medical Oncology, Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, India
| | - Krishna Undela
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER) Guwahati, Kamrup, India
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2
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Kouri M, Rekatsina M, Vadalouca A, Viswanath O, Varrassi G. Oral Neuropathy Associated with Commonly used Chemotherapeutic Agents: A Narrative Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01305-8. [PMID: 39052182 DOI: 10.1007/s11916-024-01305-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE OF REVIEW Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent complication of cytotoxic chemotherapeutic agents; its incidence largely varies, depending on type, dose, agent and preexisting risk factors. Oral-and-perioral-CIPN (OCIPN) is underreported. Neurotoxic agents can cause jaw pain or numbness. This review aims to present available data on OCIPN RECENT FINDINGS: A narrative literature review, following SANRA guidelines was conducted. PubMed and Cochrane databases were searched until September 2023. Articles referring to neuropathy or neuropathic pain due to head and neck cancer, head and neck radiotherapy, oropharyngeal mucositis, infection or post-surgical pain were excluded. Platinum-based chemotherapeutics, taxanes, vinca alkaloids, immunomodulatory and alkylating agents can cause OCIPN. Platinum-based chemotherapeutics can cause orofacial cold sensitivity, orofacial and jaw pain, oral cavity tingling and teeth hypersensitivity. Taxanes may induce oral cavity and tongue numbness and tingling as well as hot hypersensitivity. Vinca alkaloids may cause jaw, teeth and lips pain and oral mucosa hyperalgesia. Immunomodulatory drugs can cause lips, tongue and perioral numbness, while alkylating agents induce tongue and lips tingling and teeth cold-hypersensitivity. Chemotherapy may cause OCIPN due to changes in cellular structure and function, like alterations in membrane receptors and neurotransmission. OCIPN should be documented and physicians, dentists and health care providers should be alerted.
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Affiliation(s)
- Maria Kouri
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
- A Anesthesiology Clinic, Pain Management and Palliative Care Center, Aretaieio University Hospital, School of Medicine, National and Kapodistrian, University of Athens, Athens, Greece.
| | - Martina Rekatsina
- A Anesthesiology Clinic, Pain Management and Palliative Care Center, Aretaieio University Hospital, School of Medicine, National and Kapodistrian, University of Athens, Athens, Greece
| | - Athina Vadalouca
- Pain and Palliative Care Center, Athens Medical Center, Athens, Greece
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3
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de Miranda Drummond PL, Dos Santos RMM, Silveira LP, Malta JS, Moreira Reis AM, Costa NL, de Paula E Silva RO, Fagundes EM, de Pádua CAM. Chemotherapy-Induced Peripheral Neuropathy Impacts Quality of Life and Activities of Daily Living of Brazilian Multiple Myeloma Patients. Curr Drug Saf 2024; 19:356-367. [PMID: 37592770 DOI: 10.2174/1574886318666230817162424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/04/2023] [Accepted: 07/13/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Survival in multiple myeloma (MM) has improved in the past years with the introduction of immunomodulators and proteasome inhibitors. However, chemotherapyinduced peripheral neuropathy (CIPN) is associated with both drug classes affecting Health- Related Quality of Life (HRQoL) and activities of daily living (ADL). OBJECTIVE We evaluated CIPN in MM patients to identify associated factors and impacts on HRQoL and ADL. METHODS This is a cross-sectional study with Brazilian patients from public and private health services. Patients were interviewed using validated tools to measure CIPN and HRQoL, along with sociodemographic and clinical questions. Logistic regression was used to assess the association of CIPN with sociodemographic, clinical, and HRQoL variables. RESULTS In total, 217 patients were eligible for the study. The median age was 67, 50.9% were women, 51.6% had low income, 47.5% had low education, and 55.3% attended private health services. The chemotherapy regimen most used was the combination of cyclophosphamide, thalidomide, and dexamethasone (17.5%) among the 24 types of regimens found. Most patients (90.3%) had at least one CIPN symptom: 62.7% were severe, and 51.62% were extremely bothered ADL. Numbness was the most common symptom (40.6%). CIPN was independently associated with education, hospitalization, chemotherapy, side effects, disease symptoms, and global health status in HRQoL. CONCLUSION MM patients showed a high frequency of CIPN, which affected ADL and impaired HRQoL. Early and accurate detection of CIPN and dose management in patients with thalidomide and bortezomib-based regimens should be performed to provide better treatment outcomes and avoid permanent disabilities.
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Affiliation(s)
- Paula Lana de Miranda Drummond
- Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Ezequiel Dias Foundation, Regulatory Affairs, Belo Horizonte, Brazil
| | | | - Lívia Pena Silveira
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jéssica Soares Malta
- Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Naiane Lima Costa
- Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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4
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Gupta S, Ling J, Gu JG. Assessment of orofacial nociceptive behaviors of mice with the sheltering tube method: Oxaliplatin-induced mechanical and cold allodynia in orofacial regions. Mol Pain 2024; 20:17448069241261687. [PMID: 38818803 PMCID: PMC11412213 DOI: 10.1177/17448069241261687] [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] [Indexed: 06/01/2024] Open
Abstract
Preclinical studies on pathological pain rely on the von Frey test to examine changes in mechanical thresholds and the acetone spray test to determine alterations in cold sensitivity in rodents. These tests are typically conducted on rodent hindpaws, where animals with pathological pain show reliable nocifensive responses to von Frey filaments and acetone drops applied to the hindpaws. Pathological pain in orofacial regions is also an important clinical problem and has been investigated with rodents. However, performing the von Frey and acetone spray tests in the orofacial region has been challenging, largely due to the high mobility of the head of testing animals. To solve this problem, we implemented a sheltering tube method to assess orofacial nociception in mice. In experiments, mice were sheltered in elevated tubes, where they were well accommodated because the tubes provided safe shelters for mice. Examiners could reliably apply mechanical stimuli with von Frey filament, cold stimuli with acetone spray, and light stimuli with a laser beam to the orofacial regions. We validated this method in Nav1.8-ChR2 mice treated with oxaliplatin that induced peripheral neuropathy. Using the von Frey test, orofacial response frequencies and nociceptive response scores were significantly increased in Nav1.8-ChR2 mice treated with oxaliplatin. In the acetone spray test, the duration of orofacial responses was significantly prolonged in oxaliplatin-treated mice. The response frequencies to laser light stimulation were significantly increased in Nav1.8-ChR2 mice treated with oxaliplatin. Our sheltering tube method allows us to reliably perform the von Frey, acetone spray, and optogenetic tests in orofacial regions to investigate orofacial pain.
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Affiliation(s)
- Saurav Gupta
- Department of Anaesthesiology and Perioperative Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer Ling
- Department of Anaesthesiology and Perioperative Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jianguo G Gu
- Department of Anaesthesiology and Perioperative Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Stoicescu EA, Iancu RC, Popa Cherecheanu A, Iancu G. Ocular adverse effects of anti-cancer chemotherapy. J Med Life 2023; 16:818-821. [PMID: 37675170 PMCID: PMC10478646 DOI: 10.25122/jml-2023-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/15/2023] [Indexed: 09/08/2023] Open
Abstract
Cancer ranks as the second leading cause of mortality in Europe, following cardiovascular diseases. Every year, 2.6 million people are diagnosed with this disease, and 1.2 million die. It has an impact not only on individual health but also on society and the economy. The survival rate has improved with the introduction of new diagnostic methods and anti-cancer chemotherapy. While more aggressive chemotherapeutic regimens and combination therapies have demonstrated efficacy against cancer cells, they also have detrimental effects on normal cells, leading to systemic and ocular adverse reactions associated with cytotoxicity, inflammation, and neurotoxicity. Consequently, we have an increased survival rate, but the appearance of these ocular adverse effects decreases the quality of life. Ocular toxicity induced by chemotherapeutic agents is often underestimated. While prevention may not be possible, proper management by an ophthalmologist, an integral part of the oncology patient's medical team, is crucial. The ophthalmologist should assess the patient before initiating chemotherapeutic treatment and continue monitoring throughout to identify any adverse ocular reactions resulting from the systemic chemotherapy. This article aimed to briefly highlight the adverse reactions occurring at the ocular surface in patients undergoing chemotherapeutic treatment. Fortunately, these ocular side effects are limited only to the period in which the chemotherapeutic treatment is done, with most of them disappearing a few weeks after stopping the treatment.
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Affiliation(s)
- Elena Andreea Stoicescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Ophthalmology, Emergency University Hospital, Bucharest, Romania
| | - Raluca Claudia Iancu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Ophthalmology, Emergency University Hospital, Bucharest, Romania
| | - Alina Popa Cherecheanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Ophthalmology, Emergency University Hospital, Bucharest, Romania
| | - George Iancu
- Filantropia Clinical Hospital of Obstetrics and Gynecology, Bucharest, Romania
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Lagerstedt K, Efverman A. A Randomized Sham-Controlled Mixed Methods Pilot Study of the Feasibility of Acupuncture for Chemotherapy-Induced Neuropathy: Lessons Learned From Patient Experiences in Integrative Cancer Care. Integr Cancer Ther 2023; 22:15347354231178877. [PMID: 37294052 PMCID: PMC10262658 DOI: 10.1177/15347354231178877] [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: 03/30/2022] [Revised: 04/04/2023] [Accepted: 05/13/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE Since there is a lack of effective pharmacological therapies for chemotherapy-induced neuropathy and many patients ask for integrative cancer therapies such as acupuncture, the objective of this pilot study was to describe patients' experiences, and to study the feasibility and short-term effects of genuine acupuncture for chemotherapy-induced neuropathic pain and unpleasant sensations compared to sham acupuncture. METHODS The pilot study used mixed methods, collecting quantitative and qualitative data. Patients (n = 12) with chemotherapy-induced neuropathy after colorectal cancer were blindly randomized to genuine acupuncture or telescopic sham acupuncture. Individual interviews were conducted, and were analyzed using qualitative content analysis. The patients registered pain and unpleasant sensations (100 mm Visual Analog Scales) before and after n = 120 sessions, n = 60 genuine and n = 60 sham acupuncture sessions. RESULTS Five categories of patient experiences were described. The neuropathy negatively affected life. Physical activity was perceived to be important for health, but neuropathy was a barrier. The neuropathy required symptom-managing strategies. Acupuncture was pleasant and valuable, but some patients presented doubts regarding its effect mechanisms. After the genuine acupuncture sessions, pain (mean -2.0 steps relief during each session) and unpleasant sensations (-2.4) in the face was reduced more than after sham acupuncture (+0.1 steps worse pain, P = .018, +0.1 steps worse unpleasant sensations, P = .036). After genuine acupuncture, unpleasant sensations in the hands were reduced less (-0.23) compared to after sham acupuncture (-5.5, P = .002). Pain or unpleasant sensations in the feet did not change. CONCLUSIONS Patients experienced that the neuropathy negatively changed their life and that acupuncture was pleasant and valuable. Patients receiving genuine acupuncture had short-term effects regarding pain and unpleasant sensations in the face compared to patients receiving sham acupuncture, while hands and feet did not improve. The patients were successfully blinded and complied with the acupuncture. We welcome future full-scaled randomized sham-controlled acupuncture studies.
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Spera MC, Cesta MC, Zippoli M, Varrassi G, Allegretti M. Emerging Approaches for the Management of Chemotherapy-Induced Peripheral Neuropathy (CIPN): Therapeutic Potential of the C5a/C5aR Axis. Pain Ther 2022; 11:1113-1136. [PMID: 36098939 PMCID: PMC9469051 DOI: 10.1007/s40122-022-00431-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is the most common neurologic complication of chemotherapy, resulting in symptoms like pain, sensory loss, and numbness in the hands and feet that cause lots of uneasiness in patients with cancer. They often suffer from pain so severe that it interrupts the treatment, thus invalidating the entire chemotherapy-based healing process, and significantly reducing their quality of life. In this paper, we underline the role of the complement system in CIPN, highlighting the relevance of the C5a fragment and its receptor C5aR1, whose activation is thought to be involved in triggering a cascade of events that can lead to CIPN onset. Recent experimental data showed the ability of docetaxel and paclitaxel to specifically bind and activate C5aR1, thus shining light on one of the molecular mechanisms by which taxanes may activate a cascade of events leading to neuropathy. According to these new evidence, it was possible to suggest new mechanisms underlying the pathophysiology of CIPN. Hence, the C5a/C5aR1 axis may represent a new target for CIPN treatment, and the use of C5aR1 inhibitors can be proposed as a potential new therapeutic option to manage this high unmet medical need.
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Affiliation(s)
- Maria C Spera
- Dompé Farmaceutici SpA, Via Campo di Pile, snc, L'Aquila, Italy
| | - Maria C Cesta
- Dompé Farmaceutici SpA, Via Campo di Pile, snc, L'Aquila, Italy.
| | - Mara Zippoli
- Dompé Farmaceutici SpA, Via Tommaso De Amicis, 95, Naples, Italy
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Farkas DJ, Foss JD, Ward SJ, Rawls SM. Kratom alkaloid mitragynine: Inhibition of chemotherapy-induced peripheral neuropathy in mice is dependent on sex and active adrenergic and opioid receptors. IBRO Neurosci Rep 2022; 13:198-206. [PMID: 36093282 PMCID: PMC9459671 DOI: 10.1016/j.ibneur.2022.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/26/2022] [Indexed: 11/06/2022] Open
Abstract
Mitragynine (MG) is an alkaloid found in Mitragyna speciosa (kratom) that is used as an herbal remedy for pain relief and opioid withdrawal. MG acts at μ-opioid and α-adrenergic receptors in vitro, but the physiological relevance of this activity in the context of neuropathic pain remains unknown. The purpose of the present study was to characterize the effects of MG in a mouse model of chemotherapy-induced peripheral neuropathy (CIPN), and to investigate the potential impact of sex on MG's therapeutic efficacy. Inhibition of oxaliplatin-induced mechanical hypersensitivity was measured following intraperitoneal administration of MG. Both male and female C57BL/6J mice were used to characterize potential sex-differences in MG's therapeutic efficacy. Pharmacological mechanisms of MG were characterized through pretreatment with the opioid and adrenergic antagonists naltrexone, prazosin, yohimbine, and propranolol (1, 2.5, 5 mg/kg). Oxaliplatin produced significant mechanical allodynia of equal magnitude in both male and females, which was dose-dependently attenuated by repeated MG exposure. MG was more potent in males vs females, and the highest dose of MG (10 mg/kg) exhibited greater anti-allodynic efficacy in males. Mechanistically, activity at µ-opioid, α1- and α2-adrenergic receptors, but not β-adrenergic receptors contributed to the effects of MG against oxaliplatin-induced mechanical hypersensitivity. Repeated MG exposure significantly attenuated oxaliplatin-induced mechanical hypersensitivity with greater potency and efficacy in males, which has crucial implications in the context of individualized pain management. The opioid and adrenergic components of MG indicate that it shares pharmacological properties with clinical neuropathic pain treatments.
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Affiliation(s)
- Daniel J. Farkas
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA,Corresponding author.
| | - Jeffery D. Foss
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
| | - Sara Jane Ward
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA,Department of Pharmacology, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
| | - Scott M. Rawls
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA,Department of Pharmacology, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
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9
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Bai X, Huang Y, Huang W, Zhang Y, Zhang K, Li Y, Ouyang H. Wnt3a/YTHDF1 Regulated Oxaliplatin-Induced Neuropathic Pain Via TNF-α/IL-18 Expression in the Spinal Cord. Cell Mol Neurobiol 2022; 43:1583-1594. [PMID: 35939138 DOI: 10.1007/s10571-022-01267-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/25/2022] [Indexed: 11/03/2022]
Abstract
Oxaliplatin is widely used in cancer treatment, however, many patients will suffer from neuropathic pain (NP) induced by it at the same time. Therefore exploring the mechanism and founding novel target for this problem are needed. In this study, YTHDF1 showed upregulation in oxaliplatin treated mice. As m6A is known as conserved and it widely functions in numerous physiological and pathological processes. Therefore, we focused on exploring the molecular mechanism of whether and how YTHDF1 functions in NP induced by oxaliplatin. IHC and western blotting were conducted to measure proteins. Intrathecal injection for corresponding siRNAs in C57/BL6 mice or spinal microinjection for virus in YTHDF1flox/flox mice were applied to specially knockdown the expression of molecular. Von Frey, acetone test and ethyl chloride (EC) test were applied to evaluate NP behavior. YTHDF1, Wnt3a, TNF-α and IL-18 were increased in oxaliplatin treated mice, restricted the molecular mentioned above respectively can significantly attenuate oxaliplatin-induced NP, including the mechanical allodynia and cold allodynia. Silencing YTHDF1 and inhibiting Wnt3a and Wnt signaling pathways can reduce the enhancement of TNF-α and IL-18, and the decreasing of the upregulation of YTHDF1 can be found when inhibiting Wnt3a and Wnts signaling pathways in oxaliplatin treated mice. Our study indicated a novel pathway that can contribute to oxaliplatin-induced NP, the Wnt3a/YTHDF1 to cytokine pathway, which upregulating YTHDF1 functioned as the downstream of Wnt3a signal and promoted the translation of TNF-α and IL-18 in oxaliplatin treated mice.
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Affiliation(s)
- Xiaohui Bai
- Department of Anesthesiology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road West, Guangzhou, China
| | - Yongtian Huang
- Department of Anesthesiology, State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, China
| | - Wan Huang
- Department of Anesthesiology, State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, China
| | - Yingjun Zhang
- Department of Anesthesiology, State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, China
| | - Kun Zhang
- Department of Anesthesiology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road West, Guangzhou, China
| | - Yujuan Li
- Department of Anesthesiology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road West, Guangzhou, China.
| | - Handong Ouyang
- Department of Anesthesiology, State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, China.
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Kerckhove N, Tougeron D, Lepage C, Pezet D, Le Malicot K, Pelkowski M, Pereira B, Balayssac D. Efficacy of donepezil for the treatment of oxaliplatin-induced peripheral neuropathy: DONEPEZOX, a protocol of a proof of concept, randomised, triple-blinded and multicentre trial. BMC Cancer 2022; 22:742. [PMID: 35799138 PMCID: PMC9264497 DOI: 10.1186/s12885-022-09806-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of oxaliplatin in digestive tract cancers could induce severe peripheral neuropathy (OIPN) decreasing the quality of life of patients and survivors. There is currently, no univocal treatment for these peripheral neuropathies. Donepezil, a reversible inhibitor of cholinesterase, used to treat Alzheimer's disease and dementia, is reported to have a good safety profile in humans, and preclinical data have provided initial evidence of its effectiveness in diminishing neuropathic symptoms and related comorbidities in OIPN animal models. METHODS The DONEPEZOX trial will be a proof-of-concept, randomised, triple-blinded, and multicentre study. It will be the first clinical trial evaluating the efficacy and safety of donepezil for the management of OIPN. Adult cancer survivors with OIPN that report sensory neuropathy according to QLQ-CIPN20 sensory score (equivalence of a grade ≥ 2), at least 6 months after the end of an oxaliplatin-based chemotherapy will be included. Eighty patients will be randomly assigned to receive either donepezil or placebo over 16 weeks of treatment. The primary endpoint will be the rate of responders (neuropathic grade decreases according to the QLQ-CIPN20 sensory score) in the donepezil arm. The severity of OIPN will be assessed by the QLQ-CIPN20 sensory scale before and after 16 weeks of treatment. The comparison versus the placebo arm will be a secondary objective. The other secondary endpoints will be tolerance to donepezil, the severity and features of OIPN in each arm before and after treatment, related-comorbidities and quality of life. Fleming's one-stage design will be used for sample size estimation. This design yields a type I error rate of 0.0417 and power of 91% for a responder rate of at least 30% in donepezil arm. A total of 80 randomized patients is planned. DISCUSSION This study will allow, in the case of positive results, to initiate a phase 3 randomized and placebo-controlled (primary endpoint) clinical study to assess the therapeutic interest of donepezil to treat OIPN. TRIAL REGISTRATION NCT05254639 , clincialtrials.gov, Registered 24 February 2022.
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Affiliation(s)
- Nicolas Kerckhove
- UMR 1107 NEURODOL, service de pharmacologie médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, INSERM, 63000, Clermont-Ferrand, France.
| | - David Tougeron
- Service d'Hépato gastroentérologie, CHU Poitiers, 86000, Poitiers, France
| | - Côme Lepage
- Service d'Hépatogastroentérologie et oncologie digestive, CHU Dijon, Université de Bourgogne, Dijon, France
- UMR LNC 1231, EPICAD INSERM, Université de Bourgogne, Dijon, France
| | - Denis Pezet
- Service de chirurgie digestive, U1071, M2iSH, USC-INRA 2018, CHU Clermont-Ferrand, Université Clermont Auvergne, INSERM, INRA, 63000, Clermont-Ferrand, France
| | - Karine Le Malicot
- UMR LNC 1231, EPICAD INSERM, Université de Bourgogne, Dijon, France
- Fédération Francophone de Cancérologie Digestive (FFCD), 21079, Dijon, France
| | - Manon Pelkowski
- UMR LNC 1231, EPICAD INSERM, Université de Bourgogne, Dijon, France
- Fédération Francophone de Cancérologie Digestive (FFCD), 21079, Dijon, France
| | - Bruno Pereira
- Direction de la recherche clinique et de l'innovation, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - David Balayssac
- UMR 1107 NEURODOL, service de pharmacologie médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, INSERM, 63000, Clermont-Ferrand, France
- Direction de la recherche clinique et de l'innovation, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
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Karp DD, Camidge DR, Infante JR, Ames TD, Price MR, Jimeno J, Bryce AH. Phase I study of PT-112, a novel pyrophosphate-platinum immunogenic cell death inducer, in advanced solid tumours. EClinicalMedicine 2022; 49:101430. [PMID: 35747193 PMCID: PMC9156977 DOI: 10.1016/j.eclinm.2022.101430] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 04/04/2022] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND PT-112, the first pyrophosphate-platinum conjugate, causes immunogenic cell death in experimental models, leading to recruitment of tumour-infiltrating lymphocytes. PT-112 also associates with bone (osteotropism), likely driven by its pyrophosphate moiety. This is the first-in-human study of PT-112 monotherapy, exploring its safety and efficacy in a patient population where standard of care therapies were exhausted and novel treatment options are needed. METHODS Patients with progressing, advanced solid tumours received PT-112 intravenously (1 h) on days 1, 8, 15 of a 28-day cycle in an open-label, multi-centre 3 + 3 dose-escalation trial, conducted at four US research sites. The primary objective was to assess safety and pharmacokinetics, and to identify a recommended phase 2 dose (RP2D). Eligibility criteria included: age ≥18 years, Eastern Collaborative Oncology Group (ECOG) Performance Status of 0-1, and disease evaluable by Response Evaluation Criteria in Solid Tumours (RECIST) v1·1 or by informative tumour markers. Patients receiving ≥1 dose of PT-112 were included in the safety and pharmacokinetic analyses, with the exploratory efficacy analysis including patients receiving ≥1 dose at 125 mg/m2. This study is registered at ClinicalTrials.gov, number NCT02266745, with the dose-escalation portion of the study closed. FINDINGS Between July 7th, 2014 and September 18th, 2018, 66 heavily pre-treated patients (median 4 prior lines, IQR 2-6) were enrolled and treated across 11 doses (12-420 mg/m2). Treatment-related adverse events included fatigue (23 patients, 35%), nausea (16 patients, 24%), and peripheral neuropathy (14 patients, 21%). Grade 3 events were experienced by 18 patients (27%), with no grade 4-5 events observed. The recommended phase 2 dose was determined to be 360 mg/m2. Nine (17%) of the 54 efficacy evaluable patients achieved progression-free survival ≥6 months. Durable partial responses were induced in non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), and thymoma. Radiographic and serum marker reductions were observed among ten patients with metastatic castration resistant prostate cancer, four of whom survived two years or longer. INTERPRETATION PT-112 is safe and well-tolerated in a heavily pre-treated population. Prolonged responses were noted against thymoma and lung cancer, along with radiographic and serum marker improvement in prostate cancer. Given the heterogeneous patient population, subsequent studies will be needed to characterize the risk/benefit ratio in more homogenous settings. Further development of PT-112 is ongoing, as single-agent and in combination with immune checkpoint inhibition. FUNDING Funding was provided by Promontory Therapeutics Inc.
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Affiliation(s)
- Daniel D. Karp
- Investigational Cancer Therapeutics Department, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd #U421, Houston, TX 77030, USA
- Corresponding author.
| | - D. Ross Camidge
- Medical Oncology, University of Colorado Cancer Center Anschutz Cancer Pavilion, Aurora, CO, USA
| | - Jeffery R. Infante
- Department of Drug Development, Sarah Cannon Research Institute, Nashville, TN, USA
| | | | | | - José Jimeno
- Promontory Therapeutics Inc., New York, NY, USA
| | - Alan H. Bryce
- Department of Internal Medicine, Division of Hematology/Oncology, Mayo Clinic Cancer Center, Phoenix, AZ, USA
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12
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Varghese D, Castelino R, Simha V, Krishnamurthy MN, Gota V. Dose dependent slurred speech and laryngopharyngeal dysesthesia due to oxaliplatin. J Oncol Pharm Pract 2022; 28:1641-1644. [PMID: 35119329 DOI: 10.1177/10781552221077038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Oxaliplatin is a platinum containing alkylating agent commonly used in the management of colorectal cancers. The most common dose-limiting toxicity of oxaliplatin is peripheral neuropathy, which can be severe enough to cause treatment discontinuation. We present a case of dysarthria and laryngopharyngeal dysesthesia (LPD) that developed during the first dose of oxaliplatin, which showed dose-dependent reduction in severity in subsequent cycles. CASE REPORT A 52-year-old female patient with adenocarcinoma of rectum (pT4N2M0) was prescribed oxaliplatin (130 mg/m2) and capecitabine(2000mg/m2). She developed heaviness in the tongue, slurred speech, jaw pain, perioral paresthesia within 30 min after the end of 3 h infusion of oxaliplatin in the first cycle. The symptoms subsided without any sequelae in two days. However, in the subsequent cycles as the dose of the oxaliplatin was reduced, similar symptoms reappeared but were of reduced in severity. No dysesthesia symptoms were observed in the 4th cycle when the oxaliplatin was administered at 85 mg/m2. MANAGEMENT AND OUTCOME As and when the patient developed symptoms - slurred speech, jaw pain during the first three cycles, she was managed with inj. Hydrocortisone (100 mg i.v.) and one ampoule of pheniramine (45 mg i.v.). DISCUSSION Occurrence of laryngopharyngeal dysesthesia due to oxaliplatin does not warrant drug withdrawal, dose titration can be helpful, thereby preventing the drug withdrawal for the patient management.
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Affiliation(s)
- Diana Varghese
- Department of Clinical Pharmacology, Advanced Centre for Treatment, 29435Research and Education in Cancer, Tata Memorial Centre.,232022Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Renita Castelino
- Department of Clinical Pharmacology, Advanced Centre for Treatment, 29435Research and Education in Cancer, Tata Memorial Centre
| | - Vijay Simha
- Department of Medical Oncology, Advanced Centre for Treatment, 29436Research and Education in Cancer, Tata Memorial Centre
| | - Manjunath Nookala Krishnamurthy
- Department of Clinical Pharmacology, Advanced Centre for Treatment, 29435Research and Education in Cancer, Tata Memorial Centre.,232022Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vikram Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment, 29435Research and Education in Cancer, Tata Memorial Centre.,Department of Medical Oncology, Advanced Centre for Treatment, 29436Research and Education in Cancer, Tata Memorial Centre
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13
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Mezzanotte JN, Grimm M, Shinde NV, Nolan T, Worthen-Chaudhari L, Williams NO, Lustberg MB. Updates in the Treatment of Chemotherapy-Induced Peripheral Neuropathy. Curr Treat Options Oncol 2022; 23:29-42. [PMID: 35167004 PMCID: PMC9642075 DOI: 10.1007/s11864-021-00926-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 12/16/2022]
Abstract
OPINION STATEMENT Chemotherapy-induced peripheral neuropathy (CIPN) is a common toxicity associated with treatment with platinum-based agents, taxanes, vinca alkaloids, and other specific agents. The long-term consequences of this condition can result in decreased patient quality of life and can lead to reduced dose intensity, which can negatively impact disease outcomes. There are currently no evidence-based preventative strategies for CIPN and only limited options for treatment. However, there are several strategies that can be utilized to improve patient experience and outcomes as more data are gathered in the prevention and treatment setting. Before treatment, patient education on the potential side effects of chemotherapy is key, and although trials have been limited, recommending exercise and a healthy lifestyle before and while undergoing chemotherapy may provide some overall benefit. In patients who develop painful CIPN, our approach is to offer duloxetine and titrate up to 60 mg daily. Chemotherapy doses may also need to be reduced if intolerable symptoms develop during treatment. Some patients may also try acupuncture and physical therapy to help address their symptoms, although this can be limited by cost, time commitment, and patient motivation. Additionally, data on these modalities are currently limited, as studies are ongoing. Overall, approaching each patient on an individual level and tailoring treatment options for them based on overall physical condition, their disease burden, goals of care and co-morbid health conditions, and willingness to trial different approaches is necessary when addressing CIPN.
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Affiliation(s)
- Jessica N. Mezzanotte
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, Room 334B, Columbus, OH 43210
| | - Michael Grimm
- The Ohio State University Comprehensive Cancer Center, 460 W. 10th Avenue, Columbus, OH 43210
| | - Namrata V. Shinde
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, Columbus, OH 43210
| | - Timiya Nolan
- The Ohio State University College of Nursing, 1585 Neil Avenue, Columbus, OH 43210
| | - Lise Worthen-Chaudhari
- Department of Physical Medicine and Rehabilitation, The Ohio State University Wexner Medical Center, 480 Medical Center Drive, Dodd Hall, Suite 1060, Columbus, OH 43210
| | - Nicole O. Williams
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, 1800 Cannon Drive, 1310K Lincoln Tower, Columbus, OH 43210
| | - Maryam B. Lustberg
- Smilow Cancer Hospital/Yale Cancer Center, 35 Park Street, New Haven, CT 06519
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14
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Burgess J, Ferdousi M, Gosal D, Boon C, Matsumoto K, Marshall A, Mak T, Marshall A, Frank B, Malik RA, Alam U. Chemotherapy-Induced Peripheral Neuropathy: Epidemiology, Pathomechanisms and Treatment. Oncol Ther 2021; 9:385-450. [PMID: 34655433 PMCID: PMC8593126 DOI: 10.1007/s40487-021-00168-y] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/12/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This review provides an update on the current clinical, epidemiological and pathophysiological evidence alongside the diagnostic, prevention and treatment approach to chemotherapy-induced peripheral neuropathy (CIPN). FINDINGS The incidence of cancer and long-term survival after treatment is increasing. CIPN affects sensory, motor and autonomic nerves and is one of the most common adverse events caused by chemotherapeutic agents, which in severe cases leads to dose reduction or treatment cessation, with increased mortality. The primary classes of chemotherapeutic agents associated with CIPN are platinum-based drugs, taxanes, vinca alkaloids, bortezomib and thalidomide. Platinum agents are the most neurotoxic, with oxaliplatin causing the highest prevalence of CIPN. CIPN can progress from acute to chronic, may deteriorate even after treatment cessation (a phenomenon known as coasting) or only partially attenuate. Different chemotherapeutic agents share both similarities and key differences in pathophysiology and clinical presentation. The diagnosis of CIPN relies heavily on identifying symptoms, with limited objective diagnostic approaches targeting the class of affected nerve fibres. Studies have consistently failed to identify at-risk cohorts, and there are no proven strategies or interventions to prevent or limit the development of CIPN. Furthermore, multiple treatments developed to relieve symptoms and to modify the underlying disease in CIPN have failed. IMPLICATIONS The increasing prevalence of CIPN demands an objective approach to identify at-risk patients in order to prevent or limit progression and effectively alleviate the symptoms associated with CIPN. An evidence base for novel targets and both pharmacological and non-pharmacological treatments is beginning to emerge and has been recognised recently in publications by the American Society of Clinical Oncology and analgesic trial design expert groups such as ACTTION.
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Affiliation(s)
- Jamie Burgess
- Department of Cardiovascular and Metabolic Medicine, The Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool University Hospital NHS Trust, Liverpool, UK.
- Clinical Sciences Centre, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK.
| | - Maryam Ferdousi
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - David Gosal
- Department of Neurology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Cheng Boon
- Department of Clinical Oncology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Kohei Matsumoto
- Department of Cardiovascular and Metabolic Medicine, The Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool University Hospital NHS Trust, Liverpool, UK
| | - Anne Marshall
- Department of Cardiovascular and Metabolic Medicine, The Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool University Hospital NHS Trust, Liverpool, UK
| | - Tony Mak
- Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Andrew Marshall
- Faculty of Health and Life Sciences, Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L7 8TX, UK
- Faculty of Health and Life Sciences, The Pain Research Institute, University of Liverpool, Liverpool, L9 7AL, UK
- Department of Pain Medicine, The Walton Centre, Liverpool, L9 7LJ, UK
| | - Bernhard Frank
- Department of Pain Medicine, The Walton Centre, Liverpool, L9 7LJ, UK
| | - Rayaz A Malik
- Research Division, Qatar Foundation, Weill Cornell Medicine-Qatar, Education City, Doha, Qatar
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - Uazman Alam
- Department of Cardiovascular and Metabolic Medicine, The Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool University Hospital NHS Trust, Liverpool, UK.
- Division of Endocrinology, Diabetes and Gastroenterology, University of Manchester, Manchester, M13 9PT, UK.
- Clinical Sciences Centre, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK.
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15
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Endocannabinoid System Attenuates Oxaliplatin-Induced Peripheral Sensory Neuropathy Through the Activation of CB1 Receptors. Neurotox Res 2021; 39:1782-1799. [PMID: 34792764 DOI: 10.1007/s12640-021-00442-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022]
Abstract
Oxaliplatin-induced neurotoxicity is expressed as a dose-limiting peripheral sensory neuropathy (PSN). Cannabinoid substances have been investigated for the analgesic effect. This study aimed to investigate the role of cannabinoid receptors in oxaliplatin-associated PSN. Swiss male mice received nine oxaliplatin injections (2 mg/kg, i.v.). Mechanical and thermal nociceptive tests were performed for 56 days. CB1, CB2, and c-Fos expression were assessed in dorsal root ganglia (DRG), spinal cord (SC), trigeminal ganglia (TG), spinal trigeminal nucleus caudalis (Sp5C), and periaqueductal gray (PAG). Iba-1 expression was assessed in DRG and ATF3 in TG. Cannabidiol (10 mg/kg, p.o.) or a CB1/CB2 non-selective agonist (WIN 55,212-2; 0.5 mg/kg, s.c.) or AM251 (CB1 antagonist) or AM630 (CB2 antagonist) (3 mg/kg, i.p.) were injected before oxaliplatin. Oxaliplatin increased CB1 in DRG, SC, TG, Sp5C, and ventrolateral PAG, with no interference in CB2 expression. Cannabidiol increased CB1 in DRG, reduced mechanical hyperalgesia and c-Fos expression in DRG and SC. Additionally, WIN 55,212-2 increased CB1 in DRG, reduced mechanical hyperalgesia, cold allodynia and c-Fos expression in DRG and SC. CB1 blockage hastened the cold allodynia response, but the CB2 antagonist failed to modulate the oxaliplatin-induced nociceptive behavior. Oxaliplatin also increased Iba-1 in DRG, suggesting immune response modulation which was reduced by cannabidiol and enhanced by AM630. The modulation of the endocannabinoid system, through the CB1 receptor, attenuates the oxaliplatin-associated PNS. The activation of the endocannabinoid system could be considered as a therapeutic target for controlling oxaliplatin-associated neuropathy.
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16
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Malta CEN, de Lima Martins JO, Carlos ACAM, Freitas MO, Magalhães IA, de Vasconcelos HCA, de Lima Silva-Fernandes IJ, de Barros Silva PG. Risk factors for dysgeusia during chemotherapy for solid tumors: a retrospective cross-sectional study. Support Care Cancer 2021; 30:313-325. [PMID: 34283319 DOI: 10.1007/s00520-021-06219-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study retrospectively analyzed the risk factors for transchemotherapy dysgeusia. METHODS Before each chemotherapy cycle, patients were routinely evaluated for the presence/severity of dysgeusia based on the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 scale for adverse effects and graded as follows: 0, no change in taste; 1, altered taste with no impact on eating habits; or 2, altered taste with an impact on eating habits. Information from 2 years of evaluations was collected and patient medical records were reviewed to obtain data on chemotherapy cycle, sex, age, body mass index, body surface area, primary tumor, chemotherapy protocol, and history of head and neck radiotherapy. The X2 test and multinomial logistic regression were used for statistical analysis (SPSS 20.0, p < 0.05). RESULTS Among 7425 total patients, 3047, 2447, and 1931 were evaluated after the first, second, and third chemotherapy cycles, respectively. One-fifth of the patients (19.0%) presented a significant loss of taste, with 1118 (15.0%) showing grade 1 dysgeusia and 442 (6.0%) showing grade 2 dysgeusia. The chemotherapy duration (p < 0.001), female sex (p < 0.001), location of the primary tumor in the uterus (p = 0.008), head and neck (p = 0.012), and testicles (p = 0.011), and use of ifosfamide (p = 0.009), docetaxel (p = 0.001), paclitaxel (p < 0.001), pertuzumab (p = 0.005), bevacizumab (p < 0.001), and dacarbazine (p = 0.002) independently increased the risk of dysgeusia. In head and neck tumors, a previous history of radiotherapy significantly increased the prevalence of dysgeusia (p = 0.017), and the use of cisplatin (p = 0.001) increased this prevalence. CONCLUSION Cycles of chemotherapy, sex, uterine cancer, head and neck tumors, testicular cancer, ifosfamide, docetaxel, paclitaxel, pertuzumab, bevacizumab, and dacarbazine increase the risk of dysgeusia.
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Affiliation(s)
| | - Joyce Ohana de Lima Martins
- Dentistry Graduate Program, Federal University of Ceará, Fortaleza, Brazil. .,Laboratory of Molecular Biology and Oncogenetics, Ceará Cancer Institute, Papi Júnior Street, 1222, Rodolfo Teófilo, Fortaleza, Ceará, 60351-010, Brazil.
| | | | | | | | | | | | - Paulo Goberlânio de Barros Silva
- Dentistry Graduate Program, Federal University of Ceará, Fortaleza, Brazil.,Graduate Program in Dental Sciences, Unichristus, Fortaleza, Brazil.,Post-Graduate Program in Oncology, Rodolfo Teófilo College/Ceará Cancer Institute, Fortaleza, Brazil
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17
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Wu B, Su X, Zhang W, Zhang YH, Feng X, Ji YH, Tan ZY. Oxaliplatin Depolarizes the IB4 - Dorsal Root Ganglion Neurons to Drive the Development of Neuropathic Pain Through TRPM8 in Mice. Front Mol Neurosci 2021; 14:690858. [PMID: 34149356 PMCID: PMC8211750 DOI: 10.3389/fnmol.2021.690858] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/10/2021] [Indexed: 01/13/2023] Open
Abstract
Use of chemotherapy drug oxaliplatin is associated with painful peripheral neuropathy that is exacerbated by cold. Remodeling of ion channels including TRP channels in dorsal root ganglion (DRG) neurons contribute to the sensory hypersensitivity following oxaliplatin treatment in animal models. However, it has not been studied if TRP channels and membrane depolarization of DRG neurons serve as the initial ionic/membrane drives (such as within an hour) that contribute to the development of oxaliplatin-induced neuropathic pain. In the current study, we studied in mice (1) in vitro acute effects of oxaliplatin on the membrane excitability of IB4+ and IB4- subpopulations of DRG neurons using a perforated patch clamping, (2) the preventative effects of a membrane-hyperpolarizing drug retigabine on oxaliplatin-induced sensory hypersensitivity, and (3) the preventative effects of TRP channel antagonists on the oxaliplatin-induced membrane hyperexcitability and sensory hypersensitivity. We found (1) IB4+ and IB4- subpopulations of small DRG neurons displayed previously undiscovered, substantially different membrane excitability, (2) oxaliplatin selectively depolarized IB4- DRG neurons, (3) pretreatment of retigabine largely prevented oxaliplatin-induced sensory hypersensitivity, (4) antagonists of TRPA1 and TRPM8 channels prevented oxaliplatin-induced membrane depolarization, and (5) the antagonist of TRPM8 largely prevented oxaliplatin-induced sensory hypersensitivity. These results suggest that oxaliplatin depolarizes IB4- neurons through TRPM8 channels to drive the development of neuropathic pain and targeting the initial drives of TRPM8 and/or membrane depolarization may prevent oxaliplatin-induce neuropathic pain.
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Affiliation(s)
- Bin Wu
- Institute of Special Environment Medicine, Nantong University, Nantong, China.,Department of Pharmacology and Toxicology, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Xiaolin Su
- Department of Pharmacology and Toxicology, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, United States.,Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Wentong Zhang
- Department of Pharmacology and Toxicology, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Yi-Hong Zhang
- Department of Pharmacology and Toxicology, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Xinghua Feng
- Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, College of Pharmaceutical Sciences, Zhejiang University of Technology, Hangzhou, China
| | - Yong-Hua Ji
- Laboratory of Neuropharmacology and Neurotoxicology, Shanghai University, Shanghai, China
| | - Zhi-Yong Tan
- Department of Pharmacology and Toxicology, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, United States
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18
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Kubo K, Kimura N, Watanabe R, Higashino M, Tsuda M, Kato M. Oxaliplatin-Associated Amaurosis Fugax. Case Rep Oncol 2021; 14:832-837. [PMID: 34248547 PMCID: PMC8255733 DOI: 10.1159/000516271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
Oxaliplatin-associated amaurosis fugax has not been reported, and its clinical course and treatment remain largely unclear. A 70-year-old man with advanced gastric cancer was treated with the SOX regimen. After cycle 1 of oxaliplatin infusion, the patient realized that his right eye had visual field impairment, which he described as darkening of the right half of his visual field and loss of vision lasting about 1 min and occurring about 7 times a day. The daily frequency of this occurrence gradually decreased, and his visual field impairment improved in 1 week. However, as the same symptoms recurred from cycle 2 to cycle 5 of treatment, oxaliplatin was discontinued from cycle 6 and switched to S-1 monotherapy. Subsequently, the patient's amaurosis fugax improved. To our knowledge, this is the first report describing clinical course and treatment of oxaliplatin-associated amaurosis fugax.
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Affiliation(s)
- Kimitoshi Kubo
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Noriko Kimura
- Department of Pathology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Ryosuke Watanabe
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Masayuki Higashino
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Momoko Tsuda
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Mototsugu Kato
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
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19
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Grover M, Behl T, Sachdeva M, Bungao S, Aleya L, Setia D. Focus on Multi-targeted Role of Curcumin: a Boon in Therapeutic Paradigm. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:18893-18907. [PMID: 33595796 DOI: 10.1007/s11356-021-12809-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
Curcumin is a polyphenolic compound that exhibited good anticancer potential against different types of cancers through its multi-targeted effect like the termination of cell proliferation, inflammation, angiogenesis, and metastasis, thereby acting as antiproliferative and cytotoxic in nature. The present review surveys the various drug combination tried with curcumin or its synthetic analogues and also the mechanism by which curcumin potentiates the effect of almost every drug. In addition, this article also focuses on aromatherapy which is gaining much popularity in cancer patients. After thoroughly studying several articles on combination therapy of curcumin through authenticated book chapters, websites, research, and review articles available at PubMed, ScienceDirect, etc., it has been observed that multi-targeted curcumin possess enormous anticancer potential and, with whatever drug it is given in combination, has always resulted in enhanced effect with reduced dose as well as side effects. It is also capable enough in overcoming the problem of chemoresistance. Besides this, aromatherapy also proved its potency in reducing cancer-related side effects. Combining all the factors together, we can conclude that combination therapy of drugs with curcumin should be explored extensively. In addition, aromatherapy can be used as an adjuvant or supplementary therapy to reduce the cancer complications in patients.
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Affiliation(s)
- Madhuri Grover
- B.S. Anangpuria Institute of Pharmacy, Alampur, Haryana, India
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, Punjab, India.
| | | | - Simona Bungao
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Lotfi Aleya
- Chrono-Environment Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté University, Besançon, France
| | - Dhruv Setia
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
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20
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Chemotherapy-induced peripheral neuropathy (CIPN). MEMO - MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2021. [DOI: 10.1007/s12254-021-00688-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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21
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Bonomo R, Cavaletti G. Clinical and biochemical markers in CIPN: A reappraisal. Rev Neurol (Paris) 2021; 177:890-907. [PMID: 33648782 DOI: 10.1016/j.neurol.2020.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/11/2020] [Accepted: 11/03/2020] [Indexed: 12/14/2022]
Abstract
The increased survival of cancer patients has raised growing public health concern on associated long-term consequences of antineoplastic treatment. Chemotherapy-induced peripheral neuropathy (CIPN) is a primarily sensory polyneuropathy, which may be accompanied by pain, autonomic disturbances, and motor deficit. About 70% of treated cancer patients might develop CIPN during or after the completion of chemotherapy, and in most of them such complication persists after six months from the treatment. The definition of the potential risk of development and resolution of CIPN according to a clinical and biochemical profile would be certainly fundamental to tailor chemotherapy regimen and dosage on individual susceptibility. In recent years, patient-reported and clinician-related tools along with quality of life instruments have been featured as primary outcomes in clinical setting and randomized trials. New studies on metabolomics markers are further pursuing accurate and easily accessible indicators of peripheral nerve damage. The aim of this review is to outline the strengths and pitfalls of current knowledge on CIPN, and to provide a framework for future potential developments of standardized protocols involving clinical and biochemical markers for CIPN assessment and monitoring.
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Affiliation(s)
- R Bonomo
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - G Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
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Peripheral Neuropathy under Oncologic Therapies: A Literature Review on Pathogenetic Mechanisms. Int J Mol Sci 2021; 22:ijms22041980. [PMID: 33671327 PMCID: PMC7922628 DOI: 10.3390/ijms22041980] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 02/06/2023] Open
Abstract
Peripheral neurologic complications are frequent adverse events during oncologic treatments and often lead to dose reduction, administration delays with time elongation of the therapeutic plan and, not least, worsening of patients’ quality of life. Experience skills are required to recognize symptoms and clinical evidences and the collaboration between different health professionals, in particular oncologists and hospital pharmacists, grants a correct management of this undesirable occurrence. Some classes of drugs (platinates, vinca alkaloids, taxanes) typically develop this kind of side effect, but the genesis of chemotherapy-induced peripheral neuropathy is not linked to a single mechanism. This paper aims from one side at summarizing and explaining all the scattering mechanisms of chemotherapy-induced peripheral neuropathy through a detailed literature revision, on the other side at finding new approaches to possible treatments, in order to facilitate the collaboration between oncologists, hematologists and hospital pharmacists.
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Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is an unsolved and potentially life-compromising problem for most patients receiving neurotoxic chemotherapy. It manifests with numbness, tingling, and possibly neuropathic pain and motor and autonomic symptoms. This review aims to provide an evidence synthesis that prepares nurses to comprehensively assess, provide supportive care for, and critically evaluate the literature on CIPN. The prevalence, significance, characteristics, mechanisms, and risk factors of CIPN will be discussed, as well as nursing-relevant evidence on the assessment, prevention, and management of CIPN. The importance of critical literature evaluation before clinical implementation to reduce physical and financial harms to patients will also be highlighted.
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24
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Godinho PAR, Silva PGB, Lisboa MRP, Costa BA, Gifoni MAC, Rocha Filho DR, Lima-Júnior RCP, Vale ML. Electronic von Frey as an objective assessment tool for oxaliplatin-induced peripheral neuropathy: A prospective longitudinal study. Eur J Cancer Care (Engl) 2020; 30:e13360. [PMID: 33219575 DOI: 10.1111/ecc.13360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 09/28/2020] [Accepted: 10/15/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE There is wide discrepancy on how to perform clinical assessment of oxaliplatin-induced peripheral neuropathy. In this scenario, the Electronic von Frey (EVF), which evaluates pain objectively based upon mechanical pain thresholds (MPTs), may be a valuable tool. The present study aims to quantify hyperalgesia in the hands and feet of patients treated with oxaliplatin and to propose a novel method to classify the degree of neurotoxicity using EVF-derived measures as cut-off points. METHODS This is a prospective cohort study including 46 patients treated for colorectal cancer with the FLOX regimen. Before each oxaliplatin administration, patients were evaluated with the Acute and Chronic Neuropathy Questionnaire, Oxaliplatin-Specific Neurotoxicity Scale and National Cancer Institute Common Terminology Criteria for Adverse Events scale. Also, objective pain assessment with the EVF was performed. RESULTS For both upper and lower extremities, EVF was shown to correlate well with patients' symptoms and functional impairment, as assessed by subjective scales. Also, when cut-off MPT variations were determined for diagnosis of neurotoxicity grade 2 or 3, the method showed good sensitivity and specificity. CONCLUSION Electronic von Frey is a noninvasive and easy-to-perform objective method with potential to supplement the current assessment tools for oxaliplatin-induced peripheral neuropathy, which are mostly subjective.
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Affiliation(s)
- Priscilla A R Godinho
- Graduate Program in Pharmacology, School of Medicine, Federal University of Ceará (UFC, Fortaleza, Brazil
| | - Paulo G B Silva
- Centro Universitário Christus (UNICHRISTUS, Fortaleza, Brazil
| | - Mario R P Lisboa
- Centro Universitário Christus (UNICHRISTUS, Fortaleza, Brazil.,Department of Morphology, Faculty of Medicine, Universidade Federal do Ceará (UFC, Fortaleza, Brazil
| | - Bruno A Costa
- Drug Research and Development Center, Faculty of Medicine, Universidade Federal do Ceará (UFC, Fortaleza, Brazil
| | - Markus A C Gifoni
- Clinical Oncology Department, Instituto do Câncer do Ceará (ICC, Fortaleza, Brazil
| | - Duílio R Rocha Filho
- Clinical Oncology Department, Instituto do Câncer do Ceará (ICC, Fortaleza, Brazil
| | - Roberto C P Lima-Júnior
- Graduate Program in Pharmacology, School of Medicine, Federal University of Ceará (UFC, Fortaleza, Brazil.,Drug Research and Development Center, Faculty of Medicine, Universidade Federal do Ceará (UFC, Fortaleza, Brazil
| | - Mariana L Vale
- Graduate Program in Pharmacology, School of Medicine, Federal University of Ceará (UFC, Fortaleza, Brazil.,Department of Morphology, Faculty of Medicine, Universidade Federal do Ceará (UFC, Fortaleza, Brazil.,Drug Research and Development Center, Faculty of Medicine, Universidade Federal do Ceará (UFC, Fortaleza, Brazil
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25
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Mesenchymal stem cells reduce the oxaliplatin-induced sensory neuropathy through the reestablishment of redox homeostasis in the spinal cord. Life Sci 2020; 265:118755. [PMID: 33189826 DOI: 10.1016/j.lfs.2020.118755] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/02/2020] [Accepted: 11/10/2020] [Indexed: 01/02/2023]
Abstract
AIMS The present study was designed to investigate whether the antinociceptive effect of bone marrow-derived mesenchymal stem/stromal cells (MSC) during oxaliplatin (OXL)-induced sensory neuropathy is related to antioxidant properties. MAIN METHODS Male mice C57BL/6 were submitted to repeated intravenous administration of OXL (1 mg/kg, 9 administrations). After the establishment of sensory neuropathy, mice were treated with a single intravenous administration of MSC (1 × 106), vehicle or gabapentin. Paw mechanical and thermal nociceptive thresholds were evaluated through von Frey filaments and cold plate test, respectively. Motor performance was evaluated in the rota-rod test. Gene expression profile, cytokine levels, and oxidative stress markers in the spinal cord were evaluated by real-time PCR, ELISA and biochemical assays, respectively. KEY FINDINGS OXL-treated mice presented behavioral signs of sensory neuropathy, such as mechanical allodynia and thermal hyperalgesia, which were completely reverted by a single administration of MSC. Repeated oral treatment with gabapentin (70 mg/kg) induced only transient antinociception. The IL-1β and TNF-α spinal levels did not differ between mice with or without sensory neuropathy. MSC increased the levels of anti-inflammatory cytokines, IL-10 and TGF-β, in the spinal cord of neuropathic mice, in addition to increasing the gene expression of antioxidant factors SOD and Nrf-2. Additionally, nitrite and MDA spinal levels were reduced by the MSC treatment. SIGNIFICANCE MSC induce reversion of sensory neuropathy induced by OXL possibly by activation of anti-inflammatory and antioxidant pathways, leading to reestablishment of redox homeostasis in the spinal cord.
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26
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Bennedsgaard K, Ventzel L, Andersen NT, Themistocleous AC, Bennett DL, Jensen TS, Tankisi H, Finnerup NB. Oxaliplatin- and docetaxel-induced polyneuropathy: clinical and neurophysiological characteristics. J Peripher Nerv Syst 2020; 25:377-387. [PMID: 32902058 PMCID: PMC7756561 DOI: 10.1111/jns.12413] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 12/13/2022]
Abstract
The aim of this study was to evaluate the presence and characterization of chemotherapy-induced neuropathy (CIPN) and neuropathic pain 5 years after adjuvant chemotherapy with docetaxel or oxaliplatin. Patients from an ongoing prospective study, who had received adjuvant chemotherapy with docetaxel or oxaliplatin in 2011 to 2012 were invited to participate. The patients underwent a thorough examination with interview, neurological examination, questionnaires, assessment tools, nerve conduction studies (NCS), quantitative sensory testing, MScan motor unit number estimation (MUNE), and corneal confocal microscopy (CCM). Patients were divided into no, possible, probable, and confirmed CIPN. Out of the 132 eligible patients, 63 agreed to participate: 28 had received docetaxel and 35 had received oxaliplatin. Forty-one percent had confirmed CIPN, 34% possible or probable CIPN, and 22% did not have CIPN. The CIPN was characterized mainly by sensory nerve fiber loss, with a more pronounced large fiber than small fiber loss but also some motor fiber loss identified on NCS and MUNE. In general, patients had mild neuropathy with relatively low scores on assessment tools and no association with mood and quality of life. CCM was not useful as a diagnostic tool. Of the patients with probable or confirmed CIPN, 30% experienced pain, which was most often mild, but still interfered moderately with daily life in 20% to 25% and was associated with lower quality of life. In conclusion CIPN was confirmed in 41% 5 years after chemotherapy. The neuropathy was generally mild, but in patients with neuropathic pain it was associated with lower quality of life.
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Affiliation(s)
- Kristine Bennedsgaard
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lise Ventzel
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels T Andersen
- Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Andreas C Themistocleous
- Nuffield Department of Clinical Neuroscience, University of Oxford, UK.,Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David L Bennett
- Nuffield Department of Clinical Neuroscience, University of Oxford, UK
| | - Troels S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Hatice Tankisi
- Department of Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Kamei K, Ohnishi T, Nakata K, Danno K, Ohkawa A, Miyake Y, Okazaki S, Fukunaga M, Toyokawa A, Hamada T, Shindoh J, Kanazawa A. A new monitoring tool CLIP test for progression of oxaliplatin-induced peripheral neuropathy: A multicenter prospective study. Asia Pac J Clin Oncol 2020; 16:e257-e262. [PMID: 32893979 DOI: 10.1111/ajco.13404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/26/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Oxaliplatin-induced peripheral neuropathy (OIPN) is a common adverse events that can limit a patient's quality of life during/after chemotherapy. However, no appropriate methods have been established yet for monitoring the risk of progression of OIPN. METHODS A simple assessment tool using gem clips, the CLIP test, was established and its performance in predicting the risk of progression to ≥grade 2 peripheral sensory neuropathy (CTCAE ver. 4.0) was investigated in patients receiving chemotherapy with oxaliplatin. RESULTS Among 101 patients included in this study, 71 patients developed CTCAE ≥grade 1 peripheral neuropathy (grade 1, n = 67; grade 2, n = 4) at a median of 63 (range, 14-259) days after the start of treatment. Of the 67 patients with grade 1 peripheral neuropathy, 17 showed progression to ≥grade 2 neuropathy after a median interval of 84 (range, 21-246) days. Of these patients, 27 showed a positive result of the CLIP test at a median of 91 (range, 14-224) days, excluding one patient who already showed a positive result of the test at the baseline. Therefore, the risk ratio for the development of CTCAE ≥grade 2 peripheral neuropathy was 8.3 in the patients who showed a positive result on the CLIP test. Multivariate analysis confirmed that a positive results on the CLIP test was significantly correlated with the risk of future development of CTCAE ≥grade 2 peripheral neuropathy (odds ratio, 9.37; P = 0.002). CONCLUSION A positive result on the CLIP test predict is predictive of the risk of progression of OIPN during chemotherapy with oxaliplatin.
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Affiliation(s)
- Keiko Kamei
- Department of Surgery, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Tadashi Ohnishi
- Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan
| | - Ken Nakata
- Department of Coloproctological Surgery, Sakai City Medical Center, Sakai, Japan
| | - Katsuki Danno
- Department of Surgery, Minoh City Hospital, Minoh, Japan
| | - Atsushi Ohkawa
- Department of Surgery, Higashi Takarazuka Satoh Hospital, Takarazuka, Japan
| | - Yasuhiro Miyake
- Department of Surgery, Osaka Minato Central Hospital, Osaka, Japan
| | - Satoshi Okazaki
- Department of Surgery, Kansai Medical University Kori Hospital, Neyagawa, Japan
| | - Mutsumi Fukunaga
- Department of Surgery, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan
| | | | - Tetsuhiro Hamada
- Department of Surgery, Takarazuka City Hospital, Takarazuka, Japan
| | - Junichi Shindoh
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Akiyoshi Kanazawa
- Department of Surgery, Shimane Prefectural Central Hospital, Izumo, Japan
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FLOX (5-fluorouracil + leucovorin + oxaliplatin) chemotherapy for colorectal cancer leads to long-term orofacial neurotoxicity: a STROBE-guided longitudinal prospective study. Int J Clin Oncol 2020; 25:2066-2074. [PMID: 32761281 DOI: 10.1007/s10147-020-01757-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Colorectal carcinoma (CRC) is widely treated by chemotherapy based on an intensely neurotoxic drug: oxaliplatin (OXL). We objective to evaluate prospectively the orofacial neurotoxicity during FLOX (fluorouracil + leucovorin + OXL) chemotherapy. METHODS So, 46 patients with CRC were prospectively evaluated during FLOX chemotherapy by 3 cycles (C) of 6 weeks (W) each. We weekly applied the orofacial section of the Acute and Chronic Neuropathy Questionnaire of Common Toxicity Criteria for Adverse Events of the National Cancer Institute of the United States of America (Oxaliplatin-specific neurotoxicity scale). Patients were asked the following concerning the severity (scores 0-5) of orofacial symptoms: jaw pain, eyelids drooping, throat discomfort, ear pain, tingling in mouth, difficulty with speech, burning or discomfort of the eyes, loss of any vision, feeling shock/pain down back and problems breathing. We summed the scores (0-50) and evaluated the clinicopathological data. Friedman/Dunn, Chi square and multinomial regression logistic tests were used (SPSS 20.0, p < 0.05). RESULTS There was a significant increase in sum of orofacial neurotoxicity from baseline to C1.W3, C2.W1 and C3.W5 (p < 0.001) due increase in scores of jaw pain (p < 0.001), eyelids drooping (p = 0.034), throat discomfort (p < 0.001), ear pain (p = 0.034), tingling in mouth (p = 0.015), burning/discomfort of your eyes (p < 0.001), loss of any vision (p < 0.001), feeling shock/pain down back (p < 0.001), problems with breathing (p = 0.045), but not difficulty with speech (p = 0.087). Women (p = 0.021) and young patients (p = 0.027) had significant higher prevalence of orofacial neurotoxicity. CONCLUSIONS FLOX-related orofacial neurotoxicity begins acutely and remains long term with increased incidence in women and younger patients.
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Jensen MA, Yilmaz MN, Pedersen B. Involving patients and nurses in choosing between two validated questionnaires to identify chemotherapy-induced peripheral neuropathy before implementing in clinical practice-A qualitative study. J Clin Nurs 2020; 29:3847-3859. [PMID: 32681531 DOI: 10.1111/jocn.15417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/24/2020] [Accepted: 07/03/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore from a nurse and patient perspective what questionnaire-"Functional assessment of cancer treatment gynecological group neurotoxicity" or "Oxaliplatin-Associated Neuropathy Questionnaire"-best describes chemotherapy-induced peripheral neuropathy and its influence on everyday life in a comprehensive and meaningful way, prior to implementation in daily practice. BACKGROUND Patients experience chemotherapy-induced peripheral neuropathy during and after chemotherapy for colorectal cancer with oxaliplatin. This neuropathy is difficult to describe for patients and to identify for nurses. To address the specific needs of patients and improve identification of neuropathy and its influence on everyday life, we wanted to implement a questionnaire in clinical practice. DESIGN A phenomenological hermeneutic frame of reference was used. METHOD Semi-structured interviews with 15 patients and two focus groups with eight cancer nurses were used for data collection. Data were organised and interpreted by content analytical steps in a hermeneutical process. COREQ checklist was used in reporting of the study. RESULTS The analysis resulted in two main themes (a) "To dig deeper" with sub-themes "to identify the line between acceptable and nonacceptable chemotherapy-induced peripheral neuropathy," and "searching for a precise description." (b). "When everything is interrelated" with sub-themes "to be aware of different perspectives and understandings" and "recognise potential pitfalls." CONCLUSION Involving patients and nurses in choosing between the two questionnaires revealed that neither alone was sufficient to describe the patients' experiences. Instead, it seems essential to implement both questionnaires, using the answers as a basis for a dialogue to address the patients' specific needs. RELEVANCE FOR CLINICAL PRACTICE Using patients and nurses perspectives in a complementary way may provide a solid foundation before starting an implementation process in clinical practice. However, attention must be paid to potential barriers and facilitators as well as the fact that a successful implementing process requires leadership and information sharing.
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Affiliation(s)
- Marlene Ae Jensen
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Mette N Yilmaz
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark.,Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Birgith Pedersen
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark.,Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.,Clinic for Surgery and Oncology, Aalborg University Hospital, Aalborg, Denmark.,Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
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30
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Langeslag M, Kress M. The ceramide-S1P pathway as a druggable target to alleviate peripheral neuropathic pain. Expert Opin Ther Targets 2020; 24:869-884. [PMID: 32589067 DOI: 10.1080/14728222.2020.1787989] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Neuropathic pain disorders are diverse, and the currently available therapies are ineffective in the majority of cases. Therefore, there is a major need for gaining novel mechanistic insights and developing new treatment strategies for neuropathic pain. Areas covered: We performed an in-depth literature search on the molecular mechanisms and systemic importance of the ceramide-to-S1P rheostat regulating neuron function and neuroimmune interactions in the development of neuropathic pain. Expert opinion: The S1P receptor modulator FTY720 (fingolimod, Gilenya®), LPA receptor antagonists and several mechanistically related compounds in clinical development raise great expectations for treating neuropathic pain disorders. Research on S1P receptors, S1P receptor modulators or SPHK inhibitors with distinct selectivity, pharmacokinetics and safety must provide more mechanistic insight into whether they may qualify as useful treatment options for neuropathic pain disorders. The functional relevance of genetic variations within the ceramide-to-S1P rheostat should be explored for an enhanced understanding of neuropathic pain pathogenesis. The ceramide-to-S1P rheostat is emerging as a critically important regulator hub of neuroimmune interactions along the pain pathway, and improved mechanistic insight is required to develop more precise and effective drug treatment options for patients suffering from neuropathic pain disorders.
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Affiliation(s)
- Michiel Langeslag
- Institute of Physiology, DPMP, Medical University Innsbruck , Austria
| | - Michaela Kress
- Institute of Physiology, DPMP, Medical University Innsbruck , Austria
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Bennedsgaard K, Ventzel L, Themistocleous AC, Bennett DL, Jensen AB, Jensen AR, Andersen NT, Jensen TS, Tankisi H, Finnerup NB. Long-term symptoms of polyneuropathy in breast and colorectal cancer patients treated with and without adjuvant chemotherapy. Cancer Med 2020; 9:5114-5123. [PMID: 32469145 PMCID: PMC7367625 DOI: 10.1002/cam4.3129] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/14/2020] [Accepted: 04/22/2020] [Indexed: 01/05/2023] Open
Abstract
Background The aim of this study was to assess chemotherapy‐induced polyneuropathy (CIPN) 5 years after adjuvant chemotherapy in patients with breast and colorectal cancer. The association of CIPN with quality of life, anxiety, and depression was analyzed. Methods Of a set of 100 patients with breast cancer and of 74 with colorectal cancer who had undergone surgery and adjuvant chemotherapy in 2011‐2012, 80 and 52 patients alive, respectively, were included together with two reference groups of 249 breast cancer patients and 83 colorectal cancer patients who had undergone surgery only. All patients were sent a questionnaire on alcohol consumption, smoking habits, comorbidity, medicine consumption, and oxaliplatin‐specific questions, as well as the Michigan Neuropathy Screening Instrument questionnaire (MNSIq), the Douleur Neuropathique 4 Questions (DN4q), the EQ‐5D, and the Hospital Anxiety and Depression Scale. Possible polyneuropathy was defined as the presence of numbness and/or tingling in the feet, secondly as a score of ≥4 on the MNSIq. Possible painful polyneuropathy was defined as pain in both feet and a score ≥3 on the DN4q. Results The prevalence of possible polyneuropathy defined by numbness and/or tingling in the feet was 38.8% (28.1‐50.3) after adjuvant docetaxel and 57.7% (43.2‐71.3) after adjuvant oxaliplatin, with no significant difference from a previous 1‐year follow‐up (P >.35). Fewer had possible polyneuropathy as defined by the MNSIq. Patients with possible polyneuropathy after adjuvant chemotherapy reported significantly lower quality of life than patients treated with surgery only. Conclusion Symptoms of polyneuropathy following adjuvant docetaxel and oxaliplatin persist 5 years after treatment and affect quality of life negatively.
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Affiliation(s)
- Kristine Bennedsgaard
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lise Ventzel
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Andreas C Themistocleous
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK.,Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David L Bennett
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Anders B Jensen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Anni R Jensen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels T Andersen
- Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Troels S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Park SB, Alberti P, Kolb NA, Gewandter JS, Schenone A, Argyriou AA. Overview and critical revision of clinical assessment tools in chemotherapy-induced peripheral neurotoxicity. J Peripher Nerv Syst 2020; 24 Suppl 2:S13-S25. [PMID: 31647154 DOI: 10.1111/jns.12333] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/15/2019] [Indexed: 12/11/2022]
Abstract
Chemotherapy-induced peripheral neurotoxicity (CIPN) is a major toxicity of cancer treatment, leading to dose reduction and premature treatment cessation, potentially affecting patient function, and quality of life. The development of accurate and sensitive assessment tools for CIPN is essential to enable clinical monitoring during treatment, follow-up of long-term outcomes and measurement of toxicity in clinical trials. This review examines CIPN clinical assessment scales incorporating clinician-based, composite, and patient-reported outcomes (PROs), providing a systematic review of their properties and an updated critical analysis of recommendations on current evidence for their use. This systematic review of CIPN assessment tools identified 50 papers containing 41 assessment tools, across 4 categories (common toxicity criteria; composite neurological scale; PROs; pain scale). The majority of these tools were PROs, underscoring the importance of patient-based assessment of symptoms. While there has been considerable work in the field over the past 10 years, this review highlights significant gaps, including a lack of evaluation of responsiveness and problematic neuropathic pain evaluation. There remains a need for consensus on the best available tool and the need to modify existing instruments to improve utility.
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Affiliation(s)
- Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Paola Alberti
- Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Noah A Kolb
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont
| | - Jennifer S Gewandter
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | - Angelo Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genova, Genoa, Italy
| | - Andreas A Argyriou
- Department of Neurology, Saint Andrew's State General Hospital of Patras, Greece
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Chien A, Yang CC, Chang SC, Jan YM, Yang CH, Hsieh YL. Ultrasound Acupuncture for Oxaliplatin-induced Peripheral Neuropathy in Patients With Colorectal Cancer: A Pilot Study. PM R 2020; 13:55-65. [PMID: 32168417 DOI: 10.1002/pmrj.12361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 02/21/2020] [Accepted: 03/03/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Oxaliplatin is frequently used in the treatment of metastatic colorectal cancer. However, peripheral neuropathy is a severe adverse effect of oxaliplatin that may persist and impact quality of life. OBJECTIVE To assess the potential effects of ultrasound acupuncture for the alleviation of symptoms related to oxaliplatin-induced peripheral neuropathy (OIPN) among patients with metastatic colorectal cancer. DESIGN Prospective cohort pilot study. SETTING Education and research hospital. PARTICIPANTS Patients with a diagnosis of stage II-IV colorectal cancer undergoing oxaliplatin-based treatment regimens who experienced OIPN symptoms (n = 17). INTERVENTIONS Pulsed therapeutic ultrasound (1 MHz) at bilateral acupuncture points of PC6, PC7, BL60, and KI1 was administered for 5 minutes per point daily for 12 days. MAIN OUTCOME MEASUREMENTS Pain Quality Assessment Scale (PQAS), Chemotherapy-induced Neurotoxicity Questionnaire (CINQ), quantitative touch-detection threshold, cold-trigger pain withdrawal latency, and quality of life (EORTC QLQ-C30) were measured at baseline (day 0), pre-intervention (day 12, post wash-out period), post-intervention (day 24), and final follow-up (day 54). A P value of less than .05 was considered statistically significant. RESULTS Scores of PQAS and CINQ significantly improved after ultrasound acupuncture at post-intervention and follow-up compared to both baseline and pre-intervention. Similar trends were also observed for the quantitative sensory testing, where touch-detection threshold significantly decreased and cold-trigger pain withdrawal latency significantly increased after ultrasound acupuncture. Patients also showed an improvement on quality of life outcomes as measured by QLQ-C30 post-intervention and at follow-up. CONCLUSIONS Ultrasound acupuncture could be an effective intervention for OIPN symptoms for patients with colorectal cancer. However, larger and randomized clinical trials with placebo controls are needed to confirm such effects.
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Affiliation(s)
- Andy Chien
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
| | | | - Sheng-Chi Chang
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Min Jan
- Center for General Education, China Medical University, Taichung, Taiwan
| | - Ching-Hsiang Yang
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
| | - Yueh-Ling Hsieh
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
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Bennedsgaard K, Ventzel L, Grafe P, Tigerholm J, Themistocleous AC, Bennett DL, Tankisi H, Finnerup NB. Cold aggravates abnormal excitability of motor axons in oxaliplatin-treated patients. Muscle Nerve 2020; 61:796-800. [PMID: 32133655 PMCID: PMC7318596 DOI: 10.1002/mus.26852] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/26/2020] [Accepted: 02/29/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Cold allodynia is often seen in the acute phase of oxaliplatin treatment, but the underlying pathophysiology remains unclear. METHODS Patients scheduled for adjuvant oxaliplatin for colorectal cancer were examined with quantitative sensory testing and nerve excitability tests at baseline and after the second or third oxaliplatin cycle at different skin temperatures. RESULTS Seven patients were eligible for examination. All patients felt evoked pain and tingling when touching something cold after oxaliplatin infusion. Oxaliplatin decreased motor nerve superexcitability (P < .001), increased relative refractory period (P = .011), and caused neuromyotonia-like after-activity. Cooling exacerbated these changes and prolonged the accommodation half-time. DISCUSSION The findings suggest that a combined effect of oxaliplatin and cooling facilitates nerve excitability changes and neuromyotonia-like after-activity in peripheral nerve axons. A possible mechanism is the slowing in gating of voltage-dependent fast sodium and slow potassium channels, which results in symptoms of cold allodynia.
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Affiliation(s)
- Kristine Bennedsgaard
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lise Ventzel
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Peter Grafe
- Institute of Physiology, Ludwig-Maximilians University, Munich, Germany
| | - Jenny Tigerholm
- Center of Neuroplasticity and Pain, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - David L Bennett
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Hatice Tankisi
- Department of Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Hsu HT, Wu LM, Lin PC, Juan CH, Huang YY, Chou PL, Chen JL. Emotional distress and quality of life during folinic acid, fluorouracil, and oxaliplatin in colorectal cancer patients with and without chemotherapy-induced peripheral neuropathy: A cross-sectional study. Medicine (Baltimore) 2020; 99:e19029. [PMID: 32028414 PMCID: PMC7015657 DOI: 10.1097/md.0000000000019029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
When the 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) chemotherapy regimen is used to treat colorectal cancer (CRC), chemotherapy-induced peripheral neuropathy (CIPN) caused by oxaliplatin can substantially affect quality of life (QOL) in the CRC patients. This study compared emotional distress and QOL during FOLFOX in CRC patients with and without CIPN symptoms.This cross-sectional, descriptive, and comparative study recruited 68 CRC patients receiving FOLFOX at a local teaching hospital and at a medical center in southern Taiwan. Self-reported structured questionnaires (oxaliplatin-associated neuropathy questionnaire, profile of mood states short form, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core 30, version 3.0) were used for 1-time data collection. The Chi-square test, Fisher exact test, and Mann-Whitney U test were used to analyze data, and a P-value < .05 was considered statistically significant.The CIPN group had 45 (66.2%) patients, and the non-CIPN group had 23 (33.8%) patients. The 5 most common symptoms were coldness-related burning sensation or discomfort in the upper limbs, numbness in the upper limbs, tingling in the upper limbs, impairment of vision, and discomfort in the throat. The CIPN group had more females (P = .013), a more advanced stage of CRC (P = .04) and a higher chemotherapy dosage (P = .006). The 2 groups did not significantly differ in anxiety (P = .065) or depression (P = .135). Compared to the non-CIPN group, the CIPN group had significantly lower functioning (P = .001) and global health status (P < .001) and significantly more symptoms (P < .001).The CIPN group had significantly lower QOL compared to the non-CIPN group. However, the CIPN group did not have lower emotional distress compared to the non-CIPN group. The results of this study demonstrate the need for in-service courses specifically designed to train health professionals in assessing and managing CIPN symptoms to improve QOL in CRC patients receiving FOLFOX.
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Affiliation(s)
- Hsin-Tien Hsu
- School of Nursing, College of Nursing, Kaohsiung Medical University, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
| | - Li-Min Wu
- School of Nursing, College of Nursing, Kaohsiung Medical University, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
| | - Pei-Chao Lin
- School of Nursing, College of Nursing, Kaohsiung Medical University, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
| | - Chiung-Hui Juan
- Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
| | - Yu-Yen Huang
- School of Nursing, College of Nursing, Kaohsiung Medical University, Taiwan
| | - Pi-Ling Chou
- School of Nursing, College of Nursing, Kaohsiung Medical University, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
| | - Jyu-Lin Chen
- Department of Family Health Care Nursing, University of California San Francisco, CA
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Analgesic and antiallodynic activity of novel anticonvulsant agents derived from 3-benzhydryl-pyrrolidine-2,5-dione in mouse models of nociceptive and neuropathic pain. Eur J Pharmacol 2020; 869:172890. [DOI: 10.1016/j.ejphar.2019.172890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/18/2019] [Accepted: 12/19/2019] [Indexed: 12/21/2022]
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Drott J, Fomichov V, Börjeson S, Berterö C. Sense of coherence and health‐related quality of life in patients with neurotoxicity after cancer chemotherapy: Assessment from a real‐time mobile phone–based system. Psychooncology 2019; 29:107-113. [DOI: 10.1002/pon.5243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/16/2019] [Accepted: 09/19/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Jenny Drott
- Department of SurgeryLinköping University Linköping Sweden
- Division of Nursing Science, Department of Medical and Health SciencesLinköping University Linköping Sweden
| | - Victoria Fomichov
- Centre for Organisational Support and Development County Council of ÖstergötlandLinköping University Linköping Sweden
| | - Sussanne Börjeson
- Department of OncologyLinköping University Linköping Sweden
- Division of Nursing Science, Department of Medical and Health SciencesLinköping University Linköping Sweden
| | - Carina Berterö
- Division of Nursing Science, Department of Medical and Health SciencesLinköping University Linköping Sweden
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Kerckhove N, Busserolles J, Stanbury T, Pereira B, Plence V, Bonnetain F, Krakowski I, Eschalier A, Pezet D, Balayssac D. Effectiveness assessment of riluzole in the prevention of oxaliplatin-induced peripheral neuropathy: RILUZOX-01: protocol of a randomised, parallel, controlled, double-blind and multicentre study by the UNICANCER-AFSOS Supportive Care intergroup. BMJ Open 2019; 9:e027770. [PMID: 31182448 PMCID: PMC6561607 DOI: 10.1136/bmjopen-2018-027770] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Most patients (>70%) experience acute neuropathic symptoms shortly after oxaliplatin infusions. These symptoms are not always resolved between infusions. Overall, 30%-50% of patients suffer from chronic oxaliplatin-induced peripheral neuropathy (OIPN). This cumulative and dose-dependent sensory neuropathy limits compliance or results in oxaliplatin-based chemotherapies to be substituted with less neurotoxic agents. These treatment changes impair clinical outcomes, and may be associated with comorbidities, such as distress, depression and anxiety. Currently, no drug used to prevent or treat OIPN is sufficiently effective to be used routinely in clinical practice. There is, thus, an unmet therapeutic need to reduce the intensity of and/or prevent OIPN. We hypothesised that riluzole would be an excellent candidate to address this public health issue. Riluzole is approved for treating amyotrophic lateral sclerosis. In animals, there is a beneficial effect on sensorimotor and pain disorders, as well as related comorbidities, after repeated administration of oxaliplatin. In humans, riluzole has shown neuroprotective, anxiolytic and antidepressive effects. METHODS AND ANALYSIS RILUZOX-01 trial was designed as a randomised, controlled, double-blind study to evaluate the efficacy of riluzole to prevent OIPN. Patients with colorectal cancer and initiating adjuvant oxaliplatin-based chemotherapy are eligible. Patients (n=210) will be randomly assigned to either riluzole or placebo, concomitantly with chemotherapy. The primary endpoint is the change in OIPN intensity, assessed by the sensory scale of the QLQ-CIPN20, after six 2-week cycles of chemotherapy. Secondary endpoints include incidence and severity of neuropathy, grade of sensory neuropathy, intensity and features of neuropathic pain, health-related quality of life, disease-free survival, overall survival and safety. ETHICS AND DESSIMINATION The study was approved by a French ethics committee (ref:39/18_1, 'Comité de Protection des Personnes' Ouest-IV, France) and plans to start enroling patients in September 2019. The trial is registered in EudraCT and clinicaltrials.gov. TRIAL REGISTRATION NUMBER N°2017-002320-25; NCT03722680.
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Affiliation(s)
- Nicolas Kerckhove
- Medical pharmacology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
- Institut Analgesia, Faculty of medicine, Clermont-Ferrand, France
- INSERM 1107, NEURO-DOL Basic and Clinical Pharmacology of Pain, University Clermont Auvergne, Clermont-Ferrand, France
| | - Jérome Busserolles
- INSERM 1107, NEURO-DOL Basic and Clinical Pharmacology of Pain, University Clermont Auvergne, Clermont-Ferrand, France
| | | | - Bruno Pereira
- DRCI, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | | | - Alain Eschalier
- Institut Analgesia, Faculty of medicine, Clermont-Ferrand, France
- INSERM 1107, NEURO-DOL Basic and Clinical Pharmacology of Pain, University Clermont Auvergne, Clermont-Ferrand, France
| | - Denis Pezet
- INSERM 1107, NEURO-DOL Basic and Clinical Pharmacology of Pain, University Clermont Auvergne, Clermont-Ferrand, France
- University Hospital of Clermont-Ferrand, Digestive and hepatobiliary surgery, Clermont-Ferrand, France
| | - David Balayssac
- INSERM 1107, NEURO-DOL Basic and Clinical Pharmacology of Pain, University Clermont Auvergne, Clermont-Ferrand, France
- DRCI, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
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Kanzawa-Lee GA, Knoerl R, Donohoe C, Bridges CM, Smith EML. Mechanisms, Predictors, and Challenges in Assessing and Managing Painful Chemotherapy-Induced Peripheral Neuropathy. Semin Oncol Nurs 2019; 35:253-260. [PMID: 31053396 DOI: 10.1016/j.soncn.2019.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To describe the known predictors and pathophysiological mechanisms of chronic painful chemotherapy-induced peripheral neuropathy (CIPN) in cancer survivors and the challenges in assessing and managing it. DATA SOURCES PubMed/Medline, CINAHL, Scopus, and PsycINFO. CONCLUSION The research on chronic painful CIPN is limited. Additional research is needed to identify the predictors and pathophysiological mechanisms of chronic painful CIPN to inform the development of assessment tools and management options for this painful and possibly debilitating condition. IMPLICATIONS FOR NURSING PRACTICE Recognition of the predictors of chronic painful CIPN and proactive CIPN assessment and palliative management are important steps in reducing its impact on physical function and quality of life.
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Affiliation(s)
| | - Robert Knoerl
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | - Clare Donohoe
- School of Nursing, University of Michigan, Ann Arbor, MI
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Mechanisms of Chemotherapy-Induced Peripheral Neuropathy. Int J Mol Sci 2019; 20:ijms20061451. [PMID: 30909387 PMCID: PMC6471666 DOI: 10.3390/ijms20061451] [Citation(s) in RCA: 385] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/16/2019] [Accepted: 03/19/2019] [Indexed: 12/18/2022] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most frequent side effects caused by antineoplastic agents, with a prevalence from 19% to over 85%. Clinically, CIPN is a mostly sensory neuropathy that may be accompanied by motor and autonomic changes of varying intensity and duration. Due to its high prevalence among cancer patients, CIPN constitutes a major problem for both cancer patients and survivors as well as for their health care providers, especially because, at the moment, there is no single effective method of preventing CIPN; moreover, the possibilities of treating this syndrome are very limited. There are six main substance groups that cause damage to peripheral sensory, motor and autonomic neurons, which result in the development of CIPN: platinum-based antineoplastic agents, vinca alkaloids, epothilones (ixabepilone), taxanes, proteasome inhibitors (bortezomib) and immunomodulatory drugs (thalidomide). Among them, the most neurotoxic are platinum-based agents, taxanes, ixabepilone and thalidomide; other less neurotoxic but also commonly used drugs are bortezomib and vinca alkaloids. This paper reviews the clinical picture of CIPN and the neurotoxicity mechanisms of the most common antineoplastic agents. A better understanding of the risk factors and underlying mechanisms of CIPN is needed to develop effective preventive and therapeutic strategies.
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Zangui M, Atkin SL, Majeed M, Sahebkar A. Current evidence and future perspectives for curcumin and its analogues as promising adjuncts to oxaliplatin: state-of-the-art. Pharmacol Res 2019; 141:343-356. [DOI: 10.1016/j.phrs.2019.01.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 02/06/2023]
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Sheehan K, Lee J, Chong J, Zavala K, Sharma M, Philipsen S, Maruyama T, Xu Z, Guan Z, Eilers H, Kawamata T, Schumacher M. Transcription factor Sp4 is required for hyperalgesic state persistence. PLoS One 2019; 14:e0211349. [PMID: 30811405 PMCID: PMC6392229 DOI: 10.1371/journal.pone.0211349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/11/2019] [Indexed: 12/14/2022] Open
Abstract
Understanding how painful hypersensitive states develop and persist beyond the initial hours to days is critically important in the effort to devise strategies to prevent and/or reverse chronic painful states. Changes in nociceptor transcription can alter the abundance of nociceptive signaling elements, resulting in longer-term change in nociceptor phenotype. As a result, sensitized nociceptive signaling can be further amplified and nocifensive behaviors sustained for weeks to months. Building on our previous finding that transcription factor Sp4 positively regulates the expression of the pain transducing channel TRPV1 in Dorsal Root Ganglion (DRG) neurons, we sought to determine if Sp4 serves a broader role in the development and persistence of hypersensitive states in mice. We observed that more than 90% of Sp4 staining DRG neurons were small to medium sized, primarily unmyelinated (NF200 neg) and the majority co-expressed nociceptor markers TRPV1 and/or isolectin B4 (IB4). Genetically modified mice (Sp4+/-) with a 50% reduction of Sp4 showed a reduction in DRG TRPV1 mRNA and neuronal responses to the TRPV1 agonist-capsaicin. Importantly, Sp4+/- mice failed to develop persistent inflammatory thermal hyperalgesia, showing a reversal to control values after 6 hours. Despite a reversal of inflammatory thermal hyperalgesia, there was no difference in CFA-induced hindpaw swelling between CFA Sp4+/- and CFA wild type mice. Similarly, Sp4+/- mice failed to develop persistent mechanical hypersensitivity to hind-paw injection of NGF. Although Sp4+/- mice developed hypersensitivity to traumatic nerve injury, Sp4+/- mice failed to develop persistent cold or mechanical hypersensitivity to the platinum-based chemotherapeutic agent oxaliplatin, a non-traumatic model of neuropathic pain. Overall, Sp4+/- mice displayed a remarkable ability to reverse the development of multiple models of persistent inflammatory and neuropathic hypersensitivity. This suggests that Sp4 functions as a critical control point for a network of genes that conspire in the persistence of painful hypersensitive states.
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Affiliation(s)
- Kayla Sheehan
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, United States of America
| | - Jessica Lee
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, United States of America
| | - Jillian Chong
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, United States of America
| | - Kathryn Zavala
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, United States of America
| | - Manohar Sharma
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, United States of America
| | - Sjaak Philipsen
- Department of Cell Biology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tomoyuki Maruyama
- Department of Anesthesiology, Wakayama Medical University, Wakayama, Japan
| | - Zheyun Xu
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, United States of America
| | - Zhonghui Guan
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, United States of America
| | - Helge Eilers
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, United States of America
| | - Tomoyuki Kawamata
- Department of Anesthesiology, Wakayama Medical University, Wakayama, Japan
| | - Mark Schumacher
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail:
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Heuvel SASVD, Doorduin J, Steegers MAH, Bronkhorst EM, Radema SA, Vissers KCP, Wal SEIVD, Alfen NV. Simple surface EMG recording as a noninvasive screening method for the detection of acute oxaliplatin-induced neurotoxicity: a feasibility pilot study. Neurosci Lett 2019; 699:184-188. [PMID: 30753911 DOI: 10.1016/j.neulet.2019.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/30/2019] [Accepted: 02/08/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Oxaliplatin-induced neurotoxicity can be a dose-limiting side effect to effective chemotherapy. Acute hyperexcitability causes cold-evoked sensory and motor symptoms, which resemble neuromyotonia. An accessible and non-invasive technique for early detection could help select patients for potential treatments. We assessed the use of a simple surface electromyography (sEMG) in patients directly after oxaliplatin infusion. METHODS In patients with colorectal cancer, acute neurotoxicity was evaluated by means of a physical examination, a questionnaire, and sEMG directly after the second and fourth cycle of oxaliplatin. Questionnaires were also assessed 1 day after infusion. RESULTS 14 patients were measured after the second cycle and 8 patients were also measured after the fourth cycle of oxaliplatin. All patients reported to a variable degree oxaliplatin induced neurotoxicity symptoms: sensitivity to touching cold or swallowing cold items were reported as most severe. Clinical signs of hyperexcitability were observed in 55% of the measurements. Spontaneous activity compatible with neuromyotonia was observed in 82% of the sEMG recordings. CONCLUSIONS Patient reported symptoms, physical examination and simple sEMG are complementary measurements to detect acute oxaliplatin induced neurotoxicity. After further validation, sEMG recording can be used as a simple objective screenings tool to detect nerve hyperexcitability directly after oxaliplatin administration.
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Affiliation(s)
- Sandra A S van den Heuvel
- Expertise center for Pain and Palliative Medicine, Department of Anesthesiology and Pain Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jonne Doorduin
- Donders Institute for Brain Cognition and Behavior, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique A H Steegers
- Expertise center for Pain and Palliative Medicine, Department of Anesthesiology and Pain Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewald M Bronkhorst
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sandra A Radema
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kris C P Vissers
- Expertise center for Pain and Palliative Medicine, Department of Anesthesiology and Pain Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Selina E I van der Wal
- Expertise center for Pain and Palliative Medicine, Department of Anesthesiology and Pain Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nens van Alfen
- Donders Institute for Brain Cognition and Behavior, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
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Fujita S, Hirota T, Sakiyama R, Baba M, Ieiri I. Identification of drug transporters contributing to oxaliplatin-induced peripheral neuropathy. J Neurochem 2018; 148:373-385. [PMID: 30295925 DOI: 10.1111/jnc.14607] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/19/2018] [Accepted: 10/01/2018] [Indexed: 12/23/2022]
Abstract
Oxaliplatin is widely used as a key drug in the treatment of colorectal cancer. However, its administration is associated with the dose-limiting adverse effect, peripheral neuropathy. Platinum accumulation in the dorsal root ganglion (DRG) is the major mechanism responsible for oxaliplatin-induced neuropathy. Some drug transporters have been identified as platinum complex transporters in kidney or tumor cells, but not yet in DRG. In the present study, we investigated oxaliplatin transporters and their contribution to peripheral neuropathy. We identified 12 platinum transporters expressed in DRG with real-time PCR, and their transiently overexpressing cells were established. After exposure to oxaliplatin, the accumulation of platinum in these overexpressing cells was evaluated using a coupled plasma mass spectrometer. Octn1/2- and Mate1-expressing cells showed the intracellular accumulation of oxaliplatin. In an animal study, peripheral neuropathy developed after the administration of oxaliplatin (4 mg/kg, intravenously, twice a week) to siRNA-injected rats (0.5 nmol, intrathecally, once a week) was demonstrated with the von Frey test. The knockdown of Octn1 in DRG ameliorated peripheral neuropathy, and decreased platinum accumulation in DRG, whereas the knockdown of Octn2 did not. Mate1 siRNA-injected rats developed more severe neuropathy than control rats. These results indicate that Octn1 and Mate1 are involved in platinum accumulation at DRG and oxaliplatin-induced peripheral neuropathy.
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Affiliation(s)
- Shunsuke Fujita
- Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Hirota
- Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryo Sakiyama
- Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Misaki Baba
- Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Ichiro Ieiri
- Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
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Gewandter JS, Brell J, Cavaletti G, Dougherty PM, Evans S, Howie L, McDermott MP, O'Mara A, Smith AG, Dastros-Pitei D, Gauthier LR, Haroutounian S, Jarpe M, Katz NP, Loprinzi C, Richardson P, Lavoie-Smith EM, Wen PY, Turk DC, Dworkin RH, Freeman R. Trial designs for chemotherapy-induced peripheral neuropathy prevention: ACTTION recommendations. Neurology 2018; 91:403-413. [PMID: 30054438 DOI: 10.1212/wnl.0000000000006083] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/24/2018] [Indexed: 12/26/2022] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common and potentially dose-limiting side effect of neurotoxic chemotherapies. No therapies are available to prevent CIPN. The small number of positive randomized clinical trials (RCTs) evaluating preventive therapies for CIPN provide little guidance to inform the design of future trials. Moreover, the lack of consensus regarding major design features in this area poses challenges to development of new therapies. An Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities and Networks (ACTTION)-Consortium on Clinical Endpoints and Procedures for Peripheral Neuropathy Trials (CONCEPPT) meeting attended by neurologists, oncologists, pharmacists, clinical trialists, statisticians, and regulatory experts was convened to discuss design considerations and provide recommendations for CIPN prevention trials. This article outlines considerations related to design of RCTs that evaluate preventive therapies for CIPN including (1) selection of eligibility criteria (e.g., cancer types, chemotherapy types, inclusion of preexisting neuropathy); (2) selection of outcome measures and endpoints, including those that incorporate alterations in chemotherapy dosing, which may affect the rate of CIPN development and its severity; (3) potential effects of the investigational therapy on the efficacy of chemotherapy; and (4) sample size estimation. Our hope is that attention to the design considerations and recommendations outlined in this article will improve the quality and assay sensitivity of CIPN prevention trials and thereby accelerate the identification of efficacious therapies.
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Affiliation(s)
- Jennifer S Gewandter
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle.
| | - Joanna Brell
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Guido Cavaletti
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Patrick M Dougherty
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Scott Evans
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Lynn Howie
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Michael P McDermott
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Ann O'Mara
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - A Gordon Smith
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Daniela Dastros-Pitei
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Lynn R Gauthier
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Simon Haroutounian
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Matthew Jarpe
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Nathaniel P Katz
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Charles Loprinzi
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Paul Richardson
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Ellen M Lavoie-Smith
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Patrick Y Wen
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Dennis C Turk
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Robert H Dworkin
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Roy Freeman
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
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Maguire R, Kotronoulas G, Donnan PT, Paterson C, McCann L, Connaghan J, Di Domenico DGG, Kearney N. Development and preliminary testing of a brief clinical tool to enable daily monitoring of chemotherapy toxicity: The Daily Chemotherapy Toxicity self-Assessment Questionnaire. Eur J Cancer Care (Engl) 2018; 27:e12890. [PMID: 29993150 DOI: 10.1111/ecc.12890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 05/31/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022]
Abstract
Close monitoring of chemotherapy toxicity can be instrumental in ensuring prompt symptom management and quality care. Our aim was to develop a brief clinical tool to enable daily assessment of chemotherapy toxicity and investigate/establish its content validity, feasibility/applicability, internal consistency and stability. Development of the Daily Chemotherapy Toxicity self-Assessment Questionnaire (DCTAQ) was based on an initial item pool created from two scoping reviews. Expert panel review (n = 15) and cognitive debriefing with patients with cancer (n = 7) were used to establish content validity. Feasibility/acceptability, applicability (self-report vs. interview-like administration), internal consistency (KR-20) and test-retest reliability (at 1-hr intervals) of the DCTAQ were field-tested with 82 patients with breast or colorectal cancer receiving active chemotherapy at eight hospitals. Initial development/content validity stages enabled item revisions and re-wording that led to a final, 11-item DCTAQ version with 10 core symptom items plus one open-ended "any other symptom" item. Feasibility and acceptability were demonstrated through the absence of participant withdrawals, absence of missing data and no complaints about tool length. The DCTAQ was found to have modest internal consistency (KR-20 = 0.56), but very good test-retest reliability. The DCTAQ is a brief clinical tool that allows for rapid and accurate daily assessments of chemotherapy toxicity in clinical practice.
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Affiliation(s)
- Roma Maguire
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | | | - Peter T Donnan
- Population Health Sciences, Medical Research Institute, University of Dundee, Dundee, UK
| | | | - Lisa McCann
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - John Connaghan
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - David G G Di Domenico
- School of Health, Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Edinburgh, UK
| | - Nora Kearney
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Gaps in Understanding Mechanism and Lack of Treatments: Potential Use of a Nonhuman Primate Model of Oxaliplatin-Induced Neuropathic Pain. Pain Res Manag 2018; 2018:1630709. [PMID: 29854035 PMCID: PMC5954874 DOI: 10.1155/2018/1630709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/03/2018] [Indexed: 12/11/2022]
Abstract
The antineoplastic agent oxaliplatin induces an acute hypersensitivity evoked by cold that has been suggested to be due to sensitized central and peripheral neurons. Rodent-based preclinical studies have suggested numerous treatments for the alleviation of oxaliplatin-induced neuropathic pain, but few have demonstrated robust clinical efficacy. One issue is that current understanding of the pathophysiology of oxaliplatin-induced neuropathic pain is primarily based on rodent models, which might not entirely recapitulate the clinical pathophysiology. In addition, there is currently no objective physiological marker for pain that could be utilized to objectively indicate treatment efficacy. Nonhuman primates are phylogenetically and neuroanatomically similar to humans; thus, disease mechanism in nonhuman primates could reflect that of clinical oxaliplatin-induced neuropathy. Cold-activated pain-related brain areas in oxaliplatin-treated macaques were attenuated with duloxetine, the only drug that has demonstrated clinical efficacy for chemotherapy-induced neuropathic pain. By contrast, drugs that have not demonstrated clinical efficacy in oxaliplatin-induced neuropathic pain did not reduce brain activation. Thus, a nonhuman primate model could greatly enhance understanding of clinical pathophysiology beyond what has been obtained with rodent models and, furthermore, brain activation could serve as an objective marker of pain and therapeutic efficacy.
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Glimelius B, Manojlovic N, Pfeiffer P, Mosidze B, Kurteva G, Karlberg M, Mahalingam D, Buhl Jensen P, Kowalski J, Bengtson M, Nittve M, Näsström J. Persistent prevention of oxaliplatin-induced peripheral neuropathy using calmangafodipir (PledOx ®): a placebo-controlled randomised phase II study (PLIANT). Acta Oncol 2018; 57:393-402. [PMID: 29140155 DOI: 10.1080/0284186x.2017.1398836] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Oxaliplatin causes disabling acute and chronic peripheral neuropathy. We explored the preventive effects of calmangafodipir, mimicking the mitochondrial enzyme manganese superoxide dismutase, thereby protecting cells from oxidative stress, in a placebo-controlled, double-blinded randomised phase II study (ClinicalTrials.gov.NCT01619423) in patients with metastatic colorectal cancer (mCRC). PATIENT AND METHODS mCRC patients treated with modified FOLFOX-6 (folinic acid 200 mg/m2, 5-fluorouracil bolus 400 mg/m2, oxaliplatin 85 mg/m2 and 5-fluorouracil 2400 mg/m2 continuous infusion for 46 h) every fortnight for 8 cycles in first or second line were eligible. Calmangafodipir was given in a phase I dose-finding and in a phase II placebo-controlled study, as a 5-min infusion 10 min prior to oxaliplatin. Neurotoxicity was evaluated by the physician using the Oxaliplatin Sanofi Specific Scale and by the patient using the cold allodynia test and the Leonard scale. RESULTS Eleven patients were included in phase I without any detectable toxicity to calmangafodipir. In the phase II study, 173 patients were randomised to placebo (n = 60), calmangafodipir 2 µmol/kg (n = 57) and calmangafodipir 5 µmol/kg (n = 45, initially 10 µmol/kg, n = 11). Calmangafodipir-treated patients (all three doses pooled) had less physician graded neurotoxicity (odds ratio (90% confidence interval one-sided upper level) 0.62(1.15), p = .16), significantly less problems with cold allodynia (mean 1.6 versus 2.3, p < .05) and significantly fewer sensory symptoms in the Leonard scale (cycle 1-8 mean 1.9 versus 3.0, p < .05 and during follow-up after 3 and 6 months, mean 3.5 versus 7.3, p < .01). Response rate, progression-free and overall survival did not differ among groups. CONCLUSIONS Calmangafodipir at a dose of 5 µmol/kg appears to prevent the development of oxaliplatin-induced acute and delayed CIPN without apparent influence on tumour outcomes.
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Affiliation(s)
- Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Nebojsa Manojlovic
- Clinic for Gastroenterology and Hepatology of Military Medical Academy of Serbia, Belgrade, Serbia
| | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Baadur Mosidze
- LTD High Technology Medical Center, University Clinic, Tbilisi, Georgia
| | | | - Mia Karlberg
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Devalingam Mahalingam
- Cancer Therapy and Research Center, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
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Park SB, Kiernan MC. Oxaliplatin and neuropathy: A role for sodium channels. Clin Neurophysiol 2018; 129:670-671. [DOI: 10.1016/j.clinph.2017.12.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 12/19/2017] [Indexed: 11/25/2022]
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Forstenpointner J, Oberlojer VC, Naleschinski D, Höper J, Helfert SM, Binder A, Gierthmühlen J, Baron R. A-Fibers Mediate Cold Hyperalgesia in Patients with Oxaliplatin-Induced Neuropathy. Pain Pract 2018; 18:758-767. [DOI: 10.1111/papr.12670] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/23/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Julia Forstenpointner
- Division of Neurological Pain Research and Therapy; Department of Neurology; University Hospital Schleswig-Holstein; Kiel Germany
| | - Violetta C. Oberlojer
- Division of Neurological Pain Research and Therapy; Department of Neurology; University Hospital Schleswig-Holstein; Kiel Germany
| | - Dennis Naleschinski
- Division of Neurological Pain Research and Therapy; Department of Neurology; University Hospital Schleswig-Holstein; Kiel Germany
| | - Johanna Höper
- Division of Neurological Pain Research and Therapy; Department of Neurology; University Hospital Schleswig-Holstein; Kiel Germany
| | - Stephanie M. Helfert
- Division of Neurological Pain Research and Therapy; Department of Neurology; University Hospital Schleswig-Holstein; Kiel Germany
| | - Andreas Binder
- Division of Neurological Pain Research and Therapy; Department of Neurology; University Hospital Schleswig-Holstein; Kiel Germany
| | - Janne Gierthmühlen
- Division of Neurological Pain Research and Therapy; Department of Neurology; University Hospital Schleswig-Holstein; Kiel Germany
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy; Department of Neurology; University Hospital Schleswig-Holstein; Kiel Germany
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