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Tsuji D, Nakagaki S, Yonezawa I, Suzuki K, Yokokawa T, Kawasaki Y, Yamaguchi T, Kawaguchi T, Hatori M, Matsumoto T, Sakata Y, Yamamoto K, Nishimura T, Kogure Y, Hayashi T, Osawa M, Itoh K, Watanabe M. A multicenter phase II trial of the triplet antiemetic therapy with palonosetron, aprepitant, and olanzapine for a cisplatin-containing regimen. - PATROL-I. Invest New Drugs 2024; 42:44-52. [PMID: 38055127 DOI: 10.1007/s10637-023-01414-y] [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: 10/17/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023]
Abstract
Dexamethasone is one of the key antiemetic agents and is widely used even now. However, dexamethasone has been associated with several adverse reactions even after short-term administration. Therefore, developing a steroid-free antiemetic regimen is an important issue to consider. Thus, the purpose of this study was to investigate the efficacy and safety of palonosetron, aprepitant, and olanzapine in a multi-institutional phase II study. Chemotherapy-naive patients scheduled to receive cisplatin were enrolled and evaluated for the occurrence of chemotherapy-induced nausea and vomiting during 120 h after chemotherapy. The primary endpoint of the study was total control (TC) in the overall phase. The key secondary endpoint was complete response (CR), which was assessed in the acute, delayed, and overall phase, respectively. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Events. Eighty-five patients were enrolled from 8 centers in Japan, of which 83 were evaluable for analyses. The percentage of patients who achieved TC during the overall phase was 31.3%. CR was achieved in 61.4%, 84.3%, and 65.1% of patients during the overall, acute, and delayed phases, respectively. The most frequently reported adverse event was anorexia. The primary endpoint was below the threshold and we could not find benefit in the dexamethasone-free regimen, but CR during the overall phase was similar to that of the conventional three-drug regimen. This antiemetic regimen without dexamethasone might be an option for patients for whom corticosteroids should not be an active application.
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Affiliation(s)
- Daiki Tsuji
- Department of Clinical Pharmacology & Genetics, School of Pharmaceutical Sciences, University of Shizuoka, Suruga-ku, Shizuoka, Japan.
| | - Shigeru Nakagaki
- Department of Pharmacy, Shizuoka General Hospital, Shizuoka, Japan
| | - Itsuki Yonezawa
- Department of Clinical Pharmacology & Genetics, School of Pharmaceutical Sciences, University of Shizuoka, Suruga-ku, Shizuoka, Japan
| | - Kenichi Suzuki
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Takashi Yokokawa
- Department of Pharmacy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yohei Kawasaki
- Faculty of Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan
| | - Takumi Yamaguchi
- Institute for Assistance of Academic and Education, IAAE, Kanagawa, Japan
| | - Takashi Kawaguchi
- Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Masahiro Hatori
- Department of Pharmacy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takuma Matsumoto
- Pharmaceutical Department, National Hospital Organization Iwakuni Clinical Center, Yamaguchi, Japan
| | - Yukio Sakata
- Department of Pharmacy, Hakodate Municipal Hospital, Hokkaido, Japan
| | - Keisuke Yamamoto
- Department of Pharmacy, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Tomoyasu Nishimura
- Department of Pharmacy, Wakayama Medical University Hospital, Wakayama, Japan
| | - Yuki Kogure
- Department of Pharmacy, National Hospital Organization Higashihiroshima Medical Center, Hiroshima, Japan
| | - Toshinobu Hayashi
- Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan
| | - Misa Osawa
- Department of Pharmacy, Shizuoka General Hospital, Shizuoka, Japan
| | - Kunihiko Itoh
- Department of Clinical Pharmacology & Genetics, School of Pharmaceutical Sciences, University of Shizuoka, Suruga-ku, Shizuoka, Japan
| | - Masaya Watanabe
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
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Minatogawa H, Izawa N, Shimomura K, Arioka H, Iihara H, Sugawara M, Morita H, Mochizuki A, Nawata S, Mishima K, Tsuboya A, Miyaji T, Honda K, Yokomizo A, Hashimoto N, Yanagihara T, Endo J, Kawaguchi T, Furuya N, Sone Y, Inada Y, Ohno Y, Katada C, Hida N, Akiyama K, Ichikura D, Konomatsu A, Ogura T, Yamaguchi T, Nakajima TE. Dexamethasone-sparing on days 2-4 with combined palonosetron, neurokinin-1 receptor antagonist, and olanzapine in cisplatin: a randomized phase III trial (SPARED Trial). Br J Cancer 2024; 130:224-232. [PMID: 37973958 PMCID: PMC10803798 DOI: 10.1038/s41416-023-02493-7] [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: 07/07/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND This study evaluated the non-inferiority of dexamethasone (DEX) on day 1, with sparing on days 2-4 in cisplatin-based chemotherapy. METHODS Patients with malignant solid tumors who were treated with cisplatin (≥50 mg/m²) were randomly assigned (1:1) to receive either DEX on days 1-4 (Arm D4) or DEX on day 1 (Arm D1) plus palonosetron, NK-1 RA, and olanzapine (5 mg). The primary endpoint was complete response (CR) during the delayed (24-120 h) phase. The non-inferiority margin was set at -15%. RESULTS A total of 281 patients were enrolled, 278 of whom were randomly assigned to Arm D4 (n = 139) or Arm D1 (n = 139). In 274 patients were included in the efficacy analysis, the rates of delayed CR in Arms D4 and D1 were 79.7% and 75.0%, respectively (risk difference -4.1%; 95% CI -14.1%-6.0%, P = 0.023). However, patients in Arm D1 had significantly lower total control rates during the delayed and overall phases, and more frequent nausea and appetite loss. There were no significant between-arm differences in the quality of life. CONCLUSION DEX-sparing is an alternative option for patients receiving cisplatin; however, this revised administration schedule should be applied on an individual basis after a comprehensive evaluation. CLINICAL TRIALS REGISTRY NUMBER UMIN000032269.
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Affiliation(s)
- Hiroko Minatogawa
- Department of Pharmacy, St. Marianna University Hospital, Kawasaki, Japan
| | - Naoki Izawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | | | - Hitoshi Arioka
- Department of Medical Oncology, Yokohama Rosai Hospital, Yokohama, Japan
| | | | - Mitsuhiro Sugawara
- Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, Sagamihara, Japan
| | - Hajime Morita
- Department of Pharmacy, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | - Ayako Mochizuki
- Department of gynecology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shuichi Nawata
- Department of Pharmacy, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Keisuke Mishima
- Department of Digestive surgery, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Ayako Tsuboya
- Department of Pharmacy, Kawasaki municipal Tama Hospital, Kawasaki, Japan
| | - Tempei Miyaji
- Department of Clinical Trial Data Management Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazunori Honda
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Ayako Yokomizo
- Department of Pharmacy, St. Marianna University Hospital, Kawasaki, Japan
| | - Naoya Hashimoto
- Department of Pharmacy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takeshi Yanagihara
- Department of Medical Oncology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Junki Endo
- Department of Cardiology and Respiratory Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takashi Kawaguchi
- Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan
| | - Naoki Furuya
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yumiko Sone
- Department of Clinical Pharmacy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yusuke Inada
- Department of Pharmacy, Yokohama Rosai Hospital, Yokohama, Japan
| | - Yasushi Ohno
- Department of Cardiology and Respiratory Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Chikatoshi Katada
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoya Hida
- Department of Respiratory Internal Medicine, St. Marianna University Yokohama City Seibu Hospital, Yokohama, Japan
| | - Kana Akiyama
- Department of pharmacy, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Daisuke Ichikura
- Department of Pharmacy, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Akiko Konomatsu
- Department of Pharmacy, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Takashi Ogura
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Clinical Oncology, Kawasaki municipal Tama Hospital, Kawasaki, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takako Eguchi Nakajima
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan.
- Department of Early Clinical Development, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Lim MJ, Jung KH, Kwon SR, Park W. Inflammation is responsible for systemic bone loss in patients with seropositive rheumatoid arthritis treated with rituximab. Korean J Intern Med 2023; 38:912-922. [PMID: 37867140 PMCID: PMC10636556 DOI: 10.3904/kjim.2023.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND/AIMS We investigated the effect of rituximab on systemic bone metabolism in patients with seropositive rheumatoid arthritis (RA). METHODS Twenty seropositive patients with RA were enrolled and administered one cycle of rituximab. If RA became active for > 6 months after the first rituximab cycle, a second cycle was initiated; otherwise, no additional treatment was administered. Patients were divided into two groups according to the number of rituximab treatment cycles. RESULTS In patients treated with a second cycle, the total hip bone mineral density (BMD) was clinically low, whereas the serum levels of receptor activator of nuclear factor kappa-B ligand (RANKL) were increased at 12 months. BMD in patients treated with one cycle did not change at 12 months, whereas serum RANKL levels decreased at all time points. DAS28 activity improved in both groups from baseline to 4 months; however, from 4 to 12 months, DAS28 activity worsened in the develgroup with the second cycle but remained stable in the group with one cycle. CONCLUSION Systemic inflammation, reflected by increased disease activity, may be responsible for the increase in RANKL levels, which causes systemic bone loss in rituximab-treated patients with RA. Although rituximab affects inflammation, it does not seem to alter systemic bone metabolism in RA.
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Affiliation(s)
- Mie Jin Lim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Inha University, Incheon, Korea
| | - Kyong-Hee Jung
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Inha University, Incheon, Korea
| | - Seong-Ryul Kwon
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Inha University, Incheon, Korea
| | - Won Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Inha University, Incheon, Korea
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Celio L, Bartsch R, Aapro M. Dexamethasone-sparing regimens with NEPA (netupitant/palonosetron) for the prevention of chemotherapy-induced nausea and vomiting in older patients (>65 years) fit for cisplatin: A sub-analysis from a phase 3 study. J Geriatr Oncol 2023; 14:101537. [PMID: 37290207 DOI: 10.1016/j.jgo.2023.101537] [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: 12/19/2022] [Revised: 04/29/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION We recently demonstrated the non-inferiority of two dexamethasone (DEX)-sparing regimens with an oral fixed-combination of netupitant and palonosetron (NEPA) versus the guideline-recommended DEX use for cisplatin-induced nausea and vomiting. Since prevention of chemotherapy-induced nausea and vomiting is critical in older patients, we retrospectively evaluated the efficacy of the DEX-sparing regimens in this subset. MATERIALS AND METHODS Chemo-naive patients aged >65 years treated with high-dose cisplatin (≥70 mg/m2) were eligible. Patients received NEPA and DEX on day 1 and were randomized to receive either (1) no further DEX (DEX1), (2) oral low-dose DEX (4 mg) on days 2-3 (DEX3), or (3) the guideline-recommended standard DEX (4 mg twice daily) on days 2-4 (DEX4). The primary efficacy endpoint of the parent study was complete response (CR; no vomiting and no use of rescue medication) during the overall phase (days 1-5). No significant nausea (NSN; none or mild nausea) and the proportion of patients reporting no impact on daily life (NIDL) which was evaluated by the Functional Living Index-Emesis questionnaire on day 6 (overall combined score > 108), were secondary endpoints. RESULTS Among the 228 patients in the parent study, 107 were > 65 years. Similar CR rates [95% confidence intervals (CI)] were observed in patients over 65 years across treatment groups [DEX1: 75% (59.7-86.8%); DEX3: 80.6% (62.5-92.6%); DEX4: 75% (56.6-88.5%)] as well as versus the total study population. NSN rates were also similar in the older-patients across treatment groups (p = 0.480) but were higher compared with the total population. Similar rates of NIDL (95% CI) were reported in the older-patient subset across treatment groups [DEX1: 61.5% (44.6-76.6%); DEX3: 64.3% (44.1-81.4%); DEX4: 62.1% (42.3-79.3%); p = 1.0] during the overall phase, as well as versus total population. A similar proportion of older patients across treatment groups experienced DEX-related side effects. DISCUSSION This analysis shows that older-patients who are fit for cisplatin benefit from a simplified regimen of NEPA plus single-dose DEX with neither loss in antiemetic efficacy nor the adverse impact on patient daily functioning. The study was registered on ClinicalTrials.gov (identifier NCT04201769) on 17/12/2019 (retrospectively registered).
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Affiliation(s)
- Luigi Celio
- Medical Oncology Unit, Azienda Socio Sanitaria Territoriale del Garda, Desenzano del Garda, Italy.
| | - Rupert Bartsch
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Austria
| | - Matti Aapro
- Cancer Center, Clinique de Genolier, Genolier, Switzerland
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Saito Y, Takekuma Y, Takeshita T, Oshino T, Sugawara M. Impact of systemic dexamethasone dosage on docetaxel-induced oral mucositis in patients with breast cancer. Sci Rep 2023; 13:10169. [PMID: 37349388 PMCID: PMC10287713 DOI: 10.1038/s41598-023-37285-9] [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: 02/21/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023] Open
Abstract
Oral mucositis (OM) is a common adverse effect of docetaxel-containing treatment. This study aimed to assess whether dexamethasone (DEX) dose-dependently attenuates docetaxel-induced OM and dysgeusia. We retrospectively analyzed medical records of patients with breast cancer receiving docetaxel-containing regimens at Hokkaido University Hospital between June 2015 and June 2022. The patients were divided into low-dose and high-dose groups (DEX 4 or 8 mg/day on days 2-4, respectively), and incidence of OM and dysgeusia, and risk factor(s) for OM incidence were evaluated. The incidence of all-grade OM in the first cycle was 57.8% in the low-dose group and 19.2% in the high-dose group (P = 0.0002), which met our primary endpoint. The incidence of OM in all treatment cycles was also significantly lowered by DEX-dose increase (P = 0.01). In contrast, the incidence of dysgeusia was similar between the two groups in the first and all cycles (P = 0.50 and P = 0.28, respectively). These results were also confirmed in a propensity score-matched population. Multivariate logistic regression analysis also suggested that lower DEX dosage was a singular risk factor for all-grade OM incidence. In conclusion, our study suggests that DEX dose-dependently reduces the incidence of OM in docetaxel-containing regimens for breast cancer treatment.
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Affiliation(s)
- Yoshitaka Saito
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan
| | - Takashi Takeshita
- Department of Breast Surgery, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan
| | - Tomohiro Oshino
- Department of Breast Surgery, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan
| | - Mitsuru Sugawara
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan.
- Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-jo, Nishi 6-chome, Kita-ku, Sapporo, 060-0812, Japan.
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Hayashi T, Shimokawa M, Matsuo K, Uchiyama M, Kawada K, Nakano T, Egawa T. Effectiveness of Palonosetron, 1-Day Dexamethasone, and Aprepitant in Patients Undergoing Carboplatin-Based Chemotherapy. Oncology 2023; 101:584-590. [PMID: 37276851 DOI: 10.1159/000531318] [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: 01/27/2023] [Accepted: 05/17/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Dexamethasone (DEX)-sparing strategy with 5-hydroxytryptamine-3 receptor antagonist (5HT3RA) and aprepitant (APR), as triplet antiemetic prophylaxis, is associated with poor control of delayed chemotherapy-induced nausea and vomiting (CINV) in patients receiving carboplatin (CBDCA)-based chemotherapy. This study aimed to evaluate whether using palonosetron (PALO) as a 5HT3RA provides superior control with CINV than first-generation (1st) 5HT3RA in triplet antiemetic prophylaxis with a DEX-sparing strategy. METHODS Pooled patient-level data from a nationwide, multicenter, and prospective observational study were analyzed to compare the incidence of CINV between patients administered PALO and 1st 5HT3RA in combination with 1-day DEX and APR. RESULTS No significant differences were observed in the incidence of CINV, pattern of CINV, or severity of nausea by type of 5HT3RA in triplet antiemetic prophylaxis with DEX-sparing strategy. In both groups, the incidence of nausea gradually increased from day 3, peaked on day 4 or 5, and then declined slowly. The visual analog scale scores in the delayed phase remained high throughout the 7-day observation period. CONCLUSION Careful patient selection and symptom monitoring are needed when implementing the DEX-sparing strategy in triplet antiemetic prophylaxis for patients undergoing CBDCA-based chemotherapy. Furthermore, additional strategies may be needed to achieve better control of delayed CINV.
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Affiliation(s)
- Toshinobu Hayashi
- Department of Comprehensive Pharmaceutical Care, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan
| | - Mototsugu Shimokawa
- Department of Biostatistics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Koichi Matsuo
- Department of Comprehensive Pharmaceutical Care, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan
| | | | - Kei Kawada
- Department of Pharmacy, Kochi Medical School Hospital City, Nankoku, Japan
| | - Takafumi Nakano
- Department of Comprehensive Pharmaceutical Care, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan
| | - Takashi Egawa
- Department of Comprehensive Pharmaceutical Care, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan
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Saito Y, Takekuma Y, Takeshita T, Oshino T, Sugawara M. Dexamethasone dose-dependently prevents taxane-associated acute pain syndrome in breast cancer treatment. Support Care Cancer 2023; 31:372. [PMID: 37269359 DOI: 10.1007/s00520-023-07852-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: 10/03/2022] [Accepted: 05/30/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Taxane-associated acute pain syndrome (T-APS) is one of the most bothersome adverse effects caused by taxanes. We have previously reported the attenuating effect of dexamethasone (DEX) on T-APS and its risk factors under DEX prophylaxis. However, the appropriate DEX dosage administration remains unclear. Therefore, this study aimed to investigate whether DEX dose-dependently prevents T-APS in breast cancer patients. METHODS We retrospectively evaluated patients with breast cancer who received docetaxel (75 mg/m2)-containing chemotherapy without pegfilgrastim and regular non-steroidal anti-inflammatory drugs. The patients were divided into 4 mg/day and 8 mg/day DEX groups, with each DEX dosage on days 2-4 (n = 68 for each group). Primary endpoint was the comparison of all-grade T-APS incidence between the groups. Propensity score-matching was performed to adjust the baseline factors between the groups, and outcomes in the matched-population were also assessed. RESULTS The incidence of all-grade T-APS was 72.1% in 4 mg/day group and 48.5% in 8 mg/day group, which was significantly lowered by higher DEX dosage (P = 0.008). The severity of T-APS was also significantly reduced in 8 mg/day group (P = 0.02). These results were confirmed in the propensity score matching. Multivariate logistic analysis showed that higher DEX dosage was an independent T-APS preventive factor, whereas age < 55 years was a risk factor. Moreover, DEX-dosage-associated adverse effects similarly appeared in both groups. CONCLUSION Our study suggested that DEX dose-dependently prevents T-APS in breast cancer treatment. As understanding of the nature of T-APS and its appropriate management can significantly contribute to less onerous chemotherapy provision, further studies are required.
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Affiliation(s)
- Yoshitaka Saito
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-Jo, Nishi 5-Chome, Kita-Ku, Sapporo, 060-8648, Japan
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-Jo, Nishi 5-Chome, Kita-Ku, Sapporo, 060-8648, Japan
| | - Takashi Takeshita
- Department of Breast Surgery, Hokkaido University Hospital, Kita 14-Jo, Nishi 5-Chome, Kita-Ku, Sapporo, 060-8648, Japan
| | - Tomohiro Oshino
- Department of Breast Surgery, Hokkaido University Hospital, Kita 14-Jo, Nishi 5-Chome, Kita-Ku, Sapporo, 060-8648, Japan
| | - Mitsuru Sugawara
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-Jo, Nishi 5-Chome, Kita-Ku, Sapporo, 060-8648, Japan.
- Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-Jo, Nishi 6-Chome, Kita-Ku, Sapporo, 060-0812, Japan.
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Ognerubov NA. Fosaprepitant: current options to prevent chemotherapy-induced nausea and vomiting: A review. JOURNAL OF MODERN ONCOLOGY 2023. [DOI: 10.26442/18151434.2022.4.202019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background. Chemotherapy (CT) is a mainstay of treatment for malignant tumors. CT-induced nausea and vomiting are observed in 3090% of patients within 0120 h after moderate and highly emetogenic CT administration. These adverse events can severely impact the quality of treatment, daily life, and adherence to treatment, thus reducing the effectiveness of therapy and survival.
Materials and methods. The author provides the results of a systematic review of research papers, including clinical studies, on the efficacy of the neurokinin-1 receptor antagonist fosaprepitant to prevent CT-induced nausea and vomiting. Data from the PubMed database were reviewed.
Results. The prevention and treatment of CT-associated nausea and vomiting are vital during special therapy, including symptomatic therapy. International organizations recommend using a triple combination with antagonists of neurokinin-1 and 5-hydroxytryptamine-3 receptors and dexamethasone. According to the data obtained, the efficacy of fosaprepitant has been proven in delayed and general phases in several large, well-planned studies; the drug reduces the incidence of adverse events by 2.74.4 times compared with aprepitant.
Conclusion. Fosaprepitant is an antagonist of neurokinin-1 receptors; when administered intravenously, it rapidly converts into aprepitant. When used as part of a triple combination with 5-hydroxytryptamine-3 receptor antagonists and dexamethasone in patients receiving moderate and highly emetogenic CT leads to a higher rate of complete response when controlling nausea and vomiting. In general, fosaprepitant is well tolerated.
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Celio L, Cortinovis D, Cogoni AA, Cavanna L, Martelli O, Carnio S, Collovà E, Bertolini F, Petrelli F, Cassano A, Chiari R, Zanelli F, Pisconti S, Vittimberga I, Letizia A, Misino A, Gernone A, Bonizzoni E, Pilotto S, De Placido S, Bria E. Exploratory analysis of the effect of a dexamethasone-sparing regimen for prophylaxis of cisplatin-induced emesis on food intake (LUNG-NEPA study). Sci Rep 2023; 13:1257. [PMID: 36690734 PMCID: PMC9870907 DOI: 10.1038/s41598-023-28464-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
We demonstrated the non-inferiority of a dexamethasone (DEX)-sparing (single-dose) regimen with NEPA, a netupitant/palonosetron fixed combination, for preventing chemotherapy-induced nausea and vomiting (CINV) caused by cisplatin. This pre-planned exploratory analysis assessed the effect of the DEX-sparing regimen on a patient's food intake. Chemotherapy-naïve patients undergoing cisplatin (≥ 70 mg/m2) were given NEPA and DEX (12 mg) on day 1 and randomized to receive either no further DEX (DEX1), or oral DEX (4 mg BID) on days 2-4 (DEX4). Patient-reported endpoint maintenance of usual daily food intake was assessed during the 5-days post-chemotherapy. The relationship between usual daily food intake and CINV control, pre-chemotherapy self-rated food intake and BMI-adjusted weight loss (WL) were evaluated. One-hundred fifty-two patients (76/group) were assessable. The proportion of patients reporting maintenance of usual daily food intake was similar in both groups: 69.7% (95% CI, 58.6-78.9) for DEX1 vs. 72.4% (95% CI, 61.4-81.2) for DEX4. Only CINV control was significantly associated with maintenance of usual daily food intake (P ≤ 0.001) during the overall phase. The DEX-sparing regimen does not adversely affect patient-reported daily food intake post-chemotherapy. The current analysis adds further insights into antiemetic efficacy of DEX sparing beyond day 1 in the challenging setting of cisplatin.Trial registration: The parent study was registered on ClinicalTrials.gov (NCT04201769).
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Affiliation(s)
- Luigi Celio
- Medical Oncology Unit, ASST del Garda, Località Montecroce 1, 25015, Desenzano del Garda, BS, Italy.
| | - Diego Cortinovis
- Medical Oncology Department, ASST Monza San Gerardo Hospital, Monza, Italy
| | - Alessio Aligi Cogoni
- Medical Oncology Department, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Luigi Cavanna
- Oncology Department, Azienda Ospedaliera di Piacenza, Piacenza, Italy
| | | | - Simona Carnio
- Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Elena Collovà
- Cancer Centre Department - Oncology Unit, ASST Ovest Milanese - Legnano Hospital, Legnano, Milan, Italy
| | - Federica Bertolini
- Department of Oncology and Hematology, AOU Policlinico di Modena, Modena, Italy
| | - Fausto Petrelli
- Medical Oncology Unit, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Alessandra Cassano
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rita Chiari
- Oncology Unit, AULSS6 Euganea, Padova, Italy
| | - Francesca Zanelli
- Medical Oncology Unit, IRCCS Santa Maria Nuova, Reggio Emilia, Italy
| | - Salvatore Pisconti
- Medical Oncology Department, San Giuseppe Moscati Hospital, Statte, Taranto, Italy
| | | | - Antonietta Letizia
- Department of Pneumology and Oncology, AORN dei Colli-Ospedale Monaldi, Naples, Italy
| | - Andrea Misino
- Medical Oncology, Clinical Cancer Center, "Giovanni Paolo II" - IRCCS, Bari, Italy
| | - Angela Gernone
- Medical Oncology Unit, University of Bari, Policlinico di Bari, Bari, Italy
| | - Erminio Bonizzoni
- Department of Clinical Science and Community, Section of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Sabino De Placido
- Clinical Medicine and Surgery Department, University of Naples "Federico II", Naples, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
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10
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Impact of systemic dexamethasone administration on oral mucositis induced by anthracycline-containing regimens in breast cancer treatment. Sci Rep 2022; 12:12587. [PMID: 35869165 PMCID: PMC9307799 DOI: 10.1038/s41598-022-16935-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/18/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractOral mucositis (OM) is one of the most common complications associated with chemotherapy. Here, we evaluated whether systemic dexamethasone (DEX) dosage in prophylactic antiemetics affected the incidence of OM in anthracycline-containing regimens. Patients receiving anthracycline-containing regimens for breast cancer were divided into high- and low-DEX dose groups and retrospectively evaluated. The incidence of all-grade OM in the first cycle in the high- and low-dose groups was 27.3% and 53.5%, respectively, and was significantly lowered by increasing the DEX dose (P < 0.01); thus, the study met its primary endpoint. The result in all treatment cycles was also significant (P = 0.02). In contrast, the incidence of dysgeusia was similar between the high- and low-dose groups in the first and all cycles (13.6% and 16.3% in the first cycle [P = 0.79] and 27.3% and 34.9% in all cycles [P = 0.42], respectively). Multivariate analysis revealed that low DEX dosage was an independent risk factor for all-grade OM development. In conclusion, our study suggests that DEX attenuates OM in anthracycline-containing regimens for breast cancer treatment in a dose-dependent manner. Further evaluation of OM prophylaxis, including DEX administration, is required for better control.
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11
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Celio L, Bonizzoni E, Montani E, Aapro M. Efficacy of the dexamethasone-sparing triplet regimen for preventing cisplatin-induced emesis: a combined analysis. Future Oncol 2022; 18:3389-3397. [PMID: 36017782 DOI: 10.2217/fon-2022-0330] [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: 11/21/2022] Open
Abstract
Aim: To further evaluate the antiemetic efficacy of single-dose versus multiple-dose dexamethasone (DEX) against nausea and vomiting caused by cisplatin. Materials & methods: Two similar non-inferiority studies were pooled. Patients were randomized to single-day DEX or multiple-day DEX plus palonosetron and neurokinin-1 receptor-antagonists (NK-1RAs). The primary endpoint was complete response (CR; no vomiting and no rescue medication) during the overall phase. Results: The combined analysis included 242 patients. The absolute risk difference between single day versus multi-day DEX for CR was -2% (95% CI, -14 to 9%). Conclusion: Administration of single-dose DEX offers comparable antiemetic control to multiple-day DEX when combined with palonosetron and an NK-1RA in the setting of single-day cisplatin.
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Affiliation(s)
- Luigi Celio
- Medical Oncology Unit, Azienda Socio Sanitaria del Garda, Ospedale di Desenzano del Garda, Desenzano del Garda, 25015, Italy
| | - Erminio Bonizzoni
- Department of Clinical Science & Community Section of Medical Statistics, Biometry & Epidemiology 'G.A. Maccacaro', Faculty of Medicine & Surgery, University of Milan, Milan, 20100, Italy
| | - Elena Montani
- Medical Oncology Unit, Azienda Socio Sanitaria del Garda, Ospedale di Manerbio, Manerbio, 25025, Italy
| | - Matti Aapro
- Cancer Center, Clinique de Genolier, Genolier, 1272, Switzerland
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12
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Celio L, Cortinovis D, Cogoni AA, Cavanna L, Martelli O, Carnio S, Collovà E, Bertolini F, Petrelli F, Cassano A, Chiari R, Zanelli F, Pisconti S, Vittimberga I, Letizia A, Misino A, Gernone A, Bonizzoni E, Pilotto S, De Placido S, Bria E. Evaluating the impact of chemotherapy-induced nausea and vomiting on daily functioning in patients receiving dexamethasone-sparing antiemetic regimens with NEPA (netupitant/palonosetron) in the cisplatin setting: results from a randomized phase 3 study. BMC Cancer 2022; 22:915. [PMID: 35999527 PMCID: PMC9400287 DOI: 10.1186/s12885-022-10018-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/18/2022] [Indexed: 11/11/2022] Open
Abstract
Background The non-inferiority of dexamethasone (DEX) on day 1, with or without low-dose DEX on days 2 and 3, combined with oral NEPA (netupitant/palonosetron), compared with the guideline-consistent use of DEX was demonstrated in cisplatin. Here, we complete the analysis by assessing the impact of emesis on daily lives of patients receiving DEX-sparing regimens using the Functional Living Index-Emesis (FLIE). Methods Chemotherapy-naïve patients undergoing cisplatin (≥70 mg/m2), were given NEPA and DEX (12 mg) on day 1 and randomized to receive either 1) no further DEX (DEX1), 2) oral DEX (4 mg daily) on days 2–3 (DEX3), or 3) DEX (4 mg twice daily) on days 2–4 (DEX4; control). Patients completed the FLIE questionnaire on day 6 of cycle 1. Endpoints included the FLIE nausea domain, vomiting domain, and overall combined domain scores, as well as the proportion of patients with no impact on daily life (NIDL; overall score > 108). This was a protocol-planned analysis. Results In the DEX1 group, no significant differences were observed in the FLIE nausea score (48.9 [±1.8; SE] vs. 53.7 [±1.5]), vomiting score (56.6 [±1.4] vs. 58.7 [±0.8]) and overall score (105.6 [±2.8] vs.112.4 [±1.9]) versus DEX4 control; similar results were observed in the DEX3 group for nausea score (49.6 [±1.7]), vomiting score (58.2 [±1]) and overall score (107.8 [±2.4]) versus control. There were no significant between-group differences in the proportion of patients reporting NIDL. Conclusion Reducing DEX, when administered with NEPA, does not seem to adversely impact the daily functioning in patients undergoing cisplatin. Trial registration ClinicalTrials.govNCT04201769. Registration date: 17/12/2019 - Retrospectively registered.
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Affiliation(s)
- Luigi Celio
- Medical Oncology Unit, ASST del Garda, Desenzano del Garda Hospital, Località Montecroce 1, 25015, Desenzano del Garda, BS, Italy.
| | - Diego Cortinovis
- Medical Oncology Department, ASST Monza San Gerardo Hospital, Monza, Italy
| | - Alessio Aligi Cogoni
- Medical Oncology Department, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Luigi Cavanna
- Oncology Department, Azienda Ospedaliera di Piacenza, Piacenza, Italy
| | | | - Simona Carnio
- Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Elena Collovà
- Cancer Centre Department - Oncology Unit, ASST Ovest Milanese - Legnano Hospital, Legnano, Milan, Italy
| | - Federica Bertolini
- Department of Oncology and Hematology, AOU Policlinico di Modena, Modena, Italy
| | - Fausto Petrelli
- Medical Oncology Unit, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Alessandra Cassano
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rita Chiari
- Oncology Unit, AULSS6 Euganea, Padova, Italy
| | - Francesca Zanelli
- Medical Oncology Unit, IRCCS Santa Maria Nuova, Reggio Emilia, Italy
| | - Salvatore Pisconti
- Medical Oncology Department, San Giuseppe Moscati Hospital, Statte, Taranto, Italy
| | | | - Antonietta Letizia
- Department of Pneumology and Oncology, AORN dei Colli-Ospedale Monaldi, Naples, Italy
| | - Andrea Misino
- Medical Oncology, Clinical Cancer Center "Giovanni Paolo II" - IRCCS, Bari, Italy
| | - Angela Gernone
- Medical Oncology Unit, University of Bari, Policlinico di Bari, Bari, Italy
| | - Erminio Bonizzoni
- Department of Clinical Science and Community, Section of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Sabino De Placido
- Clinical Medicine and Surgery Department, University of Naples "Federico II", Naples, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
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13
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Watanabe D, Iihara H, Fujii H, Makiyama A, Nishida S, Suzuki A. One-Day Versus Three-Day Dexamethasone with NK1RA for Patients Receiving Carboplatin and Moderate Emetogenic Chemotherapy: A Network Meta-analysis. Oncologist 2022; 27:e524-e532. [PMID: 35427418 PMCID: PMC9177112 DOI: 10.1093/oncolo/oyac060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/24/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The dexamethasone (DEX)-sparing strategy, which limits administration of DEX to day one, is reportedly non-inferior to conventional antiemetic regimens comprising multiple-day DEX. However, the usefulness of the DEX-sparing strategy in triplet antiemetic prophylaxis (neurokinin-1 receptor antagonist [NK1RA] + serotonin receptor antagonist [5HT3RA] + DEX) for carboplatin and moderate emetogenic chemotherapy (MEC) has not been clarified. PATIENTS AND METHODS We systematically reviewed randomized controlled trials that examined the efficacy of antiemetics for preventing chemotherapy-induced nausea and vomiting associated with carboplatin and MEC. We conducted a network meta-analysis to compare the antiemesis efficacy of three-day DEX with NK1RA (3-DEX + NK1RA) and one-day DEX with NK1RA (1-DEX + NK1RA). The primary outcome was complete response during the delayed phase (CR-DP). The secondary outcome was no nausea during the delayed phase (NN-DP). RESULTS Seventeen trials involving 4534 patients were included. The proportion who experienced CR-DP was 82.5% (95% credible interval [CI], 73.9-88.6) and 73.5% (95% CI, 62.8-80.9) among those who received 3-DEX + NK1RA and 1-DEX + NK1RA, respectively. There was no significant difference between the two regimens. However, 3-DEX + NK1RA tended to be superior to 1-DEX + NK1RA, with an absolute risk difference of 9.0% (95% CI, -2.3 to 21.1) in CR-DP and 24.7% (95% CI: -14.9 to 54.6) in NN-DP. 3-DEX + NK1RA also tended to be superior to 1-DEX + NK1RA in patients who received carboplatin-based chemotherapy, for whom the absolute risk difference was 12.3% (95% CI, -3.2 to 30.7). CONCLUSIONS Care is needed when administering the DEX-sparing strategy in combination with NK1RA to patients receiving carboplatin and non-carboplatin MEC.
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Affiliation(s)
- Daichi Watanabe
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | | | - Hironori Fujii
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | | | - Shohei Nishida
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
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14
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Reduction of the Vertebral Bone Mineral Density in Patients with Hodgkin Lymphoma Correlates with Their Age and the Treatment Regimen They Received. Cancers (Basel) 2022; 14:cancers14030495. [PMID: 35158763 PMCID: PMC8833719 DOI: 10.3390/cancers14030495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/10/2022] [Accepted: 01/16/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Hodgkin lymphoma (HL) is considered a largely curable disease (~80%). The young patient age at diagnosis and their long life expectancy make quality-of-life issues, including osteopenia, exceedingly important. This study aimed to assess treatment-related bone mineral density (BMD) changes that are overlooked in this young population. BMD was measured using PET/CT scans. Among 213 patients (median age 29 years), post-treatment BMD reduction of >15% was significantly more common in those aged ≥30 years and was also associated with a cumulative dose of steroids used. At 6 months post-therapy, BMD recovery was observed in ABVD (adriamycin/bleomycin/vinblastine/dacarbazine) treated patients, while individuals receiving EB (bleomycin/etoposide/adriamycin/cyclophosphamide/oncovin/procarbazine/prednisone) regimens demonstrated persistent BMD loss and higher rates of osteopenia. Our findings suggest that steroid use should be minimized and highly gonadotoxic drugs like procarbazine should be substituted with less toxic ones, due to their deleterious effect on BMD. Adequate vitamin D levels should be maintained. Abstract Nowadays, Hodgkin lymphoma (HL) has become highly curable. The young age at diagnosis and long life expectancy emphasize the importance of preventing long-term treatment side effects, including bone mineral density (BMD) loss, in these patients. We aimed to evaluate the effects of first-line therapeutic modalities on BMD dynamics in HL patients, intending to identify individuals at risk for osteopenia. Demographics, HL risk factors, treatment, including cumulative steroid doses, and BMD of 213 newly-diagnosed HL patients (median age 29 years), treated at Rambam between 2008–2016, were analyzed. The main chemotherapy regimens applied were: ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) and escalated BEACOPP (EB; bleomycin, etoposide, adriamycin, cyclophosphamide, oncovin, procarbazine, prednisone). BMD was measured using PET/CT scans. BMD loss >15% was revealed in 48% of patients at therapy completion, with osteopenia prevalence of 4% and 14% at baseline and post-therapy, respectively. Cumulative hydrocortisone equivalent doses >3400 mg/m2 correlated with significant BMD reduction. Multivariate analysis at 6 months post-therapy identified age ≥30 years and EB-regimens as significant risk factors for BMD decrease >15%. Therapy-related BMD loss is common in HL patients. Its persistence is associated with age ≥30 years and EB treatment. Reduction of cumulative steroid doses and switch to non-gonadotoxic drugs should be considered.
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15
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Atsumi Y, Rino Y, Aoyama T, Okuda N, Kawahara S, Kazama K, Numata M, Tamagawa H, Oshima T, Yukawa N, Masuda M. A Gender Comparison of Bone Metabolic Changes After Gastric Cancer Surgery: A Prospective Observational Study. In Vivo 2021; 35:2341-2348. [PMID: 34182516 DOI: 10.21873/invivo.12510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND/AIM This study was designed to investigate gender-related differences in changes in bone metabolism after gastric cancer surgery. PATIENTS AND METHODS We prospectively recruited 47 patients (38 males and 9 females) who had early gastric cancer. The bone mineral density (BMD), serum levels of 1,25-dihydroxy vitamin D (1,25(OH)2VD), 25-hydroxy vitamin D (25(OH)VD), and estradiol (E2) were measured before and after surgery. RESULTS BMD significantly decreased 12 months after surgery by median degrees of 3.4% and 3.9% in male and female patients, respectively (p<0.001 and p=0.023). There was no significant difference between both genders in the rate of change in BMD after surgery. The serum E2 level in male patients significantly increased by a median value of 22 pg/ml 12 months after gastrectomy (p=0.030). Both the serum 25(OH)VD and 1,25(OH)2VD levels remained nearly within the normal range throughout the observation period in both male and female patients. CONCLUSION BMD significantly decreased within 12 months after gastrectomy in both male and female patients with gastric cancer, and there was no significant gender-related difference in the rate of change in BMD.
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Affiliation(s)
- Yosuke Atsumi
- Department of Surgery, Yokohama City University, Yokohama, Japan;
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Toru Aoyama
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Naoko Okuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | | | - Keisuke Kazama
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Masakatsu Numata
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Hiroshi Tamagawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Takashi Oshima
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Norio Yukawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
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16
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Celio L, Cortinovis D, Cogoni AA, Cavanna L, Martelli O, Carnio S, Collovà E, Bertolini F, Petrelli F, Cassano A, Chiari R, Zanelli F, Pisconti S, Vittimberga I, Letizia A, Misino A, Gernone A, Bonizzoni E, Pilotto S, De Placido S, Bria E. Dexamethasone-Sparing Regimens with Oral Netupitant and Palonosetron for the Prevention of Emesis Caused by High-Dose Cisplatin: A Randomized Noninferiority Study. Oncologist 2021; 26:e1854-e1861. [PMID: 34101934 PMCID: PMC8488764 DOI: 10.1002/onco.13851] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/25/2021] [Indexed: 11/19/2022] Open
Abstract
Background To reduce the overall exposure to dexamethasone (DEX) in patients receiving cisplatin‐based chemotherapy, we evaluated the noninferiority of DEX on day 1, with or without low‐dose DEX on days 2 and 3, combined with an oral fixed‐dose combination of netupitant and palonosetron (NEPA), compared with the guideline‐consistent use of 4‐day DEX. Patients and Methods In this open‐label, multicenter study, chemotherapy‐naïve patients undergoing high‐dose cisplatin (≥70 mg/m2), were given NEPA and DEX (12 mg) on day 1 and randomized (1:1:1 ratio) to receive either (a) no further DEX (DEX1), (b) oral DEX (4 mg daily) on days 2–3 (DEX3), or (c) DEX (4 mg twice daily) on days 2–4 (DEX4). The primary efficacy endpoint was complete response (CR: no emesis and no rescue medication) during the 5‐day overall phase. The noninferiority margin was set at −15% difference (DEX1 or DEX3 minus DEX4). Secondary efficacy endpoints included complete protection (CP: CR and none or mild nausea). Results Two‐hundred twenty‐eight patients, 76 in each arm, were assessable. Noninferiority was met for both DEX‐sparing regimens and the reference arm, with overall phase CR rates of 76.3% in each of the DEX1 and DEX3 arms and 75.0% in the DEX4 arm (95% confidence interval, −12.3% to 15% for each comparison). During the overall phase, CP rates were similar between groups. Conclusion A simplified regimen of NEPA plus single‐dose DEX offers comparable chemotherapy‐induced nausea and vomiting prevention throughout 5 days post‐chemotherapy with the advantage of sparing patients additional doses of DEX in the high–emetic‐risk setting of cisplatin‐based chemotherapy. Implications for Practice Dexamethasone (DEX) has traditionally played an integral role in the management of chemotherapy‐induced emesis. Although generally considered safe, even short‐term DEX use is associated with various side effects, and some evidence suggests that concurrent steroids may reduce the efficacy of immunotherapies. This study demonstrates comparable antiemetic control during the 5 days post‐chemotherapy with a simplified regimen of netupitant/palonosetron plus single‐dose DEX versus the standard 4‐day DEX reference treatment in high‐dose cisplatin. This represents a clinically relevant achievement as it not only simplifies antiemetic prophylaxis but also offers an opportunity to appropriately use in patients where caution with corticosteroid use is advised. This study was designed to test whether two different dexamethasone‐sparing regimens, when administered with NEPA, might provide the opportunity to reduce the total corticosteroid dose while maintaining the same degree of chemotherapy‐induced nausea and vomiting control in patients undergoing cisplatin‐based chemotherapy.
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Affiliation(s)
- Luigi Celio
- Oncology Unit, Azienda Socio Sanitaria Territoriale del Garda, Desenzano del Garda Hospital, Brescia, Italy
| | - Diego Cortinovis
- Medical Oncology Department, Azienda Socio Sanitaria Territoriale Monza San Gerardo Hospital, Monza, Italy
| | - Alessio Aligi Cogoni
- Medical Oncology Department, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Luigi Cavanna
- Oncology Department, Azienda Ospedaliera di Piacenza, Piacenza, Italy
| | - Olga Martelli
- Medical Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Simona Carnio
- Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Elena Collovà
- Cancer Centre Department, Oncology Unit, Azienda Socio Sanitaria Territoriale Ovest Milanese, Legnano Hospital, Legnano, Milan, Italy
| | - Federica Bertolini
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Fausto Petrelli
- Medical Oncology Unit, Azienda Socio Sanitaria Territoriale Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Alessandra Cassano
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy.,Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Rita Chiari
- Oncology Unit, AULSS6 Euganea, Padova, Italy
| | - Francesca Zanelli
- Medical Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Santa Maria Nuova, Reggio Emilia, Italy
| | - Salvatore Pisconti
- Medical Oncology Department, San Giuseppe Moscati Hospital, Statte, Taranto, Italy
| | - Isabella Vittimberga
- Department of Oncology, Azienda Socio Sanitaria Territoriale Lecco, Lecco, Italy
| | - Antonietta Letizia
- Department of Pneumology and Oncology, Azienda Ospedaliera di Rilievo Nazionale dei Colli-Ospedale Monaldi, Naples, Italy
| | - Andrea Misino
- Medical Oncology, Clinical Cancer Center "Giovanni Paolo II," Istituto di Ricovero e Cura a Carattere Scientifico, Bari, Italy
| | - Angela Gernone
- Medical Oncology Unit, University of Bari, Policlinico di Bari, Bari, Italy
| | - Erminio Bonizzoni
- Department of Clinical Science and Community. Section of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro," Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Sabino De Placido
- Clinical Medicine and Surgery Department, University of Naples "Federico II," Naples, Italy
| | - Emilio Bria
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy.,Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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17
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Suehiro M, Kojima Y, Takahashi M, Ito Y, Keira T, Ikegawa K, Minatogawa H, Tsugawa K, Tanaka T. Antiemetic Efficacy of Adding Olanzapine 5 mg to Aprepitant, Palonosetron and Dexamethasone-Sparing After Day Two for Cancer Patients Receiving Anthracycline and Cyclophosphamide. Cancer Manag Res 2021; 13:1617-1624. [PMID: 33628052 PMCID: PMC7898054 DOI: 10.2147/cmar.s280995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/15/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Chemotherapy-induced nausea and vomiting (CINV) decrease patient quality of life (QOL). We evaluated the efficacy of adding 5 mg Olz to a three-drug steroid-sparing antiemetic regimen (aprepitant, palonosetron, and dexamethasone-sparing after day two) for breast cancer (BC) patients receiving anthracycline plus cyclophosphamide (AC) chemotherapy. PATIENTS AND METHODS We retrospectively reviewed the records of 177 BC patients with no previous highly emetogenic chemotherapy history receiving AC plus the steroid-sparing three-drug regimen or the steroid-sparing four-drug regimen including Olz 5mg at our hospital between January 2012 and December 2018. The primary endpoint was complete response (CR), defined as no vomiting and no usage of rescue medication during the first AC cycle. We analyzed the odds ratio (OR) of the CR with 95% confidence interval (CI) in the three-drug group against the four-drug group. The OR was adjusted for types of anticancer drugs by the Cochran-Mantel-Haenszel (CMH) test. Secondary endpoints were incidences of nausea, anorexia, fatigue, and somnolence during the first cycle. RESULTS Compared to the three-drug group, the four-drug group demonstrated high incidence of no vomiting (71% vs 95%), a similar incidence of no rescue medication usage (50% vs 51%), and a similar CR rate (45% vs 49%). The OR of the CR rate in the three-drug group against the four-drug group after CMH adjustment for drug type was 0.958 (95% CI, 0.46-1.98). Compared to the three-drug group, the four-drug group demonstrated identical incidence of nausea (66%), but lower incidences of anorexia (78% vs 35%) and fatigue (86% vs 73%). The incidence of somnolence in the four-drug group was 49%. We did not have data of somnolence for the three-drug group in the records. CONCLUSION Adding 5 mg Olz to the steroid-sparing three-drug combination can reduce vomiting, anorexia, and fatigue, although there was no difference in CR rate.
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Affiliation(s)
- Marii Suehiro
- Department of Pharmacy, St. Marianna University School of Medicine Hospital, Kawasaki-shi, Kanagawa, 216-8511, Japan
| | - Yasuyuki Kojima
- Division of Breast and Endocrine Surgery, Department of Surgery, St. Marianna University School of Medicine Hospital, Kawasaki-shi, Kanagawa, 216-8511, Japan
| | - Masaki Takahashi
- Division of Medical Informatics, St. Marianna University School of Medicine Hospital, Kawasaki-shi, Kanagawa, 216-8511, Japan
| | - Yuka Ito
- Department of Pharmacy, Kawasaki Municipal Tama Hospital, Kawasak-shi, Kanagawa, 214-8525, Japan
| | - Takayuki Keira
- Department of Pharmacy, St. Marianna University School of Medicine Hospital, Kawasaki-shi, Kanagawa, 216-8511, Japan
| | - Kiwako Ikegawa
- Department of Pharmacy, St. Marianna University School of Medicine Hospital, Kawasaki-shi, Kanagawa, 216-8511, Japan
| | - Hiroko Minatogawa
- Department of Pharmacy, St. Marianna University School of Medicine Hospital, Kawasaki-shi, Kanagawa, 216-8511, Japan
| | - Koichiro Tsugawa
- Division of Breast and Endocrine Surgery, Department of Surgery, St. Marianna University School of Medicine Hospital, Kawasaki-shi, Kanagawa, 216-8511, Japan
| | - Tsuneaki Tanaka
- Department of Pharmacy, St. Marianna University School of Medicine Hospital, Kawasaki-shi, Kanagawa, 216-8511, Japan
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Efficacy of one-day versus multiple-day dexamethasone for chemotherapy-induced nausea and vomiting in lung cancer patients receiving carboplatin-based chemotherapy: a propensity score-matched analysis. Support Care Cancer 2021; 29:5029-5035. [PMID: 33590260 DOI: 10.1007/s00520-021-06061-8] [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: 12/08/2020] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Dexamethasone (DEX)-sparing strategies (one-day DEX) with palonosetron as doublet antiemetic prophylaxis have previously been studied. However, DEX-sparing regimens with 5-hydroxytryptamine-3 receptor antagonist (5-HT3RA) and aprepitant (APR), as triplet antiemetic prophylaxis, have not been evaluated. This study aimed to evaluate the efficacy of a combination of 5-HT3RA, APR, and DEX on day 1 of carboplatin (CBDCA)-based chemotherapy in patients with lung cancer. METHODS Data were pooled from a nationwide, multicenter, prospective observational study using propensity score-matched analysis to compare the incidence of chemotherapy-induced nausea and vomiting (CINV) between one- and multiple-day DEX regimens in combination with 5-HT3RA plus APR. RESULTS Incidence of delayed nausea was significantly higher in the one-day than in the multiple-day DEX group. Incidence of nausea was also significantly higher in the one-day than in the multiple-day DEX group on days 3-5. Kaplan-Meier curves for nausea showed a significant difference between the two groups; however, there was no significant difference in the occurrence of vomiting or the Kaplan-Meier curves of time to vomiting. CONCLUSION To the best of our knowledge, this study is the first to evaluate the efficacy of a DEX-sparing regimen by comparing one- and multiple-day DEX combined with 5-HT3RA and APR concerning CINV incidence in lung cancer patients receiving CBDCA-based chemotherapy. Antiemetic regimens of one-day DEX result in poor control of delayed nausea; therefore, we recommend the application of the DEX-sparing strategy only after careful patient selection while considering the development of nausea.
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Minatogawa H, Izawa N, Kawaguchi T, Miyaji T, Shimomura K, Kazunori H, Iihara H, Ohno Y, Inada Y, Arioka H, Morita H, Hida N, Sugawara M, Katada C, Nawata S, Ishida H, Tsuboya A, Tsuda T, Yamaguchi T, Nakajima TE. Study protocol for SPARED trial: randomised non-inferiority phase III trial comparing dexamethasone on day 1 with dexamethasone on days 1-4, combined with neurokinin-1 receptor antagonist, palonosetron and olanzapine (5 mg) in patients receiving cisplatin-based chemotherapy. BMJ Open 2020; 10:e041737. [PMID: 33334838 PMCID: PMC7747608 DOI: 10.1136/bmjopen-2020-041737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Dexamethasone (DEX) is administered for multiple days to prevent chemotherapy-induced nausea and vomiting for patients receiving highly emetogenic chemotherapy (HEC); however, its notorious side effects have been widely reported. Although our multicentre randomised double-blind comparative study verified non-inferiority of sparing DEX after day 2 of chemotherapy when combined with neurokinin-1 receptor antagonist (NK1-RA) and palonosetron (Palo) for patients receiving HEC regimen, DEX sparing was not non-inferior in patients receiving cisplatin (CDDP)-based HEC regimens in subgroup analysis. Recently, the efficacy of the addition of olanzapine (OLZ) to standard triple antiemetic therapy on HEC has been demonstrated by several phase III trials. This study aims to confirm non-inferiority of DEX sparing when it is combined with NK-1RA, Palo and OLZ in patients receiving CDDP-based HEC regimens. METHODS AND ANALYSIS This is a randomised, double-blind, phase III trial. Patients who are scheduled to receive CDDP ≥50 mg/m2 as initial chemotherapy are eligible. Patients are randomly assigned to receive either DEX on days 1-4 or DEX on day 1 combined with NK1-RA, Palo and OLZ (5 mg). The primary endpoint is complete response (CR) rate, defined as no emesis and no rescue medications during the delayed phase (24-120 hours post-CDDP administration). The non-inferiority margin is set at -15.0%. We assume that CR rates would be 75% in both arms. Two hundred and sixty-two patients are required for at least 80% power to confirm non-inferiority at a one-sided significance level of 2.5%. After considering the possibility of attrition, we set our final required sample size of 280. ETHICS AND DISSEMINATION The institutional review board approved the study protocol at each of the participating centres. The trial result will be presented at international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER UMIN000032269.
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Affiliation(s)
- Hiroko Minatogawa
- Department of Pharmacy, St.Marianna University School of Medicine Hospital, Kawasaki, Japan
| | - Naoki Izawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takashi Kawaguchi
- Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Tempei Miyaji
- Department of Clinical Trial Data Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Honda Kazunori
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | | | - Yasushi Ohno
- Department of Respirology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yusuke Inada
- Department of Pharmacy, Yokohama Rosai Hospital, Yokohama, Japan
| | - Hitoshi Arioka
- Department of Medical Oncology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Hajime Morita
- Department of Pharmacy, St. Marianna University Yokohama City Seibu Hospital, Yokohama, Japan
| | - Naoya Hida
- Department of Internal Medicine, St.Marianna University School of Medicine, Kawasaki, Japan
| | | | - Chikatoshi Katada
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shuichi Nawata
- Department of Hospital Pharmaceutics, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Hiroo Ishida
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Ayako Tsuboya
- Department of Pharmacy, St. Marianna University Kawasakishi Municipal Tama Hospital, Kawasaki, Japan
| | - Takashi Tsuda
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Hepato-Biliary-Pancreatic Center, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University School of Medicine, Sendai, Japan
| | - Takako Eguchi Nakajima
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
- Division of Kyoto Innovation Center for Next Generation Clinical Trials and iPS Cell Therapy, Kyoto University Hospital, Kyoto, Japan
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20
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Namikawa T, Yokota K, Iwabu J, Munekage M, Uemura S, Tsujii S, Maeda H, Kitagawa H, Karashima T, Kumon M, Inoue K, Kobayashi M, Hanazaki K. Incidence and risk factors of osteoporotic status in outpatients who underwent gastrectomy for gastric cancer. JGH OPEN 2020; 4:903-908. [PMID: 33102762 PMCID: PMC7578282 DOI: 10.1002/jgh3.12347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/14/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
Background and Aim Disorders in bone metabolism have long been recognized as typical sequelae of gastrectomy; however, the pathogenesis has not been fully elucidated, resulting in a variation of reported incidence. This study aimed to evaluate current bone health by measuring bone mineral density (BMD) in patients treated by gastrectomy for gastric cancer, with a focus on incidence and risk factors of osteoporosis. Methods The study enrolled 81 patients who underwent gastrectomy for gastric cancer at Kochi Medical School. BMD of the lumbar spine was measured by dual‐energy X‐ray mineral absorptiometry, with the results expressed as a percentage of the young adult mean (YAM). Clinical data were also obtained to investigate associations with BMD. Results Of the 81 study patients, 12 (14.8%) were deemed to have osteoporosis, defined by a percentage of YAM <70, with a dominance of females over males (66.7% vs 17.4%; P < 0.001). The median body weight, hemoglobin concentration, and serum alkaline phosphatase (ALP) level of the patients with osteoporosis was significantly lower than in those with a percentage of YAM ≥70 group (39.6 kg vs 53.1 kg, P < 0.001; 10.9 mg/dL vs 12.5 mg/dL, P = 0.010; 210 U/L vs 251 U/L, P = 0.002). Further analyses revealed a significant positive correlation between body weight and percentage of YAM (r = 0.441, P < 0.001). Despite the administration of bisphosphonates in these patients during this study, one acquired a bone fracture. Conclusion Osteoporosis was found in 14.8% of postoperative gastric cancer patients, with female gender, low body weight, and low ALP proposed as risk factors for osteoporosis and thus future bone fracture.
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Affiliation(s)
| | | | - Jun Iwabu
- Department of Surgery Kochi Medical School Nankoku Japan
| | | | - Sunao Uemura
- Department of Surgery Kochi Medical School Nankoku Japan
| | | | | | | | | | | | - Keiji Inoue
- Department of Urology Kochi Medical School Nankoku Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences Kochi Medical School Nankoku Japan
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21
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van der Vorst MJ, Toffoli EC, Beusink M, van Linde ME, van Voorthuizen T, Brouwer S, van Zweeden AA, Vrijaldenhoven S, Berends JC, Berkhof J, Verheul HM. Metoclopramide, Dexamethasone, or Palonosetron for Prevention of Delayed Chemotherapy-Induced Nausea and Vomiting After Moderately Emetogenic Chemotherapy (MEDEA): A Randomized, Phase III, Noninferiority Trial. Oncologist 2020; 26:e173-e181. [PMID: 32735029 PMCID: PMC7794169 DOI: 10.1634/theoncologist.2020-0305] [Citation(s) in RCA: 5] [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: 04/13/2020] [Accepted: 07/09/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND For the prevention of chemotherapy-induced nausea and vomiting (CINV) during the delayed phase (24-120 hours) after moderately emetogenic chemotherapy (MEC), the use of 3-day dexamethasone (DEX) is often recommended. This study compared the efficacy and safety of two DEX-sparing regimens with 3-day DEX, focusing on delayed nausea. PATIENTS AND METHODS This open-label, randomized, phase III study was designed to demonstrate noninferiority of two DEX-sparing regimens: ondansetron + DEX on day 1 + metoclopramide on days 2-3 (MCP arm), and palonosetron + DEX on day 1 (PAL arm) versus ondansetron on day 1 + DEX on days 1-3 (DEX arm) in chemotherapy-naïve patients receiving MEC. Primary efficacy endpoint was total control (TC; no emetic episodes, no use of rescue medication, no nausea) in the delayed phase. Noninferiority was defined as a lower 95% CI greater than the noninferiority margin set at -20%. Secondary endpoints included no vomiting, no rescue medication, no (significant) nausea, impact of CINV on quality of life, and antiemetics-associated side effects. RESULTS Treatment arms were comparable for 189 patients analyzed: predominantly male (55.7%), median age 65.0 years, colorectal cancer (85.7%), and oxaliplatin-based chemotherapy (81.5%). MCP demonstrated noninferiority to DEX for delayed TC (MCP 56.1% vs. DEX 50.0%; 95% CI, -11.3%, 23.5%). PAL also demonstrated noninferiority to DEX (PAL 55.6% vs. DEX 50.0%; 95% CI, -12.0%, 23.2%). There were no statistically significant differences for all secondary endpoints between treatment arms. CONCLUSION This study showed that DEX-sparing regimens are noninferior to multiple-day DEX in terms of delayed TC rate in patients undergoing MEC. ClinicalTrials.gov identifier. NCT02135510. IMPLICATIONS FOR PRACTICE Chemotherapy-induced nausea and vomiting (CINV) in the delayed phase (24-120 hours after chemotherapy) remains one of the most troublesome adverse effects associated with cancer treatment. In particular, delayed nausea is often poorly controlled. The role of dexamethasone (DEX) in the prevention of delayed nausea after moderately emetogenic chemotherapy (MEC) is controversial. This study is the first to include nausea assessment as a part of the primary study outcome to better gauge the effectiveness of CINV control and patients' experience. Results show that a DEX-sparing strategy does not result in any significant loss of overall antiemetic control: DEX-sparing strategies incorporating palonosetron or multiple-day metoclopramide are safe and at least as effective as standard treatment with a 3-day DEX regimen with ondansetron in controlling delayed CINV-and nausea in particular-following MEC.
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Affiliation(s)
- Maurice J.D.L. van der Vorst
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of Internal Medicine, Rijnstate HospitalArnhemThe Netherlands
| | - Elisa C. Toffoli
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Marlien Beusink
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Myra E. van Linde
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | - Saskia Brouwer
- Department of Internal Medicine, Rijnstate HospitalArnhemThe Netherlands
| | | | - Suzan Vrijaldenhoven
- Department of Internal Medicine, Noordwest ZiekenhuisgroepAlkmaarThe Netherlands
| | - Johan C. Berends
- Department of Internal Medicine, Noordwest ZiekenhuisgroepDen HelderThe Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Henk M.W. Verheul
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of Medical Oncology, RadboudumcNijmegenThe Netherlands
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22
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Celio L, Bonizzoni E, Zattarin E, Codega P, de Braud F, Aapro M. Impact of dexamethasone-sparing regimens on delayed nausea caused by moderately or highly emetogenic chemotherapy: a meta-analysis of randomised evidence. BMC Cancer 2019; 19:1268. [PMID: 31888544 PMCID: PMC6937643 DOI: 10.1186/s12885-019-6454-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 12/11/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Nausea can be particularly prominent during the delayed period. Therefore, we performed a meta-analysis of the available randomised evidence to assess the average effect of palonosetron plus one-day dexamethasone (DEX; also called the DEX-sparing strategy) compared with palonosetron plus 3-day DEX for control of chemotherapy-induced nausea and vomiting (CINV), focusing on delayed nausea. METHODS Eligible studies were identified through MEDLINE, Embase, and CENTRAL. Data on acute and delayed CINV were collected. Efficacy end points were complete response (CR; no vomiting, and no use of rescue medication), complete protection (CP; CR plus no clinically significant nausea), and total control (TC; CR plus no nausea) during the delayed period (days 2-5 after chemotherapy initiation). All randomised studies comparing palonosetron plus single-dose DEX (with or without another active agent) on day 1 followed by either no further DEX or additional DEX doses (both alone or in combination with another active agent) qualified. RESULTS Of 864 citations screened, 8 studies with 1970 patients were included in the meta-analysis. During the delayed period, the combined odds ratio (OR) for all comparisons was 0.92 (95% confidence interval [CI], 0.76-1.12) for CR, 0.85 (95% CI, 0.71-1.03) for CP, and 0.92 (95% CI, 0.77-1.11) for TC in patients undergoing moderately emetogenic chemotherapy (MEC) or anthracycline and cyclophosphamide-containing chemotherapy (AC). The absolute risk difference (RD) computations for all end points in the delayed period did not exceed the threshold of - 4% (range, - 1% to - 4%). The effect was similar in subgroups defined by various study design parameters. The absolute RD computations in the acute period did not exceed the threshold of 1% (range, 0 to 1%). For one-day vs. 3-day DEX, numbers needed to be treated in order for one additional patient to not experience CR, CP and TC over the delayed period were 100, 25 and 50, respectively. CONCLUSIONS This meta-analysis demonstrates that DEX-sparing regimens do not cause any significant loss in protection against not only vomiting but also nausea induced by single-day MEC or AC during the delayed period. These data should lead clinicians to optimise use of prophylactic DEX in clinical practice.
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Affiliation(s)
- Luigi Celio
- Medical Oncology Unit 1, Fondazione IRCCS "Istituto Nazionale dei Tumori", Via Venezian 1, 20133, Milan, Italy.
| | - Erminio Bonizzoni
- Section of Medical Statistics, Biometry and Epidemiology, University of Milan, Campus Cascina Rosa, Via Augusto Vanzetti 5, 20133, Milan, Italy
| | - Emma Zattarin
- Medical Oncology Unit 1, Fondazione IRCCS "Istituto Nazionale dei Tumori", Via Venezian 1, 20133, Milan, Italy
| | - Paolo Codega
- Medical Affairs Department, Italfarmaco SpA, Via dei Lavoratori 54, 20092, Cinisello Balsamo, Italy
| | - Filippo de Braud
- Medical Oncology Unit 1, Fondazione IRCCS "Istituto Nazionale dei Tumori", Via Venezian 1, 20133, Milan, Italy
| | - Matti Aapro
- Cancer Center, Clinique de Genolier, Route du Muids 3, 1272, Genolier, Switzerland
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Okada Y, Oba K, Furukawa N, Kosaka Y, Okita K, Yuki S, Komatsu Y, Celio L, Aapro M. One-Day Versus Three-Day Dexamethasone in Combination with Palonosetron for the Prevention of Chemotherapy-Induced Nausea and Vomiting: A Systematic Review and Individual Patient Data-Based Meta-Analysis. Oncologist 2019; 24:1593-1600. [PMID: 31217343 PMCID: PMC6975929 DOI: 10.1634/theoncologist.2019-0133] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/25/2019] [Indexed: 11/23/2022] Open
Abstract
Chemotherapy‐induced nausea and vomiting are common adverse effects associated with the use of cytotoxic chemotherapy drugs. This article evaluates differences in complete response rates and other antiemetic outcomes in dexamethasone‐spacing regimens. Background. A dexamethasone‐sparing regimen consisting of palonosetron plus 1‐day dexamethasone for the prevention of chemotherapy‐induced nausea and vomiting (CINV) has been studied previously. Here, we evaluate the noninferiority of the dexamethasone‐sparing regimen in overall antiemetic control using a meta‐analysis based on individual patient data (IPD). Materials and Methods. We conducted a systematic review for randomized trials reporting CINV outcomes for the comparison of palonosetron plus 1‐day dexamethasone (d1 arm) versus the same regimen followed by dexamethasone on days 2–3 after chemotherapy (d3 arm) in chemotherapy‐naïve adult patients undergoing either moderately emetogenic chemotherapy (MEC) or anthracycline plus cyclophosphamide (AC)‐containing chemotherapy. PubMed and MEDLINE were searched electronically. A manual search was also conducted. The primary endpoint was complete response (CR; no emesis and no rescue medication) in the overall 5‐day study period. The noninferiority margin was set at −8.0% (d1 arm−d3 arm). Results. Five studies (n = 1,194) were eligible for analysis and all IPD was collected. In the overall study period, the d1 arm showed noninferiority to the d3 arm for CR as well as complete control (pooled risk difference in CR rate − 1.5%, 95% confidence interval [CI] −7.1 to 4.0%, I2 = 0%; in complete control rate − 2.4%, 95% CI −7.7 to 2.9%, I2 = 0%). There was no significant interaction between dexamethasone regimen and risk factors (type of chemotherapy, sex, age, and alcohol consumption). Conclusion. This IPD meta‐analysis indicates that the dexamethasone‐sparing regimen is not associated with a significant loss in overall antiemetic control in patients undergoing MEC or AC‐containing chemotherapy, irrespective of known risk factors for CINV. Implications for Practice. Although dexamethasone in combination with other antiemetic agents has been used to prevent chemotherapy‐induced nausea and vomiting (CINV), it is of clinical importance to minimize total dose of dexamethasone in patients undergoing multiple cycles of emetogenic chemotherapy. This individual‐patient‐data meta‐analysis from five randomized controlled trials (1,194 patients) demonstrated a noninferiority of the dexamethasone‐sparing regimen for complete response and complete control of CINV. The outcomes were comparable across patients with different characteristics. These findings thus help physicians minimize use of the steroid and further reduce the burden of dexamethasone‐related side effects in patients undergoing multiple consecutive courses of emetogenic chemotherapy.
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Affiliation(s)
- Yuki Okada
- Department of Diabetes and Endocrinology, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan
- Department of Preventive Medicine and Environmental Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koji Oba
- Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Interfaculty Initiative in Information Studies, The University of Tokyo, Tokyo, Japan
| | - Naoto Furukawa
- Department of Obstetrics and Gynecology, Suita Municipal Hospital, Osaka, Japan
| | - Yoshimasa Kosaka
- Department of Breast and Endocrine Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kenji Okita
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoshi Yuki
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
| | - Yoshito Komatsu
- Department of Cancer Chemotherapy, Hokkaido University Hospital, Sapporo, Japan
| | - Luigi Celio
- Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matti Aapro
- Cancer Center, Clinique de Genolier, Genolier, Switzerland
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24
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Atsumi Y, Rino Y, Wada H, Kitani Y, Ozawa Y, Aoyama T, Oshima T, Yukawa N, Yoshikawa T, Masuda M. Changes in bone metabolism after gastric cancer surgery in male patients: a prospective observational study. Gastric Cancer 2019; 22:237-243. [PMID: 29748875 DOI: 10.1007/s10120-018-0835-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several retrospective studies have shown that bone disorders occur after gastric cancer surgery. This study was designed to prospectively evaluate the changes in bone metabolism after gastrectomy for gastric cancer. METHODS We prospectively enrolled 39 men with early gastric cancer who underwent gastrectomy. We excluded women to avoid the effects of menopause. We employed dual energy X-ray absorptiometry (DEXA) to measure bone mineral density (BMD) of the lumbar spine. DEXA was performed before and 1 and 2 years after surgery. The serum levels of alkaline phosphatase (ALP), 1,25-dihydroxy vitamin D [1,25(OH)2VD], 25-hydroxy vitamin D [25(OH)VD], and estradiol were measured before surgery and every 3 months until 2 years after surgery. RESULTS DEXA revealed that BMD significantly decreased by 0.036 ± 0.033 g/cm2 12 months after gastrectomy (P < 0.001) and by 0.046 ± 0.040 g/cm2 24 months after gastrectomy (P < 0.001). The serum ALP level significantly increased by 38.31 ± 103.8 IU/L 24 months after surgery (P = 0.013). The serum 25(OH)VD level significantly decreased by 4.88 ± 6.42 ng/ml 24 months after surgery (P < 0.001), whereas the serum 1,25(OH)2VD levels were consistently in the normal range. The serum estradiol level significantly increased by 2.94 ± 7.49 pg/ml 12 months after gastrectomy (P = 0.035). A lower preoperative body mass index (BMI) significantly correlated with the reduction in BMD 12 months after surgery; the correlation coefficient was 0.37 (P = 0.025). CONCLUSIONS This study showed that a significant decrease in BMD was observed for up to 24 months after gastrectomy, not only 12 months.
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Affiliation(s)
- Yosuke Atsumi
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan.
- Department of Surgery, Miura City Hospital, 4-33 Koyo-cho, Miura, Japan.
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Hiroo Wada
- Department of Surgery, Miura City Hospital, 4-33 Koyo-cho, Miura, Japan
| | - Yuichi Kitani
- Department of Surgery, Miura City Hospital, 4-33 Koyo-cho, Miura, Japan
| | - Yukihiro Ozawa
- Department of Surgery, Miura City Hospital, 4-33 Koyo-cho, Miura, Japan
| | - Toru Aoyama
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Takashi Oshima
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Norio Yukawa
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Takaki Yoshikawa
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
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25
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Hayashi T, Shimokawa M, Matsuo K, Miyoshi T, Toriyama Y, Yokota C, Taniguchi J, Hanada K, Tsumagari K, Okubo N, Koutake Y, Sakata K, Kawamata Y, Goto T, Tsurusaki Y, Koyabu M. Risk factors for delayed chemotherapy-induced nausea and vomiting with low-emetic-risk chemotherapy: a prospective, observational, multicenter study. Cancer Manag Res 2018; 10:4249-4255. [PMID: 30323680 PMCID: PMC6177523 DOI: 10.2147/cmar.s176574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Improvement in the control of delayed chemotherapy-induced nausea and vomiting (CINV) is needed. There is limited information on antiemetic prophylaxis for patients undergoing low-emetic-risk chemotherapy (LEC), and the optimal antiemetic treatment is not well understood. Therefore, we analyzed the risk factors for delayed CINV to aid in the development of individualized treatments. Patients and methods This prospective multicenter study was conducted in 13 hospitals and included patients with solid cancers undergoing LEC. A total of 222 patients were enrolled between September 2013 and November 2014. The participants completed a daily diary for 5 days after the commencement of the first cycle of LEC to describe the daily incidence of CINV (yes/no). Furthermore, the participants described the severity of nausea and the amount of food intake with the help of VAS. Results Two hundred and ten patients provided their data that were analyzed using multivariate logistic regression to examine the risk factors for delayed CINV. History of CINV, Eastern Cooperative Oncology Group performance status score ≥1, acute CINV, and single-day antiemetic prophylaxis were identified as independent risk factors for delayed CINV. Conclusion The current use of antiemetic prophylaxis according to the recommended guideline appears to effectively control delayed CINV in patients undergoing LEC. Therefore, patients with the abovementioned risk factors should be carefully observed, and their treatment should be adjusted according to their symptoms. The use of multiple-day dexamethasone may be beneficial for those patients who develop acute CINV, especially when it is accompanied by anorexia.
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Affiliation(s)
- Toshinobu Hayashi
- Department of Pharmacy, Clinical Research Institute, National Kyushu Medical Center, Fukuoka, Japan, .,Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan,
| | - Mototsugu Shimokawa
- Cancer Biostatistics Laboratory, Clinical Research Institute, National Kyushu Cancer Center, Fukuoka, Japan
| | - Koichi Matsuo
- Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan,
| | - Takanori Miyoshi
- Department of Pharmacy, National Hospital Organization Beppu Medical Center, Oita, Japan
| | - Yoko Toriyama
- Department of Pharmacy, National Hospital Organization Beppu Medical Center, Oita, Japan
| | - Chiaki Yokota
- Department of Pharmacy, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Jun Taniguchi
- Department of Pharmacy, National Hospital Organization Ureshino Medical Center, Saga, Japan
| | - Kiyonori Hanada
- Department of Pharmacy, National Hospital Organization Kumamoto Saishunso National Hospital, Kumamoto, Japan
| | - Kyouichi Tsumagari
- Department of Pharmacy, National Hospital Organization Miyakonojo Medical Center, Miyazaki, Japan
| | - Noriko Okubo
- Department of Pharmacy, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Yoshimichi Koutake
- Department of Pharmacy, National Hospital Organization Fukuoka National Hospital, Japan
| | - Kohei Sakata
- Department of Pharmacy, National Hospital Organization Kumamoto South National Hospital, Kumamoto, Japan
| | - Yosei Kawamata
- Department of Pharmacy, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Takashi Goto
- Department of Pharmacy, National Hospital Organization Kokura Medical Center, Kitakyushu, Japan
| | - Yasufumi Tsurusaki
- Department of Pharmacy, National Hospital Organization Saga National Hospital, Saga, Japan
| | - Makiko Koyabu
- Department of Pharmacy, Clinical Research Institute, National Kyushu Medical Center, Fukuoka, Japan,
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Celio L, Bonizzoni E, Aapro M. Is the Dexamethasone-Sparing Strategy Ready For Cisplatin? Too Early For an Answer. J Clin Oncol 2018; 36:2741-2742. [PMID: 29799771 DOI: 10.1200/jco.2018.78.8109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Luigi Celio
- Luigi Celio, Fondazione IRCCS "Istituto Nazionale dei Tumori," Milan, Italy; Erminio Bonizzoni, University of Milan, Milan, Italy; and Matti Aapro, Genolier Cancer Center, Genolier, Switzerland
| | - Erminio Bonizzoni
- Luigi Celio, Fondazione IRCCS "Istituto Nazionale dei Tumori," Milan, Italy; Erminio Bonizzoni, University of Milan, Milan, Italy; and Matti Aapro, Genolier Cancer Center, Genolier, Switzerland
| | - Matti Aapro
- Luigi Celio, Fondazione IRCCS "Istituto Nazionale dei Tumori," Milan, Italy; Erminio Bonizzoni, University of Milan, Milan, Italy; and Matti Aapro, Genolier Cancer Center, Genolier, Switzerland
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Ito Y, Tsuda T, Minatogawa H, Kano S, Sakamaki K, Ando M, Tsugawa K, Kojima Y, Furuya N, Matsuzaki K, Fukuda M, Sugae S, Ohta I, Arioka H, Tokuda Y, Narui K, Tsuboya A, Suda T, Morita S, Boku N, Yamanaka T, Nakajima TE. Placebo-Controlled, Double-Blinded Phase III Study Comparing Dexamethasone on Day 1 With Dexamethasone on Days 1 to 3 With Combined Neurokinin-1 Receptor Antagonist and Palonosetron in High-Emetogenic Chemotherapy. J Clin Oncol 2018; 36:1000-1006. [PMID: 29443652 DOI: 10.1200/jco.2017.74.4375] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose We evaluated the noninferiority of dexamethasone (DEX) on day 1, with sparing on days 2 and 3, combined with neurokinin-1 receptor antagonist (NK1-RA) and palonosetron (Palo) compared with the 3-day use of DEX in highly-emetogenic chemotherapy (HEC). Patients and Methods Patients who were scheduled to receive HEC (cisplatin ≥ 50 mg/m2 or anthracycline plus cyclophosphamide) were randomly assigned to receive either DEX on days 1 to 3 (Arm D3) or DEX on day 1 and placebo on days 2 and 3 (Arm D1) combined with NK1-RA and Palo. The primary end point was complete response (CR), defined as no emesis and no rescue medications during the overall (0 to 120 h) phase. The noninferiority margin was set at -15.0% (Arm D1 - Arm D3). Results A total of 396 patients-196 and 200 patients in Arms D3 and D1, respectively-were evaluated. CR rates during the overall period were 46.9% for Arm D3 and 44.0% for Arm D1 (95% CI, -12.6% to 6.8%; P = .007). CR rates during the acute (0 to 24 h) phase were 63.3% and 64.5% for Arms D3 and D1, respectively (95% CI, -8.1% to 10.6%; P < .001), and they were 56.6% and 51.5%, respectively, during the delayed (24 to 120 h) phase (95% CI, -14.8% to 4.6%; P = .023). Hot flushes and tremors were observed more frequently as DEX-related adverse events on days 4 and 5 in Arm D3, whereas anorexia, depression, and fatigue were observed more frequently on days 2 and 3 in Arm D1. As an indication of quality of life, global health status was similar in both arms. Conclusion Antiemetic DEX administration on days 2 and 3 can be spared when combined with NK1-RA and Palo in HEC.
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Affiliation(s)
- Yuka Ito
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Takashi Tsuda
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroko Minatogawa
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Sayaka Kano
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Kentaro Sakamaki
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Masahiko Ando
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Koichiro Tsugawa
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuyuki Kojima
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Naoki Furuya
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Kunihiro Matsuzaki
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Mamoru Fukuda
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Sadatoshi Sugae
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Ichiro Ohta
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Hitoshi Arioka
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Tokuda
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Kazutaka Narui
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Ayako Tsuboya
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Takashi Suda
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Morita
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Narikazu Boku
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Takeharu Yamanaka
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
| | - Takako Eguchi Nakajima
- Yuka Ito, Hiroko Minatogawa, and Sayaka Kano, St Marianna University School of Medicine Hospital; Takashi Tsuda, Koichiro Tsugawa, Yasuyuki Kojima, Naoki Furuya, Kunihiro Matsuzaki, Mamoru Fukuda, and Takako Eguchi Nakajima, St Marianna University School of Medicine; Ayako Tsuboya, Kawasaki Municipal Tama Hospital, Kawasaki; Kentaro Sakamaki and Takeharu Yamanaka, Yokohama City University School of Medicine; Sadatoshi Sugae and Ichiro Ohta, Yokohama City University Hospital; Hitoshi Arioka, Yokohama Rosai Hospital; Kazutaka Narui, Yokohama City University Medical Center, Yokohama; Masahiko Ando, Nagoya University Hospital, Nagoya; Yutaka Tokuda, Tokai University School of Medicine, Kanagawa; Takashi Suda, Takahata Public Hospital, Takahata-Chou; Satoshi Morita, Graduate School of Medicine, Kyoto University, Kyoto; and Narikazu Boku, National Cancer Center Hospital, Tokyo, Japan
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