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Spencer AS, da Silva Dias D, Capelas ML, Pimentel F, Santos T, Neves PM, Mäkitie A, Ravasco P. Managing Severe Dysgeusia and Dysosmia in Lung Cancer Patients: A Systematic Scoping Review. Front Oncol 2021; 11:774081. [PMID: 34881185 PMCID: PMC8646025 DOI: 10.3389/fonc.2021.774081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Lung cancer (LC) is highly prevalent worldwide, with elevated mortality. In this population, taste and smell alterations (TSAs) are frequent but overlooked symptoms. The absence of effective therapeutic strategies and evidence-based guidelines constrain TSAs’ early recognition, prevention and treatment (Tx), promoting cancer-related malnutrition and jeopardizing survival outcomes and quality of life. Objectives To systematically review the literature on TSAs in LC patients, understand the physiopathology, identify potential preventive and Tx strategies and to further encourage research in this area. Methods Literature search on English language articles indexed to PubMed, CINALH, SCOPUS and Web of Science using MeSH terms “Lung neoplasms”,”Dysgeusia”, “Olfaction Disorders”, “Carcinoma, Small Cell”,”Carcinoma, Non- Small-Cell Lung “Adenocarcinoma of Lung”,”Carcinoma, Large Cell”, and non-MeSH terms “Parageusia”, “Altered Taste”, “Smell Disorder”, “Paraosmia”, “Dysosmia”,”Lung Cancer” and “Oat Cell Carcinoma”. Results Thirty-four articles were reviewed. TSAs may follow the diagnosis of LC or develop during cancer Tx. The estimated prevalence of self-reported dysgeusia is 35-38% in treatment-naïve LC patients, and 35-69% in those undergoing Tx, based on studies involving LC patients only. One prospective pilot trial and 1 RCT demonstrated a clinically significant benefit in combining flavor enhancement, smell and taste training and individualized nutritional counselling; a systematic review, 1 RCT and 1 retrospective study favored using intravenous or oral zinc-based solutions (150mg 2-3 times a day) for the prevention and Tx of chemotherapy (CT) and radiotherapy (RT) -induced mucositis and subsequent dysgeusia. Conclusions This is the first review on dysgeusia and dysosmia in LC patients to our knowledge. We propose combining taste and smell training, personalized dietary counselling and flavor enhancement with oral zinc-based solutions (150mg, 2-3 times a day) during CT and/or RT in this population, in order to prevent and help ameliorate Tx-induced dysgeusia and mucositis. However due to study heterogeneity, the results should be interpreted with caution. Developing standardized TSA measurement tools and performing prospective randomized controlled trials to evaluate their effect are warranted.
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Affiliation(s)
- Ana Sofia Spencer
- Department of Medical Oncology, Centro Hospitalar Universitário de Lisboa Central, Hospital de Santo António dos Capuchos, Lisbon, Portugal
| | - David da Silva Dias
- Department of Medical Oncology, Centro Hospitalar Universitário do Algarve, Hospital de Faro, Faro, Portugal.,Centre for Interdisciplinary Research in Health of Universidade Católica Portuguesa (UCP), Lisbon, Portugal.,CatolicaMed Platform of of Universidade Católica Portuguesa (UCP), Lisbon, Portugal
| | - Manuel Luís Capelas
- Centre for Interdisciplinary Research in Health of Universidade Católica Portuguesa (UCP), Lisbon, Portugal.,Universidade Católica Portuguesa (UCP), Institute of Health Sciences, Centre for Interdisciplinary Research in Health (CIIS), Lisbon, Portugal
| | | | - Teresa Santos
- Centre for Interdisciplinary Research in Health of Universidade Católica Portuguesa (UCP), Lisbon, Portugal.,CatolicaMed Platform of of Universidade Católica Portuguesa (UCP), Lisbon, Portugal.,European University, Lisbon, Portugal.,Católica Medical School, Universidade Católica Portuguesa (UCP), Lisbon, Portugal
| | - Pedro Miguel Neves
- Centre for Interdisciplinary Research in Health of Universidade Católica Portuguesa (UCP), Lisbon, Portugal.,CatolicaMed Platform of of Universidade Católica Portuguesa (UCP), Lisbon, Portugal
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Paula Ravasco
- Centre for Interdisciplinary Research in Health of Universidade Católica Portuguesa (UCP), Lisbon, Portugal.,CatolicaMed Platform of of Universidade Católica Portuguesa (UCP), Lisbon, Portugal.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Quinta da Granja, Monte de Caparica, Caparica, Portugal
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Saldi S, Perrucci E, Fulcheri CPL, Mariucci C, Chierchini S, Ingrosso G, Falcinelli L, Podlesko AM, Merluzzi M, Bini V, Aristei C. Zinc-L-carnosine prevented dysphagia in breast cancer patients undergoing adjuvant radiotherapy: Results of a phase III randomized trial. Breast J 2020; 26:1882-1884. [PMID: 32383225 DOI: 10.1111/tbj.13855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Simonetta Saldi
- Radiation Oncology Section, Perugia General Hospital, Perugia, Italy
| | | | | | - Cristina Mariucci
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Sara Chierchini
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Gianluca Ingrosso
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | | | - Anna Maria Podlesko
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Mara Merluzzi
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Vittorio Bini
- Internal Medicine, Endocrinology & Metabolism, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
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Furihata K, Tsuchikawa M, Miwa T, Naito Y, Oba K, Sakagami M. Efficacy and Safety of Polaprezinc (Zinc Compound) on Zinc Deficiency: A Systematic Review and Dose-Response Meta-Analysis of Randomized Clinical Trials Using Individual Patient Data. Nutrients 2020; 12:nu12041128. [PMID: 32316581 PMCID: PMC7230469 DOI: 10.3390/nu12041128] [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] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 01/27/2023] Open
Abstract
Zinc intake is recommended for zinc deficiency. In clinical practice, polaprezinc has been used as a zinc replacement therapy for zinc deficiency. However, the efficacy of polaprezinc has not been established. To confirm the efficacy on zinc deficiency of polaprezinc and provide additional information on an appropriate regimen, we conducted a systematic review using individual patient data (IPD). We searched PubMed, the Japanese database Ichushi, and the database owned by the marketing authorization holder of polaprezinc. Randomized placebo-controlled trials that reported the serum zinc concentration were eligible. The mean difference of the change from baseline in serum zinc concentration was estimated using a fixed-effects model. The linear dose-response relationship and the subgroup effects were also assessed. Out of 54 unique randomized clinical trials (RCTs), four studies met the eligibility criteria, and we could access IPD for all of them. All three doses of polaprezinc (75 mg, 150 mg, and 300 mg) and the placebo group were examined. The dose-combined overall polaprezinc increased the change from baseline by a mean of 9.08 µg/dL (95% confidence interval: 5.46, 12.70; heterogeneity: I2 = 0.61%) compared to the placebo. A significant dose-response relationship was confirmed (p < 0.001). Baseline serum zinc concentration was considered an effect modifier in polaprezinc 300 mg. All doses of polaprezinc were tolerable, but a dose-response relationship with adverse events (AEs) was observed in gastrointestinal disorders. The dose of 300 mg may be useful among patients with baseline serum zinc concentration of less than 70 µg/dL, and 150 mg for 70 µg/dL or more.
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Affiliation(s)
- Kei Furihata
- Biostatistics, Data Science, Clinical Administration, Zeria Pharmaceutical Co., Ltd., 10-11, Nihonbashi Kobuna-cho, Chuo-ku, Tokyo 103-8351, Japan
| | - Masaru Tsuchikawa
- Biostatistics, Data Science, Clinical Administration, Zeria Pharmaceutical Co., Ltd., 10-11, Nihonbashi Kobuna-cho, Chuo-ku, Tokyo 103-8351, Japan
- Correspondence: ; Tel.: +81-3-3663-0533
| | - Takaki Miwa
- Department of Otorhinolaryngology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293, Japan
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-chi, Kawaramachi-Hirokoji Kamigyo-ku, Kyoto 602-8566, Japan
| | - Koji Oba
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Masafumi Sakagami
- Department of Otolaryngology-Head and Neck Surgery, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501, Japan
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Dietterle J, Oppermann H, Glasow A, Neumann K, Meixensberger J, Gaunitz F. Carnosine increases efficiency of temozolomide and irradiation treatment of isocitrate dehydrogenase-wildtype glioblastoma cells in culture. Future Oncol 2019; 15:3683-3691. [PMID: 31664860 DOI: 10.2217/fon-2019-0447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The naturally occurring dipeptide carnosine (CAR) has been considered for glioblastoma therapy. As CAR also protects against ionizing irradiation (IR), we investigated whether it may counteract standard therapy consisting of postsurgery IR and treatment with temozolomide (TMZ). Materials & methods: Four isocitrate dehydrogenase-wildtype primary cell cultures were exposed to different doses of IR and different concentrations of TMZ and CAR. After exposure, viability under the different conditions and combinations of them was determined. Results: All cultures responded to treatment with TMZ and IR with reduced viability. CAR further decreased viability when TMZ and IR were combined. Conclusion: Treatment with CAR does not counteract glioblastoma standard therapy. As the dipeptide also protects nontumor cells from IR, it may reduce deleterious side effects of treatment.
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Affiliation(s)
- Johannes Dietterle
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Henry Oppermann
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Annegret Glasow
- Department of Radiooncology, University of Leipzig, Leipzig, Germany
| | | | | | - Frank Gaunitz
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
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Thomsen M, Vitetta L. Zinc deficits, mucositis, and mucosal macrophage perturbation: is there a relationship? Curr Opin Clin Nutr Metab Care 2019; 22:365-370. [PMID: 31335336 DOI: 10.1097/mco.0000000000000588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Mucositis is a common and therapy-limiting adverse effect of cancer treatments including radiotherapy, chemotherapy, and immunotherapy. The optimal zinc formulation, dosage, and timing of administration warrant further research as does the efficacious prevention of febrile mucositis that predisposes to febrile neutropenia. RECENT FINDINGS Metaanalyses concluded that zinc sulfate failed to significantly reduce the incidence or severity of chemotherapy-induced oral mucositis, whereas polaprezinc was associated with a significant reduction. Three new trials were published in 2018. The first trial found that zinc sulfate reduced the incidence and severity of chemotherapy-induced oral mucositis. The second reported that polaprezinc reduced oral mucositis in pediatric patients receiving high-dose chemotherapy for hematopoietic stem cell transplantation. The third trial demonstrated efficacy for a zinc lozenge for postoperative sore throat induced by an endotracheal intubation. SUMMARY Zinc deficits, dietary or induced by cancer, are common in patients with cancer. Febrile mucositis may better describe the condition linking mucositis with febrile neutropenia. Febrile mucositis disrupts treatment and may be life-threatening. A paradigm shift is needed for a more comprehensive understanding of febrile mucositis. Zinc effects on the thymic immunological network and T lymphocytes during chemoradiotherapy regimens also warrant further investigation.
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Affiliation(s)
| | - Luis Vitetta
- The University of Sydney, Sydney Medical School
- Medlab Clinical Ltd., Sydney, New South Wales, Australia
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Pivotal role of carnosine in the modulation of brain cells activity: Multimodal mechanism of action and therapeutic potential in neurodegenerative disorders. Prog Neurobiol 2018; 175:35-53. [PMID: 30593839 DOI: 10.1016/j.pneurobio.2018.12.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/13/2018] [Accepted: 12/23/2018] [Indexed: 12/24/2022]
Abstract
Carnosine (β-alanyl-l-histidine), a dipeptide, is an endogenous antioxidant widely distributed in excitable tissues like muscles and the brain. Although discovered more than a hundred years ago and having been extensively studied in the periphery, the role of carnosine in the brain remains mysterious. Carnosinemia, a rare metabolic disorder with increased levels of carnosine in urine and low levels or absence of carnosinase in the blood, is associated with severe neurological symptoms in humans. This review deals with the role of carnosine in the brain in both physiological and pathological conditions, with a focus on preclinical evidence suggesting a high therapeutic potential of carnosine in neurodegenerative disorders. We review carnosine and carnosinemia's discoveries and the extensive research on the role and benefits of carnosine in the periphery. We then turn to carnosine's biochemistry and distribution in the brain. Using an array of recent observations as a foundation, we draw a parallel with the role of carnosine in muscles and speculate on the role of carnosine in promoting the metabolic support of neurons by glial cells. Finally, carnosine has been shown to exert a multimodal activity including inhibition of protein cross-linking and aggregation of amyloid-β and related proteins, free radical generation, nitric oxide detoxification, and an anti-inflammatory activity. It could thus play an important role in the prevention and treatment of neurodegenerative diseases such as Alzheimer's disease. We discuss the potential of carnosine in this context and speculate on new preclinical research directions.
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