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Madeddu C, Neri M, Sanna E, Oppi S, Macciò A. Experimental Drugs for Chemotherapy- and Cancer-Related Anemia. J Exp Pharmacol 2021; 13:593-611. [PMID: 34194245 PMCID: PMC8238072 DOI: 10.2147/jep.s262349] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/21/2021] [Indexed: 01/03/2023] Open
Abstract
Anemia in cancer patients is a relevant condition complicating the course of the neoplastic disease. Overall, we distinguish the anemia which arises under chemotherapy as pure adverse event of the toxic effects of the drugs used, and the anemia induced by the tumour-associated inflammation, oxidative stress, and systemic metabolic changes, which can be worsened by the concomitant anticancer treatments. This more properly cancer-related anemia depends on several overlapping mechanism, including impaired erythropoiesis and functional iron deficiency, which make its treatment more difficult. Standard therapies approved and recommended for cancer anemia, as erythropoiesis-stimulating agents and intravenous iron administration, are limited to the treatment of chemotherapy-induced anemia, preferably in patients with advanced disease, in view of the still unclear effect of erythropoiesis-stimulating agents on tumour progression and survival. Outside the use of chemotherapy, there are no recommendations for the treatment of cancer-related anemia. For a more complete approach, it is fundamentally a careful evaluation of the type of anemia and iron homeostasis, markers of inflammation and changes in energy metabolism. In this way, anemia management in cancer patient would permit a tailored approach that could give major benefits. Experimental drugs targeting hepcidin and activin II receptor pathways are raising great expectations, and future clinical trials will confirm their role as remedies for cancer-related anemia. Recent evidence on the effect of integrated managements, including nutritional support, antioxidants and anti-inflammatory substances, for the treatment of cancer anemia are emerging. In this review article, we show standard, innovative, and experimental treatment used as remedy for anemia in cancer patients.
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Affiliation(s)
- Clelia Madeddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Manuela Neri
- Department of Gynecologic Oncology, A. Businco Hospital, ARNAS G. Brotzu, Cagliari, Italy
| | - Elisabetta Sanna
- Department of Gynecologic Oncology, A. Businco Hospital, ARNAS G. Brotzu, Cagliari, Italy
| | - Sara Oppi
- Hematology and Transplant Center, A. Businco Hospital, ARNAS G. Brotzu, Cagliari, Italy
| | - Antonio Macciò
- Department of Gynecologic Oncology, A. Businco Hospital, ARNAS G. Brotzu, Cagliari, Italy
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do Nascimento Santos Lima E, Ferreira IB, Lajolo PP, Paiva CE, de Paiva Maia YC, das Graças Pena G. Health-related quality of life became worse in short-term during treatment in head and neck cancer patients: a prospective study. Health Qual Life Outcomes 2020; 18:307. [PMID: 32938480 PMCID: PMC7493852 DOI: 10.1186/s12955-020-01543-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/26/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Quality of life (QoL) is influenced in head and neck cancer (HNC) patients by a set of factors related to diagnosis, treatment and tumor impacts. The aim of this study was to evaluate the Quality of Life (QoL) changes in Head and Neck cancer (HNC) patients during treatment (radiotherapy and/or chemoradiotherapy). METHODS QoL was evaluated prospectively in 63 HNC patients during radiotherapy and/or chemoradiotherapy at three moments: before or at beginning (T0), in the middle (T1 ~ four weeks) and immediately at the end (T2 ~ eight weeks) of treatment. The differences between the scores at different time points was verified using Friedman's non-parametric test. Negative changes between time points were evaluated, with differences (delta) of ±10 points being considered to be clinically significant. RESULTS The total mean age was 59.1 ± 9.5y, and 82.5% were male. The oral cavity and larynx were more frequent tumors. The functional score for 'role' was decreased at time points T1 and T2 as compared to T0, while an improvement in scores was observed for cognitive function. Several physical symptoms also worsened over time, such as: fatigue, nausea and vomiting, dry mouth and sticky saliva, swallowing and skin symptoms, senses and teeth problems. A high frequency of altered and clinically meaningful values were observed for most of domains, ranging from 6 to 74%. CONCLUSIONS The QoL became worse at approximately one month after treatment beginning in HNC patients, and this remained until the end of therapy. Protocols directing to early nutritional counseling and management of symptoms of nutritional impact are important to improve clinical outcomes. This is part of preventive actions aiming to make the exhausting treatment process less traumatic and easier to complete.
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Affiliation(s)
- Emanuelle do Nascimento Santos Lima
- Graduate Program in Health Sciences, Federal University of Uberlandia, Pará Av, 1720 / 2U, Campus Umuarama, Uberlandia, Minas Gerais 38400-902 Brazil
| | - Isabela Borges Ferreira
- Graduate Program in Health Sciences, Federal University of Uberlandia, Pará Av, 1720 / 2U, Campus Umuarama, Uberlandia, Minas Gerais 38400-902 Brazil
| | - Paula Philbert Lajolo
- Department of Clinical Oncology, Clinical Hospital, Federal University of Uberlandia, Pará Av, 1720 / sala 9, Campus Umuarama, Uberlandia, Minas Gerais 38.405-320 Brazil
| | - Carlos Eduardo Paiva
- Department of Clinical Oncology and Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, Antenor Duarte Viléla St, 1331, Dr. Paulo Prata, Barretos, SP 14784-400 Brazil
| | - Yara Cristina de Paiva Maia
- School of Medicine; Nutrition Course, Federal University of Uberlandia, Pará Av, 1720 / 2U, Campus Umuarama, Uberlandia, Minas Gerais 38400-902 Brazil
| | - Geórgia das Graças Pena
- School of Medicine; Nutrition Course, Federal University of Uberlandia, Pará Av, 1720 / 2U, Campus Umuarama, Uberlandia, Minas Gerais 38400-902 Brazil
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Okubo H, Ando H, Ishizuka K, Kitagawa R, Okubo S, Saito H, Kokubu S, Miyazaki A, Ikejima K, Shiina S, Nagahara A. Carnitine insufficiency is associated with fatigue during lenvatinib treatment in patients with hepatocellular carcinoma. PLoS One 2020; 15:e0229772. [PMID: 32126131 PMCID: PMC7053710 DOI: 10.1371/journal.pone.0229772] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/14/2020] [Indexed: 11/19/2022] Open
Abstract
Background Fatigue is a common adverse event during lenvatinib treatment in patients with hepatocellular carcinoma. One mechanism contributing to development of fatigue might involve abnormal adenosine triphosphate synthesis that is caused by carnitine deficiency. To address this possibility, we examined the relationship between carnitine levels and fatigue during lenvatinib treatment. Methods This prospective study evaluated 20 patients with hepatocellular carcinoma who underwent lenvatinib treatment. Both blood and urine samples were collected from the patients before starting lenvatinib therapy (day 0), and on days 3, 7, 14, and 28 thereafter. Plasma and urine concentrations of free and acyl carnitine (AC) were assessed at each time point. The changes in daily fatigue were evaluated using the Brief Fatigue Inventory (BFI). Results Plasma levels of free carnitine (FC) at days 3 and 7 were significantly higher compared with baseline (p = 0.005, p = 0.005, respectively). The urine FC level at day 3 was significantly higher compared with baseline (p = 0.030) and that of day 7 tended to be higher compared with baseline (p = 0.057). The plasma AC concentration at days 14 and 28 was significantly higher compared with that of baseline (p = 0.002, p = 0.005, respectively). The plasma AC-to-FC (AC/FC) ratio on days 14 and 28 was significantly higher compared with baseline (p = 0.001, p = 0.003, respectively). There were significant correlations between the plasma AC/FC ratio and the change in the BFI score at days 14 and 28 (r = 0.461, p = 0.041; r = 0.770, p = 0.002, respectively). Conclusions Longitudinal assessments of carnitine and fatigue in patients with hepatocellular carcinoma suggest that lenvatinib affects the carnitine system in patients undergoing lenvatinib therapy and that carnitine insufficiency increases fatigue. The occurrence of carnitine insufficiency may be a common cause of fatigue during the treatment.
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Affiliation(s)
- Hironao Okubo
- Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Hitoshi Ando
- Department of Cellular and Molecular Function Analysis, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Kei Ishizuka
- Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Ryuta Kitagawa
- Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Shoki Okubo
- Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Shigehiro Kokubu
- Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo, Japan.,Department of Gastroenterology, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Akihisa Miyazaki
- Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kenichi Ikejima
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shuichiro Shiina
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
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Adnan A, Högmo A, Sjödin H, Gebre-Medhin M, Laurell G, Reizenstein J, Farnebo L, Norberg LS, Notstam I, Holmberg E, Cange HH, Hammerlid E. Health-related quality of life among tonsillar carcinoma patients in Sweden in relation to treatment and comparison with quality of life among the population. Head Neck 2020; 42:860-872. [PMID: 32040223 DOI: 10.1002/hed.26064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/11/2019] [Accepted: 12/17/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The health-related quality of life (HRQOL) of tonsillar carcinoma survivors was explored to investigate any HRQOL differences associated with tumor stage and treatment. The survivors' HRQOL was also compared to reference scores from the population. METHODS In this exploratory cross-sectional study patients were invited 15 months after their diagnosis and asked to answer two quality of life questionnaires (EORTC QLQ- C30, EORTC QLQ- HN35), 405 participated. RESULTS HRQOL was associated with gender, with males scoring better than females on a few scales. Patients' HRQOL was more associated with treatment than tumor stage. Patients' HRQOL was worse than that in an age- and sex-matched reference group from the normal population, the largest differences were found for problems with dry mouth followed by problems with sticky saliva, senses, swallowing and appetite loss. CONCLUSIONS The tonsillar carcinoma patients had a worse HRQOL compared to the general population one year after treatment.
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Affiliation(s)
- Ali Adnan
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Högmo
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Hospital, Stockholm, Sweden
| | - Helena Sjödin
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Hospital, Stockholm, Sweden
| | - Maria Gebre-Medhin
- Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden
| | - Göran Laurell
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head & Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Johan Reizenstein
- Department of Oncology, Örebro University Hospital and Örebro University, Sweden
| | - Lovisa Farnebo
- Division of Otorhinolaryngology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Lena S Norberg
- Department of Clinical Sciences/ENT, Umeå University, Umeå, Sweden
| | - Isak Notstam
- Department of Clinical Sciences/ENT, Umeå University, Umeå, Sweden
| | - Erik Holmberg
- Regional Cancer Center Western Sweden, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hedda H Cange
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Hammerlid
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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Effects of l-carnitine administration on health-related quality of life during cisplatin-based chemoradiotherapy in patients with head and neck squamous cell carcinoma. Auris Nasus Larynx 2019; 46:431-436. [DOI: 10.1016/j.anl.2018.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 07/29/2018] [Accepted: 10/02/2018] [Indexed: 11/18/2022]
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Inglis JE, Lin PJ, Kerns SL, Kleckner IR, Kleckner AS, Castillo DA, Mustian KM, Peppone LJ. Nutritional Interventions for Treating Cancer-Related Fatigue: A Qualitative Review. Nutr Cancer 2019; 71:21-40. [PMID: 30688088 DOI: 10.1080/01635581.2018.1513046] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cancer-related fatigue (CRF) is a debilitating syndrome that persists for many cancer survivors for years after treatment. Symptoms include early and persistent fatigue, functional decline, depression, and cognitive difficulties. Inflammation, assessed using pro-inflammatory biomarkers, is increased in cancer survivors with fatigue and treatments for fatigue are often aimed at reducing inflammation. Additionally, cancer and its treatment lead to nutritional complications, changes in body composition, and nutritional deficiencies that potentially weaken the cancer survivor and impact CRF. We conducted a qualitative review of clinical trials that assessed nutritional interventions for preventing and treating CRF. Further studies were examined that used nutritional interventions to address inflammation and fatigue, due to the dearth of nutrition research directly related to CRF. Dietary intake prior to, during, and after cancer treatment appears to affect fatigue levels. Increased protein intake may help preserve lean mass and body composition. Dietary patterns that reduce inflammation, such as the Mediterranean diet and other plant-based diets, appear tolerable to cancer survivors and may reduce fatigue. Supplementation with ginseng, ginger, or probiotics may improve cancer survivors' energy levels. Nutritional interventions, alone or in combination with other interventions should be considered as therapy for fatigue in cancer survivors.
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Affiliation(s)
- Julia E Inglis
- a Department of Surgery , University of Rochester Medical Center (URMC) , Rochester , New York , USA
| | - Po-Ju Lin
- a Department of Surgery , University of Rochester Medical Center (URMC) , Rochester , New York , USA
| | - Sarah L Kerns
- b Department of Radiation Oncology , University of Rochester Medical Center (URMC) , Rochester , New York , USA
| | - Ian R Kleckner
- a Department of Surgery , University of Rochester Medical Center (URMC) , Rochester , New York , USA
| | - Amber S Kleckner
- a Department of Surgery , University of Rochester Medical Center (URMC) , Rochester , New York , USA
| | - Daniel A Castillo
- c Edward G. Miner Library, University of Rochester Medical Center (URMC) , Rochester , New York , USA
| | - Karen M Mustian
- a Department of Surgery , University of Rochester Medical Center (URMC) , Rochester , New York , USA
| | - Luke J Peppone
- a Department of Surgery , University of Rochester Medical Center (URMC) , Rochester , New York , USA
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Marx W, Teleni L, Opie RS, Kelly J, Marshall S, Itsiopoulos C, Isenring E. Efficacy and Effectiveness of Carnitine Supplementation for Cancer-Related Fatigue: A Systematic Literature Review and Meta-Analysis. Nutrients 2017; 9:nu9111224. [PMID: 29112178 PMCID: PMC5707696 DOI: 10.3390/nu9111224] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/29/2017] [Accepted: 11/03/2017] [Indexed: 11/29/2022] Open
Abstract
Background: Carnitine deficiency has been implicated as a potential pathway for cancer-related fatigue that could be treated with carnitine supplementation. The aim of this systematic literature review and meta-analysis was to evaluate the literature regarding the use of supplemental carnitine as a treatment for cancer-related fatigue. Methods: Using the PRISMA guidelines, an electronic search of the Cochrane Library, MEDLINE, Embase, CINAHL and reference lists was conducted. Data were extracted and independently assessed for quality using the Academy of Nutrition and Dietetics evidence analysis by two reviewers. In studies with positive quality ratings, a meta-analysis was performed using the random-effects model on Carnitine and cancer-related fatigue. Results: Twelve studies were included for review with eight reporting improvement in measures of fatigue, while four reported no benefit. However, many studies were non-randomized, open-label and/or used inappropriate dose or comparators. Meta-analysis was performed in three studies with sufficient data. Carnitine did not significantly reduce cancer-related fatigue with a standardized mean difference (SMD) of 0.06 points ((95% CI −0.09, 0.21); p = 0.45). Conclusion: Results from studies with lower risk of bias do not support the use of carnitine supplementation for cancer-related fatigue.
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Affiliation(s)
- Wolfgang Marx
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC 3086, Australia.
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD 4226, Australia.
| | - Laisa Teleni
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD 4226, Australia.
| | - Rachelle S Opie
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC 3086, Australia.
| | - Jaimon Kelly
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD 4226, Australia.
| | - Skye Marshall
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD 4226, Australia.
| | - Catherine Itsiopoulos
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC 3086, Australia.
| | - Elizabeth Isenring
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD 4226, Australia.
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Gomi D, Tanaka A, Fukushima T, Kobayashi T, Matsushita H, Sekiguchi N, Sakamoto A, Sasaki S, Mamiya K, Koizumi T. Dynamics of L-Carnitine in Plasma and Urine in Patients Undergoing Cisplatin Chemotherapy. Chemotherapy 2017; 62:225-230. [PMID: 28419998 DOI: 10.1159/000464274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/20/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Several studies have indicated that cisplatin (cis-diamminedichloroplatinum II; CDDP) causes urinary excretion of L-carnitine (LC). However, the underlying cofactors affecting the increased urinary excretion remain unclear. The present study was performed to evaluate the dynamics of LC in plasma and urine after CDDP chemotherapy and to examine the relations with clinical parameters, such as gender, body mass index (BMI), and renal function. METHODS Twenty-two patients treated with CDDP therapy were selected. Blood and urine samples were taken from patients before starting CDDP treatment (day 0), on the next day (day 1), and on the seventh day (day 7). We measured plasma and urine concentrations of total, free, and acyl-LC, and examined the relationships with gender, age, treatment cycle, skeletal muscle mass, BMI, glomerular filtration rate, and change in creatinine concentration after CDDP administration. RESULTS Both urinary and plasma concentrations of 3 types of LC increased markedly on day 1 and subsequently reverted to the pre-CDDP level on day 7. There was a positive correlation between the % changes in plasma and urine LC (correlation coefficient 0.59, p = 0.003) on day 1, but no significant relations were seen in other clinical parameters. CONCLUSIONS CDDP transiently increased plasma LC levels. The mechanism seemed to involve recruitment for marked urinary loss of LC. However, these changes in plasma and urinary LC levels were not related to clinical factors, suggesting that the dynamics of LC were independent of preexisting physical parameters.
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Affiliation(s)
- Daisuke Gomi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
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