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Iihara H, Iwai M, Morita R, Fujita Y, Ohgino K, Ishihara T, Hirose C, Suzuki Y, Masubuchi K, Kawazoe H, Kawae D, Aihara K, Endo S, Fukunaga K, Yamazaki M, Tamura T, Kitamura Y, Fukui S, Endo J, Suzuki A. Mirtazapine plus granisetron and dexamethasone for carboplatin-induced nausea and vomiting in patients with thoracic cancers: A prospective multicenter phase II trial. Lung Cancer 2024; 192:107801. [PMID: 38678830 DOI: 10.1016/j.lungcan.2024.107801] [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: 02/15/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Mirtazapine blocks 5-hydroxytryptamine type (5-HT)2A, 5-HT2C, 5-HT3 and histamine H1 receptors, similarly to olanzapine. This study aimed to investigate the efficacy and safety of mirtazapine plus granisetron and dexamethasone for carboplatin (CBDCA)-induced nausea and vomiting in patients with thoracic cancers. METHODS We conducted a prospective, open-label, single-arm, multicenter, phase II trial in four institutions in Japan. Registered patients were moderately to highly emetogenic chemotherapy-naïve, and were scheduled to receive CBDCA at area under the curve (AUC) ≥ 4 mg/mL per minute. Patients received mirtazapine 15 mg/day orally at bedtime for four consecutive days, in combination with granisetron and dexamethasone. Primary endpoint was complete response (CR; no emesis and no use of rescue medication) rate during the delayed period (24-120 h). RESULTS Between July 2022 and July 2023, 52 patients were enrolled, and 48 patients were evaluated. CR rates in the delayed (24-120 h), overall (0-120 h), and acute periods (0-24 h) were 83.3%, 83.3%, and 100%, respectively. No grade 3 or higher treatment-related adverse events were observed except for one patient who had grade 3 dry mouth as evaluated by Common Terminology Criteria for Adverse Events version 5.0. CONCLUSIONS Prophylactic antiemetic therapy with mirtazapine plus granisetron and dexamethasone shows promising efficacy and an acceptable safety profile. This three-drug combination appears to be a reasonable treatment approach in patients with thoracic cancers receiving a CBDCA-based regimen at AUC ≥ 4 mg/mL per minute.
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Affiliation(s)
- Hirotoshi Iihara
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan; Patient Safety Division, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan; Laboratory of Pharmacy Practice and Social Science, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, Gifu 501-1196, Japan
| | - Masamichi Iwai
- Department of Cardiology and Respiratory Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan
| | - Ryo Morita
- Department of Respiratory Medicine, Akita Kousei Medical Center, 1-1-1 Nishibukuro Iijima, Akita, Akita, 011-0948, Japan
| | - Yukiyoshi Fujita
- Division of Pharmacy, Gunma Prefectural Cancer Center, 617-1 Takahayashinishi, Ota, Gunma, 373-8550, Japan
| | - Keiko Ohgino
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Chiemi Hirose
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan
| | - Yasuyuki Suzuki
- Department of Pharmacy, Akita Kousei Medical Center, 1-1-1 Nishibukuro Iijima, Akita, Akita, 011-0948, Japan
| | - Ken Masubuchi
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, 617-1 Takahayashinishi, Ota, Gunma 373-8550, Japan
| | - Hitoshi Kawazoe
- Division of Pharmaceutical Care Sciences, Center for Social Pharmacy and Pharmaceutical Care Sciences, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
| | - Daisuke Kawae
- Department of Cardiology and Respiratory Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan
| | - Kanako Aihara
- Department of Pharmacy, Akita Kousei Medical Center, 1-1-1 Nishibukuro Iijima, Akita, Akita, 011-0948, Japan
| | - Satoshi Endo
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, 617-1 Takahayashinishi, Ota, Gunma 373-8550, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Mizuki Yamazaki
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan
| | - Takuya Tamura
- Department of Pharmacy, Akita Kousei Medical Center, 1-1-1 Nishibukuro Iijima, Akita, Akita, 011-0948, Japan
| | - Yu Kitamura
- Department of Cardiology and Respiratory Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan
| | - Shin Fukui
- Department of Respiratory Medicine, Akita Kousei Medical Center, 1-1-1 Nishibukuro Iijima, Akita, Akita, 011-0948, Japan
| | - Junki Endo
- Department of Cardiology and Respiratory Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan
| | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu 501-1194, Japan; Laboratory of Advanced Medical Pharmacy, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, Gifu, 501-1196, Japan.
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2
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Yamamoto S, Iihara H, Uozumi R, Kawazoe H, Tanaka K, Fujita Y, Abe M, Imai H, Karayama M, Hayasaki Y, Hirose C, Suda T, Nakamura K, Suzuki A, Ohno Y, Morishige KI, Inui N. Efficacy and safety of 5 mg olanzapine for nausea and vomiting management in cancer patients receiving carboplatin: integrated study of three prospective multicenter phase II trials. BMC Cancer 2021; 21:832. [PMID: 34281514 PMCID: PMC8290573 DOI: 10.1186/s12885-021-08572-3] [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: 04/28/2021] [Accepted: 07/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background The efficacy of olanzapine as an antiemetic agent in cancer chemotherapy has been demonstrated. However, few high-quality reports are available on the evaluation of olanzapine’s efficacy and safety at a low dose of 5 mg among patients treated with carboplatin regimens. Therefore, in this study, we investigated the efficacy and safety of 5 mg olanzapine for managing nausea and vomiting in cancer patients receiving carboplatin regimens and identified patient-related risk factors for carboplatin regimen-induced nausea and vomiting treated with 5 mg olanzapine. Methods Data were pooled for 140 patients from three multicenter, prospective, single-arm, open-label phase II studies evaluating the efficacy and safety of olanzapine for managing nausea and vomiting induced by carboplatin-based chemotherapy. Multivariable logistic regression analyses were performed to determine the patient-related risk factors. Results Regarding the endpoints of carboplatin regimen-induced nausea and vomiting control, the complete response, complete control, and total control rates during the overall study period were 87.9, 86.4, and 72.9%, respectively. No treatment-related adverse events of grade 3 or higher were observed. The multivariable logistic regression models revealed that only younger age was significantly associated with an increased risk of non-total control. Surprisingly, there was no significant difference in CINV control between the patients treated with or without neurokinin-1 receptor antagonist. Conclusions The findings suggest that antiemetic regimens containing low-dose (5 mg) olanzapine could be effective and safe for patients receiving carboplatin-based chemotherapy.
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Affiliation(s)
- Senri Yamamoto
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Hirotoshi Iihara
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan. .,Laboratory of Pharmacy Practice and Social Science, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, Gifu, 501-1196, Japan.
| | - Ryuji Uozumi
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hitoshi Kawazoe
- Division of Pharmaceutical Care Sciences, Center for Social Pharmacy and Pharmaceutical Care Sciences, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan.,Division of Pharmaceutical Care Sciences, Keio University Graduate School of Pharmaceutical Sciences, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan
| | - Kazuki Tanaka
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1, Handayama, Hamamatsu, 431-3192, Japan
| | - Yukiyoshi Fujita
- Division of Pharmacy, Gunma Prefectural Cancer Center, 617-1 Takahayashi-nishi, Ota, Gunma, 373-8550, Japan
| | - Masakazu Abe
- Division of Gynecology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.,Present address: Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, 1-20-1, Handayama, Hamamatsu, 431-3192, Japan
| | - Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, 617-1, Takahayashi-nishi, Ota, Gunma, 373-8550, Japan.,Present address: Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Masato Karayama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1, Handayama, Hamamatsu, 431-3192, Japan.,Department of Clinical Oncology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan
| | - Yoh Hayasaki
- Department of Obstetrics and Gynecology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Chiemi Hirose
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1, Handayama, Hamamatsu, 431-3192, Japan
| | - Kazuto Nakamura
- Department of Gynecology, Gunma Prefectural Cancer Center, 617-1, Takahayashi-nishi, Ota, Gunma, 373-8550, Japan
| | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.,Laboratory of Pharmacy Practice and Social Science, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, Gifu, 501-1196, Japan
| | - Yasushi Ohno
- Department of Cardiology and Respiratory Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Ken-Ichirou Morishige
- Department of Obstetrics and Gynecology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1, Handayama, Hamamatsu, 431-3192, Japan. .,Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, 1-20-1, Handayama, Hamamatsu, 431-3192, Japan.
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Sakai C, Shimokawa M, Iihara H, Fujita Y, Ikemura S, Hirose C, Kotake M, Funaguchi N, Gomyo T, Imai H, Hakamata J, Kaito D, Minato K, Arai T, Kawazoe H, Suzuki A, Ohno Y, Okura H. Low-Dose Olanzapine Plus Granisetron and Dexamethasone for Carboplatin-Induced Nausea and Vomiting in Patients with Thoracic Malignancies: A Prospective Multicenter Phase II Trial. Oncologist 2021; 26:e1066-e1072. [PMID: 33811782 PMCID: PMC8176968 DOI: 10.1002/onco.13772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/12/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Olanzapine is an inexpensive and durable agent for the treatment of chemotherapy-induced nausea and vomiting and is also superior to neurokinin-1 receptor antagonists in the control of nausea. This study aimed to investigate the efficacy and safety of a low dose of 5 mg olanzapine plus granisetron and dexamethasone for treatment of carboplatin (CBDCA)-induced nausea and vomiting in patients with thoracic malignancies. MATERIALS AND METHODS We conducted a prospective, open-label, single-arm, multicenter, phase II trial in four centers in Japan. Registered patients were scheduled to receive area under the curve (AUC) ≥5 mg/mL per minute of CBDCA and had never received moderately to highly emetogenic chemotherapy. Patients received olanzapine 5 mg/day orally after supper for 4 days, in combination with granisetron and dexamethasone. Primary endpoint was complete response (CR; no emesis and no use of rescue medication) rate during the overall phase (0-120 hours). RESULTS Between February 2018 and June 2020, 51 patients were enrolled, and 50 patients were evaluated. The CR rates in the overall (0-120 hours), acute (0-24 hours), and delayed phases (24-120 hours) were 94.0%, 100%, and 94.0%, respectively. No grade 3 or higher adverse effects of olanzapine were observed. CONCLUSION Prophylactic antiemetic therapy with a low dose of 5 mg olanzapine plus granisetron and dexamethasone showed durable efficacy with an acceptable safety profile. This three-drug combination appears to be a reasonable treatment approach in patients with thoracic malignancies receiving an AUC ≥5 mg/mL per minute of CBDCA-based regimen. Clinical trial identification number: UMIN000031267. IMPLICATIONS FOR PRACTICE The results of this phase II trial indicated that the prophylactic administration of low-dose of 5 mg olanzapine combined with granisetron and dexamethasone has promising activity with acceptable safety profile in patients with thoracic malignancy receiving high-dose carboplatin chemotherapy.
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Affiliation(s)
- Chizuru Sakai
- Department of Cardiology and Respiratory Medicine, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Mototsugu Shimokawa
- Department of Biostatistics, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.,Cancer Biostatistics Laboratory, Clinical Research Institute, National Hospital Organization Kyushu Cancer Center, Minami-ku, Fukuoka, Japan
| | - Hirotoshi Iihara
- Department of Pharmacy, Gifu University Hospital, Gifu, Gifu, Japan.,Laboratory of Pharmacy Practice and Social Science, Gifu Pharmaceutical University, Gifu, Gifu, Japan
| | - Yukiyoshi Fujita
- Division of Pharmacy, Gunma Prefectural Cancer Center, Ohta, Gunma, Japan
| | - Shinnosuke Ikemura
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Shinjuku-ku, Tokyo, Japan.,Keio Cancer Center, Keio University, School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Chiemi Hirose
- Department of Pharmacy, Gifu University Hospital, Gifu, Gifu, Japan
| | - Mie Kotake
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ohta, Gunma, Japan
| | | | - Takenobu Gomyo
- Department of Cardiology and Respiratory Medicine, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ohta, Gunma, Japan.,Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan (present address)
| | - Jun Hakamata
- Department of Pharmacy, Keio University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Daizo Kaito
- Department of Cardiology and Respiratory Medicine, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ohta, Gunma, Japan
| | - Takahiro Arai
- Division of Pharmacy, Gunma Prefectural Cancer Center, Ohta, Gunma, Japan
| | - Hitoshi Kawazoe
- Division of Pharmaceutical Care Sciences, Center for Social Pharmacy and Pharmaceutical Care Sciences, Keio University Faculty of Pharmacy, Minato-ku, Tokyo, Japan
| | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, Gifu, Gifu, Japan.,Laboratory of Pharmacy Practice and Social Science, Gifu Pharmaceutical University, Gifu, Gifu, Japan
| | - Yasushi Ohno
- Department of Cardiology and Respiratory Medicine, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Hiroyuki Okura
- Department of Cardiology and Respiratory Medicine, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
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Efe Ertürk N, Taşcı S. The Effects of Peppermint Oil on Nausea, Vomiting and Retching in Cancer Patients Undergoing Chemotherapy: An Open Label Quasi-Randomized Controlled Pilot Study. Complement Ther Med 2020; 56:102587. [PMID: 33197662 DOI: 10.1016/j.ctim.2020.102587] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/29/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES The current study evaluated the effects of peppermint oil on the frequency of nausea, vomiting, retching, and the severity of nausea in cancer patients undergoing chemotherapy. DESIGN A quasi-randomized controlled study. SETTING Patients were recruited from the ambulatory chemotherapy unit of a public hospital located (Batman, Turkey) between September 2017 and September 2018. INTERVENTIONS The participants in the intervention group applied one drop the aromatic mixture on the spot between their upper lip and their nose, three times a day for the five days following chemotherapy administration, in addition to the routine antiemetic treatment. Participants in the control group underwent only the routine antiemetic treatment. Main outcome measures VAS-the severity of nausea and the Index of Nausea, Vomiting, and Retching. RESULTS The VAS nausea score was significantly lower after peppermint oil applying in the patients receiving Folfirinox (treatment effect (mean dif.): 4.00±2.28; P<0.001), Paclitaxel-Trastuzumab (treatment effect (mean dif.): 1.70±0.90; P=0.014), Carboplatin-Paclitaxel (treatment effect (mean dif.): 3.71±1.41; P<0.001), and Cyclophosphamide-Adriamycin (treatment effect (mean dif.): 1.41±0.73; P=0.005) excluding cisplatin scedule (treatment effect (mean dif.): 0.56±2,18; P=0.642). We detected a statistical significant difference in the change in frequency of nausea, vomiting, retching in the other all schedules excluding cisplatin schedule (P<0.05). CONCLUSIONS The peppermint oil was significantly reduced the frequency of nausea, vomiting, retching and the severity of nausea in cancer patients undergoing chemotherapy. Therefore, usage of peppermint oil together with antiemetics after chemotherapy with moderate and low emetic risk may be recommended to cope with CINV.
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Affiliation(s)
- Nuriye Efe Ertürk
- Department of Nursing, Batman University Health College, Batman, Turkey.
| | - Sultan Taşcı
- Department of Internal Medicine Nursing, Erciyes University Faculty of Health Science, Kayseri, Turkey
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Su Q, Luo S, Tan Q, Deng J, Zhou S, Peng M, Tao T, Yang X. The role of pyruvate kinase M2 in anticancer therapeutic treatments. Oncol Lett 2019; 18:5663-5672. [PMID: 31788038 PMCID: PMC6865080 DOI: 10.3892/ol.2019.10948] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 09/06/2019] [Indexed: 12/13/2022] Open
Abstract
Cancer cells are characterized by a high glycolytic rate, which leads to energy regeneration and anabolic metabolism; a consequence of this is the abnormal expression of pyruvate kinase isoenzyme M2 (PKM2). Multiple studies have demonstrated that the expression levels of PKM2 are upregulated in numerous cancer types. Consequently, the mechanism of action of certain anticancer drugs is to downregulate PKM2 expression, indicating the significance of PKM2 in a chemotherapeutic setting. Furthermore, it has previously been highlighted that the downregulation of PKM2 expression, using either inhibitors or short interfering RNA, enhances the anticancer effect exerted by THP treatment on bladder cancer cells, both in vitro and in vivo. The present review summarizes the detailed mechanisms and therapeutic relevance of anticancer drugs that inhibit PKM2 expression. In addition, the relationship between PKM2 expression levels and drug resistance were explored. Finally, future directions, such as the targeting of PKM2 as a strategy to explore novel anticancer agents, were suggested. The current review explored and highlighted the important role of PKM2 in anticancer treatments.
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Affiliation(s)
- Qiongli Su
- Department of Pharmacy, Zhuzhou Central Hospital, Zhuzhou, Hunan 412000, P.R. China
| | - Shengping Luo
- Department of Pharmacy, Zhuzhou Central Hospital, Zhuzhou, Hunan 412000, P.R. China
| | - Qiuhong Tan
- Department of Pharmacy, Zhuzhou Central Hospital, Zhuzhou, Hunan 412000, P.R. China
| | - Jun Deng
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Changsha, Hunan 410013, P.R. China
| | - Sichun Zhou
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Changsha, Hunan 410013, P.R. China
| | - Mei Peng
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Ting Tao
- Department of Pharmacy, Yueyang Maternal-Child Medicine Health Hospital, Yueyang, Hunan 414000, P.R. China
| | - Xiaoping Yang
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Changsha, Hunan 410013, P.R. China
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Iihara H, Shimokawa M, Gomyo T, Fujita Y, Yoshida T, Funaguchi N, Minato K, Kaito D, Osawa T, Yamada M, Hirose C, Suzuki A, Ohno Y. Clinical trial protocol of doublet therapy and olanzapine for carboplatin-induced nausea and vomiting in patients with thoracic cancer: a multicentre phase II trial. BMJ Open 2019; 9:e028056. [PMID: 31278102 PMCID: PMC6615793 DOI: 10.1136/bmjopen-2018-028056] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Adding neurokinin-1 receptor antagonist (NK1RA) to 5-hydroxytryptamine-3 receptor antagonist and dexamethasone (DEX) improved carboplatin (CBDCA)-induced chemotherapy-induced nausea and vomiting (CINV) in patients with thoracic cancer. NK1RAs with high-drug cost are raising medical expenses. Olanzapine (OLZ) is less expensive and can be expected to have an excellent effect on CINV. This phase II trial aimed at evaluating the efficacy and safety of 5 mg OLZ plus granisetron (GRN) and DEX in CBDCA combination therapy with area under curve (AUC) ≥5 mg/mL/min for the prevention of nausea and vomiting in patients with thoracic cancer. METHODS AND ANALYSIS This is an open-label, single-arm, multicentre, phase II trial. Patients who receive CBDCA-based therapies (AUC ≥5) and have never been administered moderate to high emetogenic chemotherapy will be enrolled. All patients will receive a combination of GRN, DEX and OLZ. The primary endpoint is complete response (CR) rate, defined as the absence of emetic episodes and no use of rescue medication for 120 hours after the initiation of CBDCA. Forty-eight patients are required based on our hypothesis that this regimen can improve CR rate from 65% (null hypothesis) to 80% (alternative hypothesis) with a one-sided type I error of 0.1 and a power of 0.8. We set the target sample size at 50 considering dropouts. ETHICS AND DISSEMINATION The study protocol was approved by the institutional review board at each of the participating centres. Data will be presented at international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER UMIN000031267.
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Affiliation(s)
- Hirotoshi Iihara
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
- Laboratory of Pharmacy Practice and Social Science, Gifu Pharmaceutical University, Gifu, Japan
| | - Mototsugu Shimokawa
- Cancer Biostatistics Laboratory, Clinical Research Institute, National Hospital Organization Kyusyu Cancer Center, Fukuoka, Japan
| | - Takenobu Gomyo
- Department of Cardiology and Respirology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yukiyoshi Fujita
- Division of Pharmacy, Gunma Prefectural Cancer Center, Ohta, Japan
| | - Tsutomu Yoshida
- Department of Respiratory Medicine and Medical Oncology, Gifu Municipal Hospital, Gifu, Japan
| | - Norihiko Funaguchi
- Department of Cardiology and Respirology, Gifu University Graduate School of Medicine, Gifu, Japan
- Department of Respiratory Medicine, Asahi University Hospital, Gifu, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Gifu, Japan
| | - Daizo Kaito
- Department of Cardiology and Respirology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tomohiro Osawa
- Department of Pharmacy, Gifu Municipal Hospital, Gifu, Japan
| | - Momoko Yamada
- Department of Pharmacy, Asahi University Hospital, Gifu, Japan
| | - Chiemi Hirose
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Yasushi Ohno
- Department of Cardiology and Respirology, Gifu University Graduate School of Medicine, Gifu, Japan
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Metformin partially reverses the carboplatin-resistance in NSCLC by inhibiting glucose metabolism. Oncotarget 2017; 8:75206-75216. [PMID: 29088858 PMCID: PMC5650413 DOI: 10.18632/oncotarget.20663] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/12/2017] [Indexed: 01/22/2023] Open
Abstract
Platinum-based chemotherapeutic drugs are irreplaceable for the treatment of advanced non-small cell lung cancer (NSCLC). However, acquired drug resistance has become a major obstacle for the clinical application of chemotherapy on NSCLC. In the present study, we established carboplatin-resistant NSCLC models on A549 and PC9 cell lines, which were named A549/R and PC9/R. Besides the low sensitivity of A549/R and PC9/R to carboplatin treatment, they exhibited higher metabolism rate of glucose compared to their parental A549 and PC9 cells, respectively. Mechanically, we confirmed that overexpression of PKM2 in A549/R and PC9/R was responsible for the high glucose metabolism and carboplatin resistance. Metformin, an antidiabetic drug, was observed to increase the sensitivity of carboplatin-resistant NSCLC cells to carboplatin treatment in vitro and in vivo. Mechanically, metformin decreased expression of PKM2 and subsequently inhibited the glucose uptake, lactate generation and ATP production in A549/R and PC9/R. Therefore, metformin promoted carboplatin-induced apoptosis through the mitochondria pathway. In addition, we demonstrated that metformin treatment also impaired the cross-resistance of A549/R and PC9/R to cisplatin, etoposide and 5-fluorouracil.
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8
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Inui N. Antiemetic therapy for non-anthracycline and cyclophosphamide moderately emetogenic chemotherapy. Med Oncol 2017; 34:77. [PMID: 28365889 DOI: 10.1007/s12032-017-0937-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
Although antiemetic management in cancer therapy has improved, chemotherapy-induced nausea and vomiting remain common and troubling adverse events. Chemotherapeutic agents are classified based on their emetogenic effects, and appropriate antiemetics are recommended according to this categorization. Chemotherapy categorized as moderately emetogenic is associated with a wide spectrum of emetic risks. Combined anthracycline and cyclophosphamide regimens have been recently reclassified as highly emetogenic chemotherapy regimen. This review focuses on antiemetic pharmacotherapy in patients receiving non-anthracycline and cyclophosphamide-based moderately emetogenic chemotherapy regimens. Combination therapy with a 5-hydroxytryptamine-3 receptor agonist, preferably palonosetron, and dexamethasone is the standard therapy in moderately emetogenic chemotherapy, although triple therapy with add-on neurokinin-1 receptor antagonist is used as an alternative treatment strategy. Among moderately emetogenic chemotherapy regimens, carboplatin-containing chemotherapy has considerable emetic potential, particularly during the delayed phase. However, the additional of a neurokinin-1 receptor antagonist to the standard antiemetic therapy prevents carboplatin-induced nausea and vomiting. For regimens including oxaliplatin, the benefit of adding neurokinin-1 receptor antagonist requires further clarification.
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Affiliation(s)
- Naoki Inui
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan. .,Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan.
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