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Nishioka S, Watanabe T, Asano M, Yamamoto T, Kawakami K, Yada S, Aramaki E, Yajima H, Kizaki H, Hori S. Identification of hand-foot syndrome from cancer patients' blog posts: BERT-based deep-learning approach to detect potential adverse drug reaction symptoms. PLoS One 2022; 17:e0267901. [PMID: 35507636 PMCID: PMC9067685 DOI: 10.1371/journal.pone.0267901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/18/2022] [Indexed: 12/29/2022] Open
Abstract
Early detection and management of adverse drug reactions (ADRs) is crucial for improving patients' quality of life. Hand-foot syndrome (HFS) is one of the most problematic ADRs for cancer patients. Recently, an increasing number of patients post their daily experiences to internet community, for example in blogs, where potential ADR signals not captured through routine clinic visits can be described. Therefore, this study aimed to identify patients with potential ADRs, focusing on HFS, from internet blogs by using natural language processing (NLP) deep-learning methods. From 10,646 blog posts, written in Japanese by cancer patients, 149 HFS-positive sentences were extracted after pre-processing, annotation and scrutiny by a certified oncology pharmacist. The HFS-positive sentences described not only HFS typical expressions like "pain" or "spoon nail", but also patient-derived unique expressions like onomatopoeic ones. The dataset was divided at a 4 to 1 ratio and used to train and evaluate three NLP deep-learning models: long short-term memory (LSTM), bidirectional LSTM and bidirectional encoder representations from transformers (BERT). The BERT model gave the best performance with precision 0.63, recall 0.82 and f1 score 0.71 in the HFS user identification task. Our results demonstrate that this NLP deep-learning model can successfully identify patients with potential HFS from blog posts, where patients' real wordings on symptoms or impacts on their daily lives are described. Thus, it should be feasible to utilize patient-generated text data to improve ADR management for individual patients.
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Affiliation(s)
- Satoshi Nishioka
- Keio University Faculty of Pharmacy, Division of Drug Informatics, Tokyo, Japan
| | - Tomomi Watanabe
- Keio University Faculty of Pharmacy, Division of Drug Informatics, Tokyo, Japan
| | - Masaki Asano
- Keio University Faculty of Pharmacy, Division of Drug Informatics, Tokyo, Japan
| | - Tatsunori Yamamoto
- Keio University Faculty of Pharmacy, Division of Drug Informatics, Tokyo, Japan
| | - Kazuyoshi Kawakami
- Department of Pharmacy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shuntaro Yada
- Nara Institute of Science and Technology, Nara, Japan
| | - Eiji Aramaki
- Nara Institute of Science and Technology, Nara, Japan
| | | | - Hayato Kizaki
- Keio University Faculty of Pharmacy, Division of Drug Informatics, Tokyo, Japan
| | - Satoko Hori
- Keio University Faculty of Pharmacy, Division of Drug Informatics, Tokyo, Japan
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Treiber H, von der Brelie C, Malinova V, Mielke D, Rohde V, Chapuy CI. Regorafenib for recurrent high-grade glioma: a unicentric retrospective analysis of feasibility, efficacy, and toxicity. Neurosurg Rev 2022; 45:3201-3208. [PMID: 35725846 PMCID: PMC9492606 DOI: 10.1007/s10143-022-01826-z] [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: 02/02/2022] [Revised: 05/13/2022] [Accepted: 06/07/2022] [Indexed: 02/03/2023]
Abstract
We describe here 11 consecutive patients with recurrence of high-grade glioma treated with regorafenib at our university medical center. The majority of patients had MGMT promoter methylation (9/11 cases). Regorafenib was given as 2nd line systemic treatment in 6/11 patients and 3rd or higher line treatment in 5/11 patients. The median number of applied cycles was 2 with dosage reductions in 5/11. Response to treatment was observed in 4/11 (PR in 1/11, and SD in 3/11). Median overall survival for the cohort was 16.1 months, median progression-free survival 9.0 months, and median time to treatment failure 3.3 months. Side effects of any CTCAE grade were noted in all patients, hereby 6/11 with CTCAE °III-IV reactions. High-grade side effects were of dermatologic, cardiovascular, and hematologic nature. A mean treatment delay of 57.5 days (range 23-119) was noted between tumor board recommendation and treatment initiation due to the application process for off-label use in this indication. In conclusion, treatment with regorafenib in relapsed high-grade glioma is a feasible treatment option but has to be considered carefully due to the significant side effect profile.
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Affiliation(s)
- Hannes Treiber
- grid.411984.10000 0001 0482 5331Department of Hematology and Medical Oncology, University Medicine Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - Christian von der Brelie
- grid.411984.10000 0001 0482 5331Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany
| | - Vesna Malinova
- grid.411984.10000 0001 0482 5331Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany
| | - Dorothee Mielke
- grid.411984.10000 0001 0482 5331Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany
| | - Veit Rohde
- grid.411984.10000 0001 0482 5331Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany
| | - Claudia Ilse Chapuy
- grid.411984.10000 0001 0482 5331Department of Hematology and Medical Oncology, University Medicine Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
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Yin X, Zhao Z, Yin Y, Shen C, Chen X, Cai Z, Wang J, Chen Z, Yin Y, Zhang B. Adverse event profiles of epidermal growth factor receptor-tyrosine kinase inhibitors in cancer patients: A systematic review and meta-analysis. Clin Transl Sci 2021; 14:919-933. [PMID: 33382906 PMCID: PMC8212741 DOI: 10.1111/cts.12957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/06/2020] [Accepted: 11/08/2020] [Indexed: 02/05/2023] Open
Abstract
The efficacy of agents targeting epidermal growth factor receptor (EGFR) in patients with various cancers was well elucidated. However, the safety profile of EGFR tyrosine kinase inhibitors (EGFR-TKIs) has not been systematically investigated. This meta-analysis aimed to evaluate the safety profile of EGFR-TKIs in patients with cancer. A systematic search of PubMed, EMBASE, Cochrane Library databases, ASCO, and ESMO abstracts were conducted. Randomized controlled trials (RCTs) that compared safety profile of EGFR-TKIs with placebo were included. The end points included treatment-related adverse events (AEs), treatment discontinuation, and toxic death. Twenty-eight RCTs containing 17,800 patients were included. The analyses showed that the most frequently observed all-grade AEs in patients treated with EGFR-TKIs were diarrhea (53.7%), rash (48.6%), mucositis (46.5%), alanine aminotransferase (ALT) increased (38.9%), and skin reaction (35.2%). The most common high-grade (grade ≥3) AEs were mucositis (14.8%), pain (8.2%,), metabolism and nutrition disorders (7.4%), diarrhea (6.2%), dyspnea (6.1%), and hypertension (6.1%). The incidence of serious AEs, treatment discontinuation, and toxic death due to AEs were 18.2%, 12.36%, and 3.0%, respectively. Pooled risk ratio (RR) showed that the use of EGFR-TKIs was associated with an increased risk of developing AEs. Subgroup analysis indicated that the risk of AEs varied significantly according to tumor type, generation line, and drug type. Our meta-analysis indicates EGFR-TKIs was associated with a significant increased risk of a series of unique AEs. Early detection and proper management of AEs are important to reduce morbidity, avoid treatment discontinuation, and improve patient quality of life. Study Highlights WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC? The safety profile of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) varied in different trials, and has not been systemically investigated. WHAT QUESTION DID THIS STUDY ADDRESS? We conducted this meta-analysis of randomized control trials (RCTs) to provide a comprehensive evaluation of adverse event in patients with cancer receiving EGFR-TKIs. WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE? Our meta-analysis indicates EGFR-TKIs was associated with a significant increased risk of a series of unique adverse events (AEs). HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE? The integrated understanding of safety profile of EGFR-TKIs will help in the future design of new EGFR-TKIs with a better safety profile.
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Affiliation(s)
- Xiaonan Yin
- Department of Gastrointestinal SurgeryWest China HospitalSichuan UniversityChengduSichuanChina
| | - Zhou Zhao
- Department of Gastrointestinal SurgeryWest China HospitalSichuan UniversityChengduSichuanChina
| | - Yuan Yin
- Department of Gastrointestinal SurgeryWest China HospitalSichuan UniversityChengduSichuanChina
| | - Chaoyong Shen
- Department of Gastrointestinal SurgeryWest China HospitalSichuan UniversityChengduSichuanChina
| | - Xin Chen
- Department of Gastrointestinal SurgeryWest China HospitalSichuan UniversityChengduSichuanChina
| | - Zhaolun Cai
- Department of Gastrointestinal SurgeryWest China HospitalSichuan UniversityChengduSichuanChina
| | - Jian Wang
- Department of Gastrointestinal SurgeryWest China HospitalSichuan UniversityChengduSichuanChina
| | - Zhixin Chen
- Department of Gastrointestinal SurgeryWest China HospitalSichuan UniversityChengduSichuanChina
| | - Yiqiong Yin
- Department of Gastrointestinal SurgeryWest China HospitalSichuan UniversityChengduSichuanChina
| | - Bo Zhang
- Department of Gastrointestinal SurgeryWest China HospitalSichuan UniversityChengduSichuanChina
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Siddiqui NS, Godara A, Byrne MM, Saif MW. Capecitabine for the treatment of pancreatic cancer. Expert Opin Pharmacother 2019; 20:399-409. [PMID: 30649964 DOI: 10.1080/14656566.2018.1560422] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Capecitabine is an oral prodrug of 5-fluorouracil (5-FU) which is converted to 5FU by a series of reactions catalyzed by different enzymes, the last of the enzymes being thymidine phosphorylase (TP). TP is found to be elevated in tumor cells in comparison to normal cells, which consequently tumor-localizes the production of 5-FU, thereby limiting its systemic toxicity. Today, capecitabine is extensively used for the treatment of many solid malignancies, with a particular focus in breast and gastrointestinal tumors, but also in pancreatic cancer. Areas covered: This review summarizes the pharmacology and the clinical evidence relevant to the use of capecitabine in the treatment of pancreas cancer. The authors provide, furthermore, provide their expert perspectives on its use. Expert opinion: Capecitabine has the advantage over other therapeutics in so much that it has both convenient oral administration and a favorable toxicity profile. Current data has promised the use of capecitabine in all stages of pancreatic cancer. However, predictive markers for outcome and toxicity remain to be validated.
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Affiliation(s)
- Nauman S Siddiqui
- a Division of Hematology/Oncology , Tufts Medical Center - Tufts University School of Medicine , Boston , MA , USA
| | - Amandeep Godara
- a Division of Hematology/Oncology , Tufts Medical Center - Tufts University School of Medicine , Boston , MA , USA
| | - Margaret M Byrne
- a Division of Hematology/Oncology , Tufts Medical Center - Tufts University School of Medicine , Boston , MA , USA
| | - Muhammad Wasif Saif
- a Division of Hematology/Oncology , Tufts Medical Center - Tufts University School of Medicine , Boston , MA , USA.,b Department of Medical Oncology , Northwell Health Cancer Institute , New York , NY , USA
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Irigoyen A, Gallego J, Guillén Ponce C, Vera R, Iranzo V, Ales I, Arévalo S, Pisa A, Martín M, Salud A, Falcó E, Sáenz A, Manzano Mozo JL, Pulido G, Martínez Galán J, Pazo-Cid R, Rivera F, García García T, Serra O, Fernández Parra EM, Hurtado A, Gómez Reina MJ, López Gomez LJ, Martínez Ortega E, Benavides M, Aranda E. Gemcitabine-erlotinib versus gemcitabine-erlotinib-capecitabine in the first-line treatment of patients with metastatic pancreatic cancer: Efficacy and safety results of a phase IIb randomised study from the Spanish TTD Collaborative Group. Eur J Cancer 2017; 75:73-82. [PMID: 28222309 DOI: 10.1016/j.ejca.2016.12.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/30/2016] [Accepted: 12/26/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Gemcitabine and erlotinib have shown a survival benefit in the first-line setting in metastatic pancreatic cancer (mPC). The aim of this study was to assess whether combining capecitabine (C) with gemcitabine + erlotinib (GE) was safe and effective versus GE in patients with mPC. PATIENTS AND METHODS Previously untreated mPC patients were randomised to receive G (1000 mg/m2, days 1, 8, 15) + E (100 mg/day, days 1-28) + C (1660 mg/m2, days 1-21) or GE, q4 weeks, until progression or unacceptable toxicity. Primary end-point: progression-free survival (PFS); secondary end-points: overall survival (OS), response rate, relationship of rash with PFS/OS and safety. RESULTS 120 patients were randomised, median age 63 years, ECOG status 0/1/2 33%/58%/8%; median follow-up 16.5 months. Median PFS in the gemcitabine-erlotinib-capecitabine (GEC) and GE arms was 4.3 and 3.8 months, respectively (hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.58-1.31; p = 0.52). Median OS in the GEC and GE arms was 6.8 and 7.7 months, respectively (HR: 1.09, 95% CI: 0.72-1.63; p = 0.69). Grade 3/4 neutropenia (GEC 43% versus GE 15%; p = 0.0008) and mucositis (GEC 9% versus GE 0%; p = 0.03) were the only statistically significant differences in grade 3/4 adverse events. PFS and OS were significantly longer in patients with rash (grade ≥1) versus no rash (grade = 0): PFS 5.5 versus 2.0 months (HR = 0.39, 95% CI: 0.26-0.6; p < 0.0001) and OS: 9.5 versus 4.0 months (HR = 0.51, 95% CI: 0.33-0.77; p = 0.0014). CONCLUSION PFS with GEC was not significantly different to that with GE in patients with mPC. Skin rash strongly predicted erlotinib efficacy. The study was registered with ClinicalTrials.gov: NCT01303029.
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Affiliation(s)
| | - Javier Gallego
- General Universitario de Elche Hospital, Alicante, Spain
| | | | | | | | - Inmaculada Ales
- Hospital Regional Universitario y Virgen de la Victoria, Málaga, Spain
| | | | - Aleydis Pisa
- Sabadell Hospital, Corporación Sanitaria Parc Tauli, Barcelona, Spain
| | - Marta Martín
- Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | | | - Esther Falcó
- Fundación Son Llatzer Hospital, Palma de Mallorca, Spain
| | | | | | - Gema Pulido
- Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Córdoba, Spain
| | | | - Roberto Pazo-Cid
- Aragon Institute of Biomedical Research (IISA), Miguel Servet University Hospital, Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Zaragoza, Spain
| | | | | | - Olbia Serra
- Moisés Broggi Hospital, Institut Català Oncologia - Hospitalet del Llobregat, Barcelona, Spain
| | | | | | | | | | | | - Manuel Benavides
- Hospital Regional Universitario y Virgen de la Victoria, Málaga, Spain
| | - Enrique Aranda
- Maimonides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Córdoba, Spain
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Chen J, Kaley K, Garcon MC, Rodriguez T, Saif MW. A novel schedule of erlotinib/capecitabine (7/7) as salvage therapy in previously treated advanced pancreatic adenocarcinoma: a case series. Therap Adv Gastroenterol 2016; 9:162-8. [PMID: 26929778 PMCID: PMC4749861 DOI: 10.1177/1756283x15622779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The objective of this study was to report a case series on the efficacy and safety of capecitabine 7/7 schedule combined with erlotinib (CAP-ERL) in patients with advanced pancreatic cancer (APC) who have failed prior therapies. METHODS We retrospectively evaluated 13 patients with locally advanced or metastatic pancreatic cancer previously treated with gemcitabine or oxaliplatin-irinotecan-based first-line regimens. Treatment consisted of capecitabine (Xeloda) at a flat dose of 1000 mg orally twice daily on days 1-7 out of 14 days (7/7 schedule) and erlotinib (Tarceva) 100 mg orally once daily until unacceptable toxicity or disease progression. Tumor assessments were repeated every two cycles (8 weeks) and serum tumor markers were measured every 4 weeks. RESULTS All patients (median age: 63 years; 7 female/3 male) had various previous lines of treatments of chemotherapies. Median number of cycles with CAP-ERL was 4 (range 2-12). The overall response rate was 20%. CA19-9 was reduced more than 25% in 40% patients. The median overall survival and progression-free survival from the start of CAP-ERL were 4.5 months (range 3-7.5) and 2 months (range 1.5-4), respectively. The most common grade 3 toxicities included hand-foot syndrome, nausea, vomiting, diarrhea, rash, and fatigue. CONCLUSIONS Our result suggests that the combination of a fixed low dose of CAP-ERL 7/7 schedule was tolerated with manageable toxicity and showed encouraging activity as salvage treatment in patients with refractory APC with ECOG performance status 0-2. Further prospective studies are warranted to evaluate this combination.
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Affiliation(s)
- Jiezhong Chen
- School of Biomedical Sciences and Australian Institute of Bioengineering and Nanotechnology, University of Queensland, QLD, Australia
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Affiliation(s)
- Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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