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Ross TL, Na R, Au-Yeung G, DeFazio A, Friedlander M, Sivakumaran T, Livingstone K, Nagle CM, O'Neill H, Williams M, Webb PM, Beesley VL. Are exercise and sitting time during chemotherapy for ovarian cancer associated with treatment-related side-effects, chemotherapy completion and survival? Gynecol Oncol 2024; 190:53-61. [PMID: 39146755 DOI: 10.1016/j.ygyno.2024.07.684] [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: 02/04/2024] [Revised: 07/22/2024] [Accepted: 07/30/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE To evaluate if exercise and sitting time during chemotherapy were associated with chemotherapy side-effects, completion of planned chemotherapy and survival. METHODS We used data from the Ovarian cancer Prognosis And Lifestyle (OPAL) Study, a national prospective cohort of adults with newly-diagnosed epithelial ovarian cancer. At 3-monthly questionnaires we asked about exercise and sitting time in the past week, and treatment-related side-effects. Details about treatment, toxicities, progression and death were abstracted from medical records. We used linear, logistic and Cox regression, respectively, to assess associations between both exercise and sitting time, and chemotherapy side-effects and completion (≥85% relative dose intensity) and survival. RESULTS 503 eligible participants were included in one or more analyses. Patients participating in higher-intensity exercise (≥30 min of moderate-vigorous exercise/week; 24%) reported significantly better Functional Assessment of Chronic Illness/Cancer Therapy (FACIT)-Fatigue (32.2 vs. 26.7) and FACT-Trial Outcome Index (69.4 vs. 61.7) scores, and were less likely to have clinician-reported moderate-severe neurotoxicity (odds ratio [OR]:0.50; 95% confidence interval [95%CI]:0.29-0.88), than minimal exercisers (<30 min moderate-vigorous exercise/week & <120 min walking/week; 52%). Participating in higher-intensity exercise was also possibly associated with greater chemotherapy completion (OR:1.70; 95%CI:0.90-3.20), particularly for paclitaxel. Sitting time was not associated with chemotherapy completion. For patients with advanced disease who underwent cytoreduction and received first-line carboplatin and paclitaxel, there was a suggestion higher-intensity exercise during chemotherapy may improve survival (HR:0.68; 95%CI:0.47-1.01). CONCLUSIONS Patients with ovarian cancer who carry out moderate-vigorous exercise during chemotherapy have fewer side-effects and potentially better completion of planned chemotherapy and overall survival.
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Affiliation(s)
- Tanya L Ross
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Renhua Na
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | - George Au-Yeung
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3010, Australia
| | - Anna DeFazio
- The Westmead Institute for Medical Research, Sydney, Australia; Department of Gynaecological Oncology, Westmead Hospital, Sydney, Australia; The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Michael Friedlander
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | - Tharani Sivakumaran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3010, Australia
| | | | - Christina M Nagle
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | | | | | - Penelope M Webb
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | - Vanessa L Beesley
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia; School of Nursing, Queensland University of Technology, Brisbane, Australia
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Lin D, Sturgeon KM, Muscat JE, Zhou S, Hobkirk AL, O'Brien KM, Sandler DP, Thompson CL. Associations of pre-diagnosis physical activity with treatment tolerance and treatment efficacy in breast cancer patients with neoadjuvant chemotherapy. Breast Cancer 2024; 31:519-528. [PMID: 38564089 PMCID: PMC11273821 DOI: 10.1007/s12282-024-01569-3] [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: 01/11/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Higher pre-diagnosis physical activity (PA) is associated with lower all-cause mortality in breast cancer (BCa) patients. However, the association with pathological complete response (pCR) is unclear. We investigated the association between pre-diagnosis PA level and chemotherapy completion, dose delay, and pCR in BCa patients receiving neoadjuvant chemotherapy (NACT). METHODS 180 stage I-III BCa patients receiving NACT (mean [SD] age of diagnosis: 60.8 [8.8] years) in the Sister Study were included. Self-reported recreational and total PA levels were converted to metabolic equivalent of task-hours per week (MET-hrs/wk). The pCR was defined as no invasive or in situ residual in breast or lymph node (ypT0 ypN0). Multivariable logistic regression analyses estimated odds ratios (ORs) and 95% confidence intervals (CIs) for treatment outcomes. RESULTS In this sample, 45 (25.0%) BCa patients achieved pCR. Higher pre-diagnosis recreational PA was not associated with lower likelihood of chemotherapy completion (highest vs. lowest tertile: OR = 0.87, 95% CI = 0.30-2.56; Ptrend = 0.84), greater dose delay (OR = 1.45, 95% CI = 0.54-3.92; Ptrend = 0.46), or greater odds of pCR (OR = 1.28, 95% CI = 0.49-3.34; Ptrend = 0.44). Associations were similar for pre-diagnosis total PA. Meeting the recommended level of recreational PA was not associated with pCR overall (≥ 7.5 vs. < 7.5 MET-hrs/wk: OR = 1.33, 95% CI = 0.59-3.01). CONCLUSIONS Although small sample size and limited information on exercise closer to time of diagnosis limit interpretation, pre-diagnosis PA was not convincingly associated with treatment tolerance or treatment efficacy in BCa patients receiving NACT. Future investigations are needed to better understand the impact of pre-diagnosis PA on BCa treatment.
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Affiliation(s)
- Dan Lin
- Division of Epidemiology, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, 17033, USA
| | - Kathleen M Sturgeon
- Division of Epidemiology, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, 17033, USA
| | - Joshua E Muscat
- Division of Epidemiology, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, 17033, USA
| | - Shouhao Zhou
- Division of Epidemiology, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, 17033, USA
| | - Andrea L Hobkirk
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, PA, 17033, USA
| | - Katie M O'Brien
- Epidemiology Branch, Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, NC, 27709, USA
| | - Dale P Sandler
- Epidemiology Branch, Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, NC, 27709, USA
| | - Cheryl L Thompson
- Division of Epidemiology, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, 17033, USA.
- Penn State Cancer Institute, 500 University Drive, Hershey, PA, 17033, USA.
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Hatsy S, Brambs C, Kiechle M. Incidence and predictors for chemotherapy modifications and their impact on the outcome of ovarian cancer patients. Arch Gynecol Obstet 2023; 307:1891-1899. [PMID: 36326848 PMCID: PMC10147744 DOI: 10.1007/s00404-022-06813-9] [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: 06/12/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Chemotherapy (CTX) is an important part of the treatment strategy of stage II-IV ovarian cancer. CTX modifications, such as delays, dose reductions or premature terminations might have a negative impact on overall survival (OS) and progression free survival (PFS). The goal of this study was to determine the incidence and predictors of CTX modifications and their influence on survival. METHODS An observational retrospective cohort analysis of 192 ovarian cancer patients who were treated at the Department of Obstetrics and Gynaecology, Technical University Munich, Germany, according to international guidelines was performed including from 2009 to 2013. A potential association between patient and disease characteristics and CTX modifications was tested with multivariate logistic regression. OS and PFS were estimated by Kaplan-Meier analysis. RESULTS 44.8% (86/192) received a modification of CTX. 34 (17.7%) women discontinued CTX prematurely, 17 (8.9%) underwent a dose reduction, 16 (8.3%) experienced a CTX delay and 10 (5.2%) had both a delay and a dose modification. In nine (4.7%) patients, the dose needed to be divided. Leukopenia (p < 0.001) and anaemia (p = 0.003) were significantly more common in patients with CTX modifications. Significant predictors for CTX modifications were a history of thrombosis or embolism (p < 0.001) and residual tumour postoperatively (p = 0.003). Patients with CTX modifications showed a significantly lower OS as well as PFS (p < 0.001), even after adjustment for prognostic factors such as age, body-mass-index, residual tumour, histology, FIGO stage and grading (p = 0.005 for OS and p = 0.001 for PFS). CONCLUSION CTX modifications have a negative impact on survival. Significant predictors for such modifications are a history of thrombosis or embolism and the presence of residual postoperative tumour. Further studies are needed to avoid CTX modifications and to improve survival of ovarian cancer patients.
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Affiliation(s)
- Sandra Hatsy
- Department of Obstetrics and Gynaecology, Technical University Munich, Munich, Germany.
| | - Christine Brambs
- Department of Obstetrics and Gynaecology, Technical University Munich, Munich, Germany
| | - Marion Kiechle
- Department of Obstetrics and Gynaecology, Technical University Munich, Munich, Germany
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Martin AL, Colin-Leitzinger CM, Sinha SK, Chern JY, Peres LC. Impact of obesity on chemotherapy dosing of carboplatin and survival of women with ovarian cancer. Br J Cancer 2023; 128:2236-2242. [PMID: 37024666 PMCID: PMC10241930 DOI: 10.1038/s41416-023-02259-1] [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: 11/07/2022] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND The study objective is to examine the impact of obesity on frontline carboplatin dosing in the neoadjuvant and adjuvant settings and to evaluate the association of dosing with survival among epithelial ovarian cancer (EOC) patients. METHODS We selected 1527 women diagnosed with EOC from January 1, 2011 to October 20, 2021 from a nationwide electronic health record-derived de-identified database. The dose reduction of frontline carboplatin was defined as a relative dose intensity (RDI) < 0.85. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of RDI with survival overall and by histology. RESULTS Women with a BMI ≥ 30 kg/m2 versus <30 kg/m2 were more likely to be underdosed (RDI < 0.85) with frontline carboplatin. Underdosing of carboplatin in the neoadjuvant setting was associated with worse survival among women with serous tumours (HR = 1.98, 95% CI = 1.15, 3.42). Underdosing of carboplatin in the adjuvant setting was not associated with survival. DISCUSSION In the real-world setting, underdosing of carboplatin in the neoadjuvant setting was associated with inferior survival among women with serous tumours. With the increasing utilisation of neoadjuvant chemotherapy in EOC, actual weight-based dosing of carboplatin may be important to improve outcomes in this patient population.
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Affiliation(s)
- Alexandra L Martin
- H. Lee Moffitt Cancer Center and Research Institute, Department of Gynecologic Oncology, 12902 Magnolia Dr, Tampa, FL, 33612, USA
- University of Tennessee Health Sciences Center, Department of Gynecologic Oncology, 920 Madison Ave, Memphis, TN, 38163, USA
| | - Christelle M Colin-Leitzinger
- H. Lee Moffitt Cancer Center and Research Institute, Department of Cancer Epidemiology, 13131 Magnolia Dr, Tampa, FL, 33612, USA
| | - Sweta K Sinha
- H. Lee Moffitt Cancer Center and Research Institute, Department of Cancer Epidemiology, 13131 Magnolia Dr, Tampa, FL, 33612, USA
- Cedars-Sinai, Inflammatory Bowel and Immunobiology Research Institute, 110 George Burns Rd., Davis Building D4094B, Los Angeles, CA, 90048, USA
| | - Jing-Yi Chern
- H. Lee Moffitt Cancer Center and Research Institute, Department of Gynecologic Oncology, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Lauren C Peres
- H. Lee Moffitt Cancer Center and Research Institute, Department of Cancer Epidemiology, 13131 Magnolia Dr, Tampa, FL, 33612, USA.
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Itani Y, Sakai H, Hamano T, Asai-Sato M, Futagami M, Fujimura M, Aoki Y, Suzuki N, Yoshida Y, Enomoto T. Comparison of older and younger patients with ovarian cancer: A post hoc study (JGOG3016-A3) of the treatment strength and prognostic outcomes of conventional or dose-dense chemotherapy. J Obstet Gynaecol Res 2023; 49:1400-1411. [PMID: 36859635 DOI: 10.1111/jog.15620] [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: 09/05/2022] [Accepted: 02/09/2023] [Indexed: 03/03/2023]
Abstract
AIM To evaluate changes of treatment strength and its impact on prognosis in older patients with ovarian cancer. METHODS We compared relative dose intensity (RDI) as a representative of treatment strength, prognosis, and other features between older (≥65 years) and younger patients (<65 years) retrospectively. Seventy-seven older patients of 301 who received dose-dense-paclitaxel-carboplatin (dTC) and 93 older patients of 304 who received conventional-paclitaxel-carboplatin (cTC) from the Japanese Gynecologic Oncology Group (JGOG) 3016 clinical trial were analyzed. RESULTS The RDI of older patients was lower than that of younger patients in cTC (87.4% vs. 90.8%, p = 0.009) but not in dTC (79.0% vs. 81.2%, p = 0.205). In both regimens, older patients had worse overall survival than younger patients: hazard ratio [HR] = 1.80; 95% confidence interval [CI]: 1.25-2.59; p = 0.001 for dTC, and HR = 1.59; 95% CI: 1.15-2.19; p = 0.04 for cTC. However, the RDI was not determined as a prognostic factor statistically. The prognostic factors identified by multivariate analysis for both regimens were clinical stage and residual disease; for dTC were age, performance status, and serum albumin; and for cTC was white blood cell count. There was no difference in neutropenia observed between age groups in either regimen. CONCLUSIONS The RDI of older patients varies according to the administered schedule and is not always lower than that of younger patients. Older patients with comparable treatment strength to younger patients in the dTC group did not accomplish the same level of prognosis as younger patients. Other biologic factors attributable to aging may affect prognosis.
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Affiliation(s)
- Yoshio Itani
- Yao Municipal Hospital Palliative Care Center, Yao-Shi, Japan
| | - Hitomi Sakai
- Advanced Cancer Translational Research Institute (ACT), Showa University, Tokyo, Japan
| | | | - Mikiko Asai-Sato
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Itabashiku, Japan
| | - Masayuki Futagami
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan
| | - Masaki Fujimura
- Tokyo Medical University Ibaraki Medical Center, Inashikigun, Japan
| | | | - Nao Suzuki
- St. Marianna University School of Medicine Hospital, Kawasaki, Japan
| | | | - Takayuki Enomoto
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Wu YH, Chen HY, Hong WC, Wei CY, Pang JHS. Carboplatin-Induced Thrombocytopenia through JAK2 Downregulation, S-Phase Cell Cycle Arrest and Apoptosis in Megakaryocytes. Int J Mol Sci 2022; 23:ijms23116290. [PMID: 35682967 PMCID: PMC9181531 DOI: 10.3390/ijms23116290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/28/2022] [Accepted: 06/02/2022] [Indexed: 02/01/2023] Open
Abstract
Chemotherapy-induced thrombocytopenia (CIT) is a common complication when treating malignancies with cytotoxic agents wherein carboplatin is one of the most typical agents causing CIT. Janus kinase 2 (JAK2) is one of the critical enzymes to megakaryocyte proliferation and differentiation. However, the role of the JAK2 in CIT remains unclear. In this study, we used both carboplatin-induced CIT mice and MEG-01 cell line to examine the expression of JAK2 and signal transducer and activator of transcription 3 (STAT3) pathway. Under CIT, the expression of JAK2 was significantly reduced in vivo and in vitro. More surprisingly, the JAK2/STAT3 pathway remained inactivated even when thrombopoietin (TPO) was administered. On the other hand, carboplatin could cause prominent S phase cell cycle arrest and markedly increased apoptosis in MEG-01 cells. These results showed that the thrombopoiesis might be interfered through the downregulation of JAK2/STAT3 pathway by carboplatin in CIT, and the fact that exogenous TPO supplement cannot reactivate this pathway.
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Affiliation(s)
- Yi-Hong Wu
- Department of Chinese Medicine, Chang Gung Memorial Hospital, Guishan, Taoyuan 333, Taiwan; (Y.-H.W.); (H.-Y.C.); (W.-C.H.); (C.-Y.W.)
- School of Traditional Chinese Medicine, Chang Gung University, Guishan, Taoyuan 333, Taiwan
| | - Hsing-Yu Chen
- Department of Chinese Medicine, Chang Gung Memorial Hospital, Guishan, Taoyuan 333, Taiwan; (Y.-H.W.); (H.-Y.C.); (W.-C.H.); (C.-Y.W.)
- School of Traditional Chinese Medicine, Chang Gung University, Guishan, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan 333, Taiwan
| | - Wei-Chin Hong
- Department of Chinese Medicine, Chang Gung Memorial Hospital, Guishan, Taoyuan 333, Taiwan; (Y.-H.W.); (H.-Y.C.); (W.-C.H.); (C.-Y.W.)
| | - Chen-Ying Wei
- Department of Chinese Medicine, Chang Gung Memorial Hospital, Guishan, Taoyuan 333, Taiwan; (Y.-H.W.); (H.-Y.C.); (W.-C.H.); (C.-Y.W.)
| | - Jong-Hwei Su Pang
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan 333, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Guishan, Taoyuan 333, Taiwan
- Correspondence: ; Tel.: +886-3-2118800 (ext. 3482); Fax: +886-3-2118800 (ext. 3484)
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Bruno KDA, Sobreira da Silva MJ, Chaves GV. Association of body composition with toxicity to first-line chemotherapy and three-year survival in women with ovarian adenocarcinoma. Acta Oncol 2021; 60:1611-1620. [PMID: 34634224 DOI: 10.1080/0284186x.2021.1983210] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND This study aimed to evaluate the association of body composition with toxicity to first-line chemotherapy and three-year survival in women with ovarian adenocarcinoma. METHODS We enrolled, in a retrospective cohort, 239 women treated with carboplatin and paclitaxel between 2008 and 2017. Pretreatment computed tomography scans were used to quantify skeletal muscle index (SMI), skeletal muscle radiodensity (SMD), and subcutaneous adipose tissue index (SATI). Chemotherapy doses, related toxicities, potential drug-drug interactions (DDI), and clinical variables were collected from medical records. Outcomes were the number of adverse events ≥ grade 3 toxicity, toxicity-induced modification of treatment (TIMT), and three-year survival. RESULTS Average age was 56.3 years and 35.1% had myopenia. Almost 33% had TIMT and 51.3% presented any grade 3 toxicity. Potential severe DDI occurred in 48.1% of the patients and 65.1% died three years after the first treatment. The SMD and SATI below the median were independent predictors for the number of adverse events ≥ grade 3 and TIMT. Also, SMD was the only body composition parameter able to predict reduced three-year survival. The SMI was not associated with any of the outcomes. CONCLUSION Fewer amounts of SATI and low SMD were associated with the occurrence of toxicity to chemotherapy, and the low SMD increased the risk of death in the three years after oncologic treatment.
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Docetaxel-dasatinib combination: A strategy to overcome unfavorable treatment outcomes due to dose reduction. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2020.102085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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9
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Sivakumaran T, Mileshkin L, Grant P, Na L, DeFazio A, Friedlander M, Obermair A, Webb PM, Au-Yeung G. Evaluating the impact of dose reductions and delays on progression-free survival in women with ovarian cancer treated with either three-weekly or dose-dense carboplatin and paclitaxel regimens in the national prospective OPAL cohort study. Gynecol Oncol 2020; 158:47-53. [PMID: 32381362 DOI: 10.1016/j.ygyno.2020.04.706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/25/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To determine the impact of chemotherapy dose reductions and dose delays on progression-free survival (PFS) in women with ovarian cancer receiving first line chemotherapy in a real world prospective cohort study. METHODS Patients with newly diagnosed epithelial ovarian (or peritoneal, fallopian tube) cancer enrolled in a national Australian prospective study, OPAL, who commenced three-weekly carboplatin (AUC 5 or 6) and paclitaxel 175 mg/m2 (CP) or carboplatin (AUC 5 or 6) and dose-dense weekly paclitaxel 80 mg/m2 (DD-CP) were eligible. Primary endpoint was PFS. RESULTS 634 evaluable patients, 309 commenced CP and 325 DD-CP. Patient's age was similar in the two groups (median 62 years, range 21-79). All planned chemotherapy doses were completed by 66% vs 40% (p < 0.001) in the CP and DD-CP groups respectively. There was at least one treatment delay in 28% vs 58% (p < 0.001) in the CP and DD-CP groups, respectively, and 29% vs 49% (p < 0.001), respectively, required at least a 15% dose reduction for either carboplatin or paclitaxel. Median PFS was 29.2 [22.9, 43.8] and 21.5 [19.4, 23.1] months in the CP and DD-CP groups respectively. Adjusting for age, histology and FIGO stage PFS did not differ between treatment groups. Median PFS was similar in patients irrespective of dose reduction or dose delay. CONCLUSION Patients receiving DD-CP required more dose reductions and delays due to haematological toxicities and lower completion rates than CP without significant difference in median PFS between CP and DD-CP. Median PFS was similar in patients irrespective of dose reduction or dose delay.
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Affiliation(s)
- T Sivakumaran
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
| | - L Mileshkin
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - P Grant
- Gynaecological Oncology Unit, Mercy Hospital for Women, Melbourne, VIC, Australia
| | - L Na
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - A DeFazio
- Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia; Department of Gynaecological Oncology, Westmead Hospital, Sydney, NSW, Australia
| | - M Friedlander
- Prince of Wales Clinical School, University of New South Wales, Department of Medical Oncology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - A Obermair
- Queensland Centre for Gynaecological Cancer Research, University of Queensland, Centre for Clinical Research, RBWH, Herston, QLD, Australia
| | - P M Webb
- QIMR Berghofer Medial Research Institute, Brisbane, QLD, Australia
| | - G Au-Yeung
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
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- QIMR Berghofer Medial Research Institute, Brisbane, QLD, Australia
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10
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Impact of chemotherapy schedule modification on breast cancer patients: a single-centre retrospective study. Int J Clin Pharm 2020; 42:642-651. [PMID: 32185605 DOI: 10.1007/s11096-020-01011-6] [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: 09/05/2019] [Accepted: 03/07/2020] [Indexed: 12/25/2022]
Abstract
Background Nonconformity to chemotherapy schedules is common in clinical practice. Multiple clinical studies have established the negative prognostic impact of dose delay on survival outcome. Objective This study investigated the prevalence and reason for chemotherapy schedule modifications of breast cancer patients. This study also investigated the impact of schedule modifications on overall survival (OS). Setting This retrospective cohort study was done among breast cancer patient receiving chemotherapy from 2013 to 2017 and patients were followed until 31 Dec 2018. Methods Medical records of patients with cancer were reviewed. Female patients over eighteen years old were included, with primary carcinoma of the breast, who received anthracycline or taxane based chemotherapy regime and completed more than two cycles of chemotherapy. Patients were categorized into three groups of (1) no schedule modification, (2) with schedule modification and (3) incomplete schedule. The Kaplan-Meier was used to test for survival differences in the univariate setting and Cox regression model was used in the multivariate setting. Main outcome measure Prevalence, overall survival rates and hazard ratio of three schedule group Results Among 171 patient who were included in the final analysis, 28 (16.4%) had no schedule modification, 118 (69.0%) with schedule modification and 25 (14.6%) had incomplete schedule with OS of 75.0%, 59.3% and 52.0% respectively. 94% (189) of all cycle rescheduling happened because of constitutional symptoms (70), for non-medical reasons (61) and blood/bone marrow toxicity (58). When compared to patients with no schedule modification, patients with schedule modification had a 2.34-times higher risk of death (HR 2.34, 95% CI 1.03-5.32; p = 0.043). Conclusion Nonconformity to the chemotherapy schedule is common in clinical practice because of treatment complications, patients' social schedule conflicts, and facility administrative reasons. Cumulative delays of ≥ 14 days are likely to have negative prognostic effect on patient survival. Thus, the duration of the delays between cycles should be reduced whenever possible to achieve the maximum chemotherapeutic benefit.
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Hassanzadeganroudsari M, Heydarinasab A, Soltani M, Chen P, Akbarzadeh Khiyavi A. Enhancing anti-cancer efficacy of carboplatin by PEGylated poly(butyl cyanoacrylate) nano-particles. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2019.101218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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12
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Rapoport B, Arani RB, Mathieson N, Krendyukov A. Meta-analysis comparing incidence of grade 3-4 neutropenia with ALK inhibitors and chemotherapy in patients with non-small-cell lung cancer. Future Oncol 2019; 15:2163-2174. [PMID: 31116035 DOI: 10.2217/fon-2018-0863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim: This meta-analysis compared incidence of grade 3-4 neutropenia with ALK inhibitors versus chemotherapy in patients with non-small-cell lung cancer. Materials & methods: PubMed/MEDLINE was searched to identify Phase II and III randomized clinical trials published up to 25 October 2018. Summary incidence, relative risk and corresponding 95% CIs were calculated for grade 3-4 neutropenia. Results: Five randomized clinical trials were included. Relative risk (95% CI) of developing grade 3-4 neutropenia with ALK inhibitor versus chemotherapy was 0.27 (0.07-1.06). Probabilities of developing grade 3-4 neutropenia were 6.56 and 14.19%, respectively; no significant difference was found. Conclusion: In patients with non-small-cell lung cancer, incidence of grade 3-4 neutropenia with ALK-targeted therapy is not significantly different compared with chemotherapy.
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Affiliation(s)
- Bernardo Rapoport
- The Medical Oncology Centre of Rosebank, Johannesburg, 2196, South Africa.,Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, 0084, South Africa
| | - Ramin B Arani
- Biostatistics, Sandoz Inc., Princeton, NJ 08540, USA
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Risk factors for septic adverse events and their impact on survival in advanced ovarian cancer patients treated with neoadjuvant chemotherapy and interval debulking surgery. Gynecol Oncol 2018; 151:32-38. [DOI: 10.1016/j.ygyno.2018.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 01/13/2023]
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Use of Chinese Herbal Medicine Improves Chemotherapy-Induced Thrombocytopenia among Gynecological Cancer Patients: An Observational Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:4201325. [PMID: 30174705 PMCID: PMC6106719 DOI: 10.1155/2018/4201325] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/04/2018] [Accepted: 06/10/2018] [Indexed: 11/18/2022]
Abstract
Background Chemotherapy-induced thrombocytopenia (CIT) is a serious complication among patients with gynecological malignancies, yet management options are limited. This study aimed at reporting the potential of the Chang Gung platelet elevating formula (CGPEF), a prescription with a fixed proportion of Chinese herbs, for improving CIT among gynecologic cancer patients. Materials From 1/1/2007 to 31/12/2009, a total of 23 patients with two consecutive CIT episodes (≤ 100×103 /μL) (last cycle: C0; index cycle: C1) received the CGPEF from the nadir of platelet count of C1 and through the subsequent chemotherapy cycles (C2 and beyond). The CGPEF was taken orally four times a day. The evolution of platelet counts of 18 patients after administration of CGPEF was analyzed (2 patients had different chemotherapy regimens after CGPEF, two patients discontinued CGPEF due to the flavor and the amount of CGPEF, and one patient had no further chemotherapy). Results Most of the patients had recurrent ovarian cancer (11/18, 61%) with a median of 2.5 previous chemotherapy regimens, and carboplatin-based regimens were the most commonly used for these patients (13/18, 72%). The trend of successive CIT could be reversed after taking CGPEF. Also, the platelet nadir was higher after CGPEF treatment (16.5×103/μL versus 32×103/μL, before and after CGPEF treatment, resp., p = 0.002). Moreover, the chemotherapy interval decreased from 30.5 days to 24 days. No thrombocytosis, clinical bleeding, thromboembolism, or other adverse events were found among these patients. Conclusions The CGPEF is worthy of further large-scale, well-designed clinical trials for CIT among gynecological cancer patients.
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Liutkauskiene S, Grizas S, Jureniene K, Suipyte J, Statnickaite A, Juozaityte E. Retrospective analysis of the impact of anthracycline dose reduction and chemotherapy delays on the outcomes of early breast cancer molecular subtypes. BMC Cancer 2018; 18:453. [PMID: 29678165 PMCID: PMC5910571 DOI: 10.1186/s12885-018-4365-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 04/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of study was to determine the effect of anthracycline dose reduction and chemotherapy delays on 5-year overall survival in patients with stage I-III breast cancer, to establish the impact of molecular subtypes on the anthracycline modification effects and to analyze reasons for such chemotherapy scheme modifications. METHODS Medical records of patients with stage I-III breast cancer were reviewed. Inclusion criteria involved stage I- III breast carcinoma; radical surgery performed and 4 courses of AC regimen (doxorubicin and cyclophosphamide), or at least 6 courses of FAC regimen (fluorouracil, doxorubicin and cyclophosphamide) completed; no neoadjuvant chemotherapy applied; no taxane group medications administered; medical records maintain comprehensive data on treatment and follow-up. 5- year overall survival were analyzed using Kaplan-Meier and Cox proportional hazards models. RESULTS Significant 3.17 times higher death risk at 5 year period in patients who experienced anthracycline dose reduction compared with patients who did not experience any modifications was established (HR = 3.17, 95% CI 1.7-5.9, p < 0.001). Increased death risk in patients who experienced both chemotherapy dose reduction and treatment delays compared with patients who did not experience any modifications was also established (HR = 2.76, 95% CI 1.3-5.6, p < 0.05). 5- year overall survival was affected by anthracycline dose reduction by more than 15% in ER-HER2- group (80% v. 55.6%, p = 0.015), ER + HER2- group (90.7% v. 64.9%, p < 0.01) and ER+/-HER2+ group (100% v. 84.4%, p = 0.019). 5-year overall survival was affected by chemotherapy delays more than 2 cycles in ER-HER2- group (79.2% v. 51.4%, p = 0.002), ER + HER2- group (86.3% v. 58.8%, p = 0.014) and there was no difference in ER+/-HER2+ group. Main reasons for chemotherapy scheme modifications (in decreasing order) were the following: neutropenia, modifications with no objective medical reasons, thrombocytopenia, anaemia, fatigue, infection. CONCLUSIONS Anthracycline dose reduction in patients with stage I- III breast cancer were associated with higher mortality risk and significantly decreased 5- year absolute survival in all molecular subtypes. Chemotherapy delays alone were not associated with decreased survival only in HER2 positive subtype. The most common reason for dose reduction or chemotherapy delays was neutropenia.
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Affiliation(s)
- Sigita Liutkauskiene
- Oncology Institute of Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Saulius Grizas
- Clinic of Surgery of Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kristina Jureniene
- Cardiology Institute of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jorune Suipyte
- Medical Academy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Akvile Statnickaite
- Medical Academy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Elona Juozaityte
- Oncology Institute of Lithuanian University of Health Sciences, Kaunas, Lithuania
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16
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Efficacy of weekly administration of paclitaxel and carboplatin for advanced ovarian cancer patients with poor performance status. Int J Clin Oncol 2018; 23:698-706. [PMID: 29572761 DOI: 10.1007/s10147-018-1264-9] [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: 10/21/2017] [Accepted: 02/14/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to reveal the efficacy of weekly administration of paclitaxel and carboplatin for advanced ovarian cancer patients with poor performance status (PS). METHODS FIGO stage III/IV ovarian cancer or fallopian tube cancer patients who underwent interval debulking surgery (IDS) followed by neoadjuvant chemotherapy (NAC) were analyzed retrospectively. Patients were divided into two groups based on NAC: weekly paclitaxel and carboplatin (W-TC) and 3 weeks of paclitaxel and carboplatin (TW-TC). Toxicity, efficacy of NAC, surgery outcome, and prognosis were assessed by comparing the two groups. RESULTS Twenty patients treated with W-TC and 18 patients treated with TW-TC were analyzed. All of the W-TC patients were poor PS (PS ≥ 2), and all of the TW-TC patients were good PS (PS ≤ 1). The overall clinical response rates were 70% in W-TC and 83.4% in TW-TC. In the W-TC group, Grade 3/4 anemia and thrombocytopenia and greater than grade 2 neuropathy were significantly reduced compared to TW-TC patients. A frequency of treatment delay greater than 7 and 14 days, G-CSF support, blood transfusion, and dose reduction or regimen change were also significantly reduced in the W-TC group. The rate of IDS, optimal debulking surgery, complications during operation, and blood transfusion were similar between the W-TC and TW-TC groups. Progression-free survival and overall survival were also similar between the two groups. CONCLUSION Our study suggested that NAC with W-TC for poor PS patients with non-treated ovarian cancer reduced the toxicity of chemotherapy and had the same efficacy as TW-TC.
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Fournier Q, Serra J, Handel I, Lawrence J. Impact of Pretreatment Neutrophil Count on Chemotherapy Administration and Toxicity in Dogs with Lymphoma Treated with CHOP Chemotherapy. J Vet Intern Med 2018; 32:384-393. [PMID: 29205493 PMCID: PMC5787211 DOI: 10.1111/jvim.14895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 10/26/2017] [Accepted: 11/06/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Prechemotherapy absolute neutrophil count (ANC) cutoffs are arbitrary and vary across institutions and clinicians. Similarly, subjective guidelines are utilized for the administration of prophylactic antibiotics in neutropenic dogs. OBJECTIVES To evaluate the impact of various ANC cutoffs on chemotherapy administration in dogs with lymphoma treated with CHOP chemotherapy and to determine whether an association between prechemotherapy ANC and subsequent toxicity exists. The secondary objective was to evaluate a currently used ANC cutoff to indicate prescription of prophylactic antibiotics. ANIMALS Dogs diagnosed with lymphoma treated with CHOP chemotherapy (n = 64). METHODS Six hundred and fifteen ANCs were stratified into 6 classes. The 3 ANC cutoffs 1.5 × 103 /μL, 2.0 × 103 /μL, and 2.5 × 103 /μL were assessed. The presence of an association between prechemotherapy ANC class and toxicity was determined. Afebrile neutropenic dogs with ANC <1.5 × 103 /μL but above the criteria for prophylactic antibiotics were evaluated. RESULTS Chemotherapy was not administered in 7% of visits with an ANC cutoff of 1.5 × 103 /μL; chemotherapy would not have been administered in 10% and 16% of visits with an ANC cutoff of 2.0 × 103 /μL or 2.5 × 103 /μL, respectively. There was no association among the 3 lower prechemotherapy ANC classes and toxicity. All dogs with ANC 0.75-1.5 × 103 /μL recovered spontaneously without medical intervention. CONCLUSION AND CLINICAL IMPORTANCE The number of dose delays was minimized with a prechemotherapy ANC cutoff of 1.5 × 103 /μL, and the prechemotherapy ANC class 1.5-1.99 × 103 /μL was not associated with an increased toxicity. Further investigation of an ANC cutoff near 0.75 × 103 /μL in which to prescribe prophylactic antibiotics is indicated.
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Affiliation(s)
- Q. Fournier
- Royal (Dick) School of Veterinary StudiesRoslin InstituteThe University of EdinburghRoslinUK
| | - J.‐C. Serra
- Royal (Dick) School of Veterinary StudiesRoslin InstituteThe University of EdinburghRoslinUK
| | - I. Handel
- Royal (Dick) School of Veterinary StudiesRoslin InstituteThe University of EdinburghRoslinUK
| | - J. Lawrence
- Royal (Dick) School of Veterinary StudiesRoslin InstituteThe University of EdinburghRoslinUK
- Present address:
Lawrence is presently affiliated with Department of Veterinary Clinical SciencesCollege of Veterinary MedicineUniversity of MinnesotaSaint PaulMN
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Impact of chemotherapy-induced neutropenia (CIN) and febrile neutropenia (FN) on cancer treatment outcomes: An overview about well-established and recently emerging clinical data. Crit Rev Oncol Hematol 2017; 120:163-179. [DOI: 10.1016/j.critrevonc.2017.11.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/20/2017] [Accepted: 11/06/2017] [Indexed: 12/13/2022] Open
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Shao X, He Y, Ji M, Chen X, Qi J, Shi W, Hao T, Ju S. Quantitative analysis of cell-free DNA in ovarian cancer. Oncol Lett 2015; 10:3478-3482. [PMID: 26788153 PMCID: PMC4665352 DOI: 10.3892/ol.2015.3771] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 08/17/2015] [Indexed: 12/23/2022] Open
Abstract
The aim of the present study was to investigate the association between cell-free DNA (cf-DNA) levels and clinicopathological characteristics of patients with ovarian cancer using a branched DNA (bDNA) technique, and to determine the value of quantitative cf-DNA detection in assisting with the diagnosis of ovarian cancer. Serum specimens were collected from 36 patients with ovarian cancer on days 1, 3 and 7 following surgery, and additional serum samples were also collected from 22 benign ovarian tumor cases, and 19 healthy, non-cancerous ovaries. bDNA techniques were used to detect serum cf-DNA concentrations. All data were analyzed using SPSS version 18.0. The cf-DNA levels were significantly increased in the ovarian cancer group compared with those of the benign ovarian tumor group and healthy ovarian group (P<0.01). Furthermore, cf-DNA levels were significantly increased in stage III and IV ovarian cancer compared with those of stages I and II (P<0.01). In addition, cf-DNA levels were significantly increased on the first day post-surgery (P<0.01), and subsequently demonstrated a gradual decrease. In the ovarian cancer group, the area under the receiver operating characteristic curve of cf-DNA and the sensitivity were 0.917 and 88.9%, respectively, which was higher than those of cancer antigen 125 (0.724, 75%) and human epididymis protein 4 (0.743, 80.6%). There was a correlation between the levels of serum cf-DNA and the occurrence and development of ovarian cancer in the patients evaluated. bDNA techniques possessed higher sensitivity and specificity than other methods for the detection of serum cf-DNA in patients exhibiting ovarian cancer, and bDNA techniques are more useful for detecting cf-DNA than other factors. Thus, the present study demonstrated the potential value for the use of bDNA as an adjuvant diagnostic method for ovarian cancer.
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Affiliation(s)
- Xuefeng Shao
- Department of Clinical Laboratory, Maternity and Child Healthcare Hospital of Nantong, Nantong, Jiangsu 226018, P.R. China
| | - Yan He
- Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000, P.R. China
| | - Min Ji
- Department of Internal Medicine, Maternity and Child Healthcare Hospital of Nantong, Nantong, Jiangsu 226018, P.R. China
| | - Xiaofang Chen
- Department of Gynecology, Maternity and Child Healthcare Hospital of Nantong, Nantong, Jiangsu 226018, P.R. China
| | - Jing Qi
- Department of Laboratory of Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226018, P.R. China
| | - Wei Shi
- Department of Laboratory of Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226018, P.R. China
| | - Tianbo Hao
- Department of Laboratory of Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226018, P.R. China
| | - Shaoqing Ju
- Department of Laboratory of Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226018, P.R. China
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