Incidence and risk of hematologic toxicities in cancer patients treated with regorafenib

Glucans and applications in drug delivery

Glucan is a natural polysaccharide widely distributed in cereals and microorganisms that has various biological activities, including immunomodulatory, anti-infective, anti-inflammatory, and antitumor activities. In addition to wide applications in the broad fields of food, healthcare, and biomedicines, glucans hold promising potential as drug delivery carrier materials or ligands. Specifically, glucan microparticles or yeast cell wall particles are naturally enclosed vehicles with an interior cavity that can be exploited to carry and deliver drug payloads. The biological activities and targeting capacities of glucans depend largely on the recognition of glucan moieties by receptors such as dectin-1 and complement receptor 3, which are widely expressed on the cell membranes of mononuclear phagocytes, dendritic cells, neutrophils, and some lymphocytes. This review summarizes the chemical structures, sources, fundamental properties, extraction methods, and applications of these materials, with an emphasis on drug delivery. Glucans are utilized mainly as vaccine adjuvants, targeting ligands and as carrier materials for various drug entities. It is believed that glucans and glucan microparticles may be useful for the delivery of both small-molecule and macromolecular drugs, especially for potential treatment of immune-related diseases.

Lentinan as a natural stabilizer with bioactivities for preparation of drug-drug nanosuspensions

Lentinan is a natural β-glucan with various bioactivities and is combined with chemotherapy drugs for cancer treatment. Regorafenib is an oral multi-kinase inhibitor approved by FDA for treatment of metastatic colorectal cancer, advanced hepatocellular carcinoma, and metastatic gastrointestinal stromal tumors. Regorafenib has poor water solubility and multiple toxicities. We report drug-drug nanosuspensions of regorafenib and lentinan. Results of dynamic light scattering and scanning electron microscopy showed that the mean particle size of the regorafenib-lentinan nanosuspensions was approximately 200 nm and was uniformly distributed. Transmission electron microscopy findings indicated that lentinan stabilized the nanosuspensions by steric manner. Hydrogen bonds and hydrophobic interactions were found between regorafenib and lentinan by molecular dynamics simulation. The results of cytotoxicity assay and pharmacokinetics study in rats showed that the regorafenib-lentinan nanosuspensions reduced the toxicity and enhanced the in vitro anticancer activity and oral bioavailability of regorafenib. Lentinan as a natural stabilizer has the potential using for drug nanosuspensions. Drug-drug nanosuspensions are a new form of combination therapies that can reduce the number of drugs taken by patients and improve their compliance.

Regorafenib-induced exacerbation of chronic immune thrombocytopenic purpura in remission: A case report

Regorafenib is an oral multi-kinase inhibitor which targets tumor angiogenesis, the tumor microenvironment and oncogenesis. Based on this mode of action, regorafenib has a broad spectrum of toxicities. However, at present, few reports have focused on autoimmune adverse events. We report a first case of regorafenib-induced exacerbation of chronic immune thrombocytopenic purpura in remission during treatment for the patients with heavily treated advanced colorectal cancer. This case report highlights the need for caution with regard to regorafenib treatment in patients with cancer with concomitant immune thrombocytopenic purpura.