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Kehl N, Gessner A, Maas R, Fromm MF, Taudte RV. A supervised machine-learning approach for the efficient development of a multi method (LC-MS) for a large number of drugs and subsets thereof: focus on oral antitumor agents. Clin Chem Lab Med 2024; 62:293-302. [PMID: 37606251 DOI: 10.1515/cclm-2023-0468] [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: 05/09/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Accumulating evidence argues for a more widespread use of therapeutic drug monitoring (TDM) to support individualized medicine, especially for therapies where toxicity and efficacy are critical issues, such as in oncology. However, development of TDM assays struggles to keep pace with the rapid introduction of new drugs. Therefore, novel approaches for faster assay development are needed that also allow effortless inclusion of newly approved drugs as well as customization to smaller subsets if scientific or clinical situations require. METHODS We applied and evaluated two machine-learning approaches i.e., a regression-based approach and an artificial neural network (ANN) to retention time (RT) prediction for efficient development of a liquid chromatography mass spectrometry (LC-MS) method quantifying 73 oral antitumor drugs (OADs) and five active metabolites. Individual steps included training, evaluation, comparison, and application of the superior approach to RT prediction, followed by stipulation of the optimal gradient. RESULTS Both approaches showed excellent results for RT prediction (mean difference ± standard deviation: 2.08 % ± 9.44 % ANN; 1.78 % ± 1.93 % regression-based approach). Using the regression-based approach, the optimum gradient (4.91 % MeOH/min) was predicted with a total run time of 17.92 min. The associated method was fully validated following FDA and EMA guidelines. Exemplary modification and application of the regression-based approach to a subset of 14 uro-oncological agents resulted in a considerably shortened run time of 9.29 min. CONCLUSIONS Using a regression-based approach, a multi drug LC-MS assay for RT prediction was efficiently developed, which can be easily expanded to newly approved OADs and customized to smaller subsets if required.
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Affiliation(s)
- Niklas Kehl
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Arne Gessner
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Renke Maas
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- FAU NeW - Research Center for New Bioactive Compounds, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Martin F Fromm
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- FAU NeW - Research Center for New Bioactive Compounds, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - R Verena Taudte
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Core Facility for Metabolomics, Department of Medicine, Philipps-Universität Marburg, 35043 Marburg, Germany
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2
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Lohr LK, Blake KT, Chan CM, Sturm S, Walsh GT. Managing Drug Interactions With Oral Anticancer Treatments. J Adv Pract Oncol 2023; 14:419-438. [PMID: 37576366 PMCID: PMC10414528 DOI: 10.6004/jadpro.2023.14.5.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
The use of oral anticancer treatments is widespread and vital to modern cancer treatment. Novel oral chemotherapy and targeted therapy treatments continue to receive US Food and Drug Administration approval every year, making knowledge of these agents a necessity for practitioners working in oncology. Many oral anticancer agents are prone to drug interactions that can contribute to adverse effects and decrease therapy efficacy. Potential drug-drug interactions include (1) interactions with CYP3A4 inhibitors and inducers, (2) interactions related to gastric acid suppression, (3) interactions related to prolongation of the cardiac QT interval, (4) interactions related to anticoagulant medications, and (5) drug-food and drug-herb interactions. Identifying potential drug interactions and appropriately managing them is key to preventing adverse effects and ensuring maximum efficacy while on oral anticancer therapy. Management of adverse effects increases patient compliance, ensures medication safety, and allows patients to remain on therapy. This article discusses the mechanisms of interactions and types of interacting medications. Specific recommendations are discussed.
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Affiliation(s)
- Lisa K Lohr
- From M Health/Fairview Pharmacy Services, Minneapolis, Minnesota
| | - Kimball T Blake
- From M Health/Fairview Pharmacy Services, Minneapolis, Minnesota
| | - Cindy M Chan
- From M Health/Fairview Pharmacy Services, Minneapolis, Minnesota
| | - Sabrina Sturm
- From M Health/Fairview Pharmacy Services, Minneapolis, Minnesota
| | - Gavyn T Walsh
- From M Health/Fairview Pharmacy Services, Minneapolis, Minnesota
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3
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Arojojoye AS, Olelewe C, Gukathasan S, Kim JH, Vekaria H, Parkin S, Sullivan PG, Awuah SG. Serum-Stable Gold(III) Bisphosphine Complex Induces Mild Mitochondrial Uncoupling and In Vivo Antitumor Potency in Triple Negative Breast Cancer. J Med Chem 2023; 66:7868-7879. [PMID: 37279147 PMCID: PMC10317555 DOI: 10.1021/acs.jmedchem.3c00238] [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] [Indexed: 06/08/2023]
Abstract
The preparation of cyclometalated complexes offers a path to stable materials, catalysts, and therapeutic agents. Here, we explore the anticancer potential of novel biphenyl organogold(III) cationic complexes supported by diverse bisphosphine ligands, Au-1-Au-5, toward aggressive glioblastoma and triple negative breast cancer cells (TNBCs). The [C^C] gold(III) complex, Au-3, exhibits significant tumor growth inhibition in a metastatic TNBC mouse model. Remarkably, Au-3 displays promising blood serum stability over a relevant therapeutic window of 24 h and alteration in the presence of excess L-GSH. The mechanism-of-action studies show that Au-3 induces mitochondrial uncoupling, membrane depolarization, and G1 cell cycle arrest and prompts apoptosis. To the best of our knowledge, Au-3 is the first biphenyl gold-phosphine complex to uncouple mitochondria and inhibit TNBC growth in vivo.
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Affiliation(s)
| | - Chibuzor Olelewe
- Department of Chemistry, University of Kentucky, Lexington KY 40506, USA
| | | | - Jong H. Kim
- Department of Chemistry, University of Kentucky, Lexington KY 40506, USA
| | - Hemendra Vekaria
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington KY 40536, U.S.A
- Department of Neuroscience, University of Kentucky, Lexington KY 40536, U.S.A
| | - Sean Parkin
- Department of Chemistry, University of Kentucky, Lexington KY 40506, USA
| | - Patrick G. Sullivan
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington KY 40536, U.S.A
- Department of Neuroscience, University of Kentucky, Lexington KY 40536, U.S.A
- Department of Neuroscience, University of Kentucky Lexington KY 40536, U.S.A
| | - Samuel G. Awuah
- Department of Chemistry, University of Kentucky, Lexington KY 40506, USA
- Center for Pharmaceutical Research and Innovation and Department of Pharmaceutical Sciences, College of Pharmacy University of Kentucky, Lexington KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington KY 40536
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4
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Wang H, Jin J, Pang X, Bian Z, Zhu J, Hao Y, Zhang H, Xie Y. Plantaricin BM-1 decreases viability of SW480 human colorectal cancer cells by inducing caspase-dependent apoptosis. Front Microbiol 2023; 13:1103600. [PMID: 36687624 PMCID: PMC9845772 DOI: 10.3389/fmicb.2022.1103600] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
Plantaricin BM-1 is a class IIa bacteriocin produced by Lactobacillus plantarum BM-1 that has significant antimicrobial activity against food-borne bacteria. In this study, a cell proliferation assay and scanning electron microscopy were used to detect changes in the viability of SW480, Caco-2, and HCT-116 colorectal cancer cells treated with plantaricin BM-1. We found that plantaricin BM-1 significantly reduced the viability of all colorectal cancer cell lines tested, especially that of the SW480 cells. Scanning electron microscopy showed that plantaricin BM-1 treatment reduced the number of microvilli and slightly collapsed the morphology of SW480 cells. Fluorescence microscopy and flow cytometry demonstrated that plantaricin BM-1 induced apoptosis of SW480 cells in a concentration-dependent manner. Western blotting further showed that plantaricin BM-1-induced apoptosis of SW480 cells was mediated by the caspase pathway. Finally, transcriptomic analysis showed that 69 genes were differentially expressed after plantaricin BM-1 treatment (p < 0.05), of which 65 were downregulated and four were upregulated. The Kyoto Encyclopedia of Genes and Genomes enrichment analysis showed that expression levels of genes involved in the TNF, NF-κB, and MAPK signaling pathways, as well as functional categories such as microRNAs in cancer and transcriptional misregulation in cancer, were affected in SW480 cells following the treatment with plantaricin BM-1. In conclusion, plantaricin BM-1 induced death in SW480 cells via the caspase-dependent apoptosis pathway. Our study provides important information for further development of plantaricin BM-1 for potential applications in anti-colorectal cancer.
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Affiliation(s)
- He Wang
- Beijing Laboratory of Food Quality and Safety, Beijing Key Laboratory of Agricultural Product Detection and Control of Spoilage Organisms and Pesticide Residue, College of Food Science and Engineering, Beijing University of Agriculture, Beijing, China
| | - Junhua Jin
- Beijing Laboratory of Food Quality and Safety, Beijing Key Laboratory of Agricultural Product Detection and Control of Spoilage Organisms and Pesticide Residue, College of Food Science and Engineering, Beijing University of Agriculture, Beijing, China
| | - Xiaona Pang
- Beijing Laboratory of Food Quality and Safety, Beijing Key Laboratory of Agricultural Product Detection and Control of Spoilage Organisms and Pesticide Residue, College of Food Science and Engineering, Beijing University of Agriculture, Beijing, China
| | - Zheng Bian
- Beijing Laboratory of Food Quality and Safety, Beijing Key Laboratory of Agricultural Product Detection and Control of Spoilage Organisms and Pesticide Residue, College of Food Science and Engineering, Beijing University of Agriculture, Beijing, China
| | - Jingxin Zhu
- Beijing Laboratory of Food Quality and Safety, Beijing Key Laboratory of Agricultural Product Detection and Control of Spoilage Organisms and Pesticide Residue, College of Food Science and Engineering, Beijing University of Agriculture, Beijing, China
| | - Yanling Hao
- Department of Nutrition and Health, Ministry of Education and Beijing Government, Beijing, China
| | - Hongxing Zhang
- Beijing Laboratory of Food Quality and Safety, Beijing Key Laboratory of Agricultural Product Detection and Control of Spoilage Organisms and Pesticide Residue, College of Food Science and Engineering, Beijing University of Agriculture, Beijing, China,*Correspondence: Hongxing Zhang,
| | - Yuanhong Xie
- Beijing Laboratory of Food Quality and Safety, Beijing Key Laboratory of Agricultural Product Detection and Control of Spoilage Organisms and Pesticide Residue, College of Food Science and Engineering, Beijing University of Agriculture, Beijing, China,Yuanhong Xie,
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Liu X, Su Q, Zhang X, Yang W, Ning J, Jia K, Xin J, Li H, Yu L, Liao Y, Zhang D. Recent Advances of Organ-on-a-Chip in Cancer Modeling Research. BIOSENSORS 2022; 12:bios12111045. [PMID: 36421163 PMCID: PMC9688857 DOI: 10.3390/bios12111045] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 05/27/2023]
Abstract
Although many studies have focused on oncology and therapeutics in cancer, cancer remains one of the leading causes of death worldwide. Due to the unclear molecular mechanism and complex in vivo microenvironment of tumors, it is challenging to reveal the nature of cancer and develop effective therapeutics. Therefore, the development of new methods to explore the role of heterogeneous TME in individual patients' cancer drug response is urgently needed and critical for the effective therapeutic management of cancer. The organ-on-chip (OoC) platform, which integrates the technology of 3D cell culture, tissue engineering, and microfluidics, is emerging as a new method to simulate the critical structures of the in vivo tumor microenvironment and functional characteristics. It overcomes the failure of traditional 2D/3D cell culture models and preclinical animal models to completely replicate the complex TME of human tumors. As a brand-new technology, OoC is of great significance for the realization of personalized treatment and the development of new drugs. This review discusses the recent advances of OoC in cancer biology studies. It focuses on the design principles of OoC devices and associated applications in cancer modeling. The challenges for the future development of this field are also summarized in this review. This review displays the broad applications of OoC technique and has reference value for oncology development.
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Affiliation(s)
- Xingxing Liu
- Guangdong Provincial Key Laboratory of Industrial Surfactant, Institute of Chemical Engineering, Guangdong Academy of Sciences, Guangzhou 510075, China
| | - Qiuping Su
- Guangdong Provincial Key Laboratory of Industrial Surfactant, Institute of Chemical Engineering, Guangdong Academy of Sciences, Guangzhou 510075, China
| | - Xiaoyu Zhang
- Research Center for Intelligent Sensing Systems, Zhejiang Laboratory, Hangzhou 311100, China
| | - Wenjian Yang
- Research Center for Intelligent Sensing Systems, Zhejiang Laboratory, Hangzhou 311100, China
| | - Junhua Ning
- Guangdong Provincial Key Laboratory of Industrial Surfactant, Institute of Chemical Engineering, Guangdong Academy of Sciences, Guangzhou 510075, China
| | - Kangle Jia
- Guangdong Provincial Key Laboratory of Industrial Surfactant, Institute of Chemical Engineering, Guangdong Academy of Sciences, Guangzhou 510075, China
| | - Jinlan Xin
- Guangdong Provincial Key Laboratory of Industrial Surfactant, Institute of Chemical Engineering, Guangdong Academy of Sciences, Guangzhou 510075, China
| | - Huanling Li
- Guangdong Provincial Key Laboratory of Industrial Surfactant, Institute of Chemical Engineering, Guangdong Academy of Sciences, Guangzhou 510075, China
| | - Longfei Yu
- Guangdong Provincial Key Laboratory of Industrial Surfactant, Institute of Chemical Engineering, Guangdong Academy of Sciences, Guangzhou 510075, China
| | - Yuheng Liao
- Research Center for Intelligent Sensing Systems, Zhejiang Laboratory, Hangzhou 311100, China
| | - Diming Zhang
- Research Center for Intelligent Sensing Systems, Zhejiang Laboratory, Hangzhou 311100, China
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Dennis M, Haines A, Johnson M, Soggee J, Tong S, Parsons R, Sunderland B, Czarniak P. Cross-sectional Census Survey of Patients With Cancer who Received a Pharmacist Consultation in a Pharmacist Led Anti-cancer Clinic. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1553-1561. [PMID: 35867307 PMCID: PMC9305046 DOI: 10.1007/s13187-022-02196-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 06/15/2023]
Abstract
Pharmacists have a critical consulting role in patients undergoing oral antineoplastic drug therapy to ensure harm minimisation. Studies exploring the benefits of pharmacists in this role are limited. This study evaluated patient perceptions, experiences and overall satisfaction with clinical pharmacist consultations in patients treated with oral antineoplastic drugs. Data on 160 patients initiated on oral antineoplastic drugs between January 2019 and February 2021 were collected retrospectively from an outpatient Comprehensive Cancer Centre of a quaternary hospital in Western Australia (demographics, cancer type, oral antineoplastic drugs prescribed). In addition, patients were mailed a hard copy questionnaire in March 2021 to assess their satisfaction with pharmacist consultations in the pharmacist clinic, using a 5-point Likert scale. The statements included perceptions of the patient's understanding, medication adherence, experiences and overall satisfaction with the clinical pharmacist consultation. There were 76 (47.5%) completed questionnaires returned (52.6% female; average age was 63.2 ± 13.9 years). The majority of patients were satisfied with the service offered by the clinical pharmacist (73/76; 96.1%), perceived that clinical pharmacists provided an important service in outpatient cancer care (71/76; 93.4%) and improved their understanding of the use of oral antineoplastic drugs and side-effect management (48/74; 64.9%). Patients' perceived understanding of their medication regimen and additional health services available improved after pharmacist counselling. The patients also reported overall satisfaction with the service provided by the clinical pharmacist and found it beneficial to their care. The study supports the expanding role of the clinical pharmacist in an outpatient cancer centre.
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Affiliation(s)
- Madeleine Dennis
- Curtin Medical School, Curtin University, GPO Box U1987, 6845 Perth, Western Australia
| | - Aasha Haines
- Curtin Medical School, Curtin University, GPO Box U1987, 6845 Perth, Western Australia
| | - Marie Johnson
- Curtin Medical School, Curtin University, GPO Box U1987, 6845 Perth, Western Australia
| | - Jonathan Soggee
- Department of Pharmacy, Perth Children’s Hospital, 6009 Perth, Western Australia
| | - Selina Tong
- Department of Pharmacy, Fiona Stanley Hospital, 6150 Perth, Western Australia
| | - Richard Parsons
- Curtin Medical School, Curtin University, GPO Box U1987, 6845 Perth, Western Australia
| | - Bruce Sunderland
- Curtin Medical School, Curtin University, GPO Box U1987, 6845 Perth, Western Australia
| | - Petra Czarniak
- Curtin Medical School, Curtin University, GPO Box U1987, 6845 Perth, Western Australia
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7
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Ahn L, Alexander T, Vlassak S, Berghoff K, Lemmens L. Tepotinib: Management of Adverse Events in Patients With MET Exon 14 Skipping Non-Small Cell Lung Cancer. Clin J Oncol Nurs 2022; 26:543-551. [PMID: 36108212 PMCID: PMC10034867 DOI: 10.1188/22.cjon.543-551] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tepotinib, a highly selective, oral, once-daily MET inhibitor, has been approved for treatment of metastatic MET exon 14 skipping non-small cell lung cancer. OBJECTIVES This article provides nurse-specific recommendations for identification and management of tepotinib adverse events (AEs). METHODS Guidance on monitoring and proactive/reactive AE management was developed based on published literature and real-world nursing experience. Case studies of VISION trial participants were summarized to illustrate key principles. FINDINGS Tepotinib AEs are generally mild to moderate and manageable, and can include peripheral edema, hypoalbuminemia, nausea, diarrhea, and creatinine increase. Alongside supportive care, tepotinib interruption and dose reduction is recommended for grade 3 AEs. For peripheral edema, proactive monitoring is crucial, and treatment interruption (including frequent, short treatment holidays) should be considered early. Nursing management of tepotinib AEs includes proactive monitoring, patient education, and interprofessional team coordination.
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Affiliation(s)
- Linda Ahn
- Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
- Corresponding author. Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Linda Ahn
| | - Terri Alexander
- MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Soetkin Vlassak
- the healthcare business of Merck KGaA, Frankfurter Str. 250, 64293, Darmstadt, Germany
| | - Karin Berghoff
- the healthcare business of Merck KGaA, Frankfurter Str. 250, 64293, Darmstadt, Germany
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8
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Schlichtig K, Cuba L, Dürr P, Bellut L, Meidenbauer N, Kunath F, Goebell PJ, Mackensen A, Dörje F, Fromm MF, Wullich B. New Oral Antitumor Drugs and Medication Safety in Uro-Oncology: Implications for Clinical Practice Based on a Subgroup Analysis of the AMBORA Trial. J Clin Med 2022; 11:jcm11154558. [PMID: 35956173 PMCID: PMC9369799 DOI: 10.3390/jcm11154558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 02/01/2023] Open
Abstract
Oral antitumor therapeutics (OAT) bear a high risk for medication errors, e.g., due to drug–drug or drug–food interactions or incorrect drug intake. Advanced age, organ insufficiencies, and polymedication are putting uro-oncological patients at an even larger risk. This analysis sets out to (1) investigate the frequency and relevance of medication errors in patients with prostate cancer or renal cell carcinoma treated with OAT and (2) compile recommendations for clinical practice. This post-hoc subgroup analysis used data collected in the randomized AMBORA trial (2017–2020; DRKS00013271). Clinical pharmacologists/pharmacists conducted advanced medication reviews over 12 weeks after initiation of a new oral regimen and assessed the complete medication process for drug–related problems. Medication errors related to either the OAT, prescribed or prescription-free concomitant medication, or food were classified regarding cause and severity. We identified 67 medication errors in 38 patients within the complete medication within 12 weeks. Thereof, 55% were detected at therapy initiation, 27% were caused by the patients, and 25% were drug–drug or drug–food interactions. Problem-prone issues are summarized in a ‘medication safety table’ to provide recommendations for clinical practice in uro-oncology. Tailored strategies including intensified care by clinical pharmacologists/pharmacists should be implemented in clinical practice to improve medication safety.
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Affiliation(s)
- Katja Schlichtig
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Lisa Cuba
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
- Pharmacy Department, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Pauline Dürr
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
- Pharmacy Department, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Laura Bellut
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
- Department of Urology and Pediatric Urology, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Norbert Meidenbauer
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
- Department of Internal Medicine 5, Hematology and Oncology, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Frank Kunath
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
- Department of Urology and Pediatric Urology, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Peter J. Goebell
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
- Department of Urology and Pediatric Urology, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Andreas Mackensen
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
- Department of Internal Medicine 5, Hematology and Oncology, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Frank Dörje
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
- Pharmacy Department, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Martin F. Fromm
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
| | - Bernd Wullich
- Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, 91054 Erlangen, Germany
- Department of Urology and Pediatric Urology, Erlangen University Hospital, 91054 Erlangen, Germany
- Correspondence: ; Tel.: +49-9131-822-3178
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Wakui N, Ozawa M, Yanagiya T, Endo S, Togawa C, Matsuoka R, Shirozu S, Machida Y, Kikuchi M. Factors Associated With Medication Compliance in Elderly Patients With Type 2 Diabetes Mellitus: A Cross-Sectional Study. Front Public Health 2022; 9:771593. [PMID: 35087782 PMCID: PMC8787062 DOI: 10.3389/fpubh.2021.771593] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/14/2021] [Indexed: 11/13/2022] Open
Abstract
The average age of patients with type 2 diabetes in Japan is over 70 years. Elderly patients tend to have poor medication compliance, therefore, it is important to understand their individual situations to improve medication compliance, the treatment of their diabetes, and their quality of life (QOL). This study aimed to identify factors associated with medication compliance in elderly type 2 diabetic patients. A cross-sectional study based on questionnaires was conducted on type 2 diabetes patients aged 65 years or older. The participants were recruited from patients who visited three dispensing pharmacies in the Shinagawa area of Tokyo between March 1 and September 30, 2019. The questionnaire consisted of patient information (sex, age, medication compliance status, knowledge of drug effects, and side effects), 12-Item Short Form Survey quality of life rating scale (SF-12), and Diabetes Treatment Satisfaction Questionnaire (DTSQ). Factors related to medication compliance were then evaluated. In all, there were 47 respondents: 31 males and 16 females. Four factors were found to be associated with medication compliance in elderly type 2 diabetic patients: medication storage (P = 0.01), knowledge of drug effects (P < 0.001), knowledge of side effects (P = 0.026), and physical functioning: (PF) (P = 0.045), a subscale of SF-12. Furthermore, the strength of the association between these four factors and medication compliance was calculated using Cramer's V coefficient of association. Knowledge of drug effects was the most strongly associated (knowledge of drug effects: V = 0.559; knowledge of side effects: V = 0.464; medication storage: V = 0.451; PF: V = 0.334). Because diabetes mellitus has no subjective symptoms and treatment effects are not felt to a great extent, it is difficult to motivate patients to consistently adhere to medication. When pharmacists provide medication guidance to elderly patients with type 2 diabetes mellitus, it is important to provide sufficient information to ensure they fully understand the drug effects to maintain medication compliance.
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Affiliation(s)
- Nobuyuki Wakui
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, Tokyo, Japan
| | - Mizue Ozawa
- Shinagawa Pharmaceutical Association, Tokyo, Japan
| | | | - Saki Endo
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, Tokyo, Japan
| | - Chikako Togawa
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, Tokyo, Japan
| | - Raini Matsuoka
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, Tokyo, Japan
| | - Shunsuke Shirozu
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, Tokyo, Japan
| | - Yoshiaki Machida
- Division of Applied Pharmaceutical Education and Research, Faculty of Pharmaceutical Sciences, Hoshi University, Tokyo, Japan
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10
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An Easily Expandable Multi-Drug LC-MS Assay for the Simultaneous Quantification of 57 Oral Antitumor Drugs in Human Plasma. Cancers (Basel) 2021; 13:cancers13246329. [PMID: 34944950 PMCID: PMC8699473 DOI: 10.3390/cancers13246329] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Oral antitumor therapy has significantly improved clinical outcomes in multiple tumor entities. However, following a standard dosing regime, strong interindividual variability in patients’ plasma concentrations can be observed for many oral antitumor drugs. This results in risks of reduced therapeutic effect and increased side effects. Monitoring these variable plasma concentrations is an important tool in evaluating multiple factors influencing drug exposure and, if necessary, adjusting therapeutic doses. Here, we developed a method for the simultaneous measurement of 57 oral antitumor drug plasma concentrations. Detection and quantification were achieved using liquid chromatography coupled to an Orbitrap mass spectrometer, which can be easily expanded to newly approved oral antitumor drugs in the future. Applicability of the method was proven by measuring 71 plasma samples from 39 patients undergoing oral antitumor therapy. In summary, the developed method provides an important tool for exposure measurements of oral antitumor drugs. Abstract Oral anticancer drugs have led to significant improvements in the treatment of multiple tumor entities. However, in patients undergoing oral antitumor therapy, plasma concentrations are highly variable, resulting in risks of reduced therapeutic effects or an increase in side effects. One important tool to reduce this variability is therapeutic drug monitoring. In this work we describe a method to simultaneously quantify the plasma concentrations of 57 oral antitumor agents. Quantification of these drugs was achieved using liquid chromatography coupled to an Orbitrap mass spectrometer. The method was fully validated according to the FDA guidelines and constitutes a simple and robust way for exposure monitoring of a wide variety of oral anticancer drugs. Applicability to clinical routine was demonstrated by the analysis of 71 plasma samples taken from 39 patients. In summary, this new multi-drug method allows simultaneous quantification of 57 oral antitumor drugs, which can be applied to exposure monitoring in clinical studies, taking into account the broad variety of oral antitumor drugs prescribed in clinical routine.
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van Dyk M, Bulamu N, Boylan C, Mc Laughlin AM, Kichenadasse G, May N, Michelet R, Kloft C, Kaambwa B. Cost-effectiveness of oral anticancer drugs and associated individualised dosing approaches in patients with cancer: protocol for a systematic review. BMJ Open 2021; 11:e047173. [PMID: 34404700 PMCID: PMC8372804 DOI: 10.1136/bmjopen-2020-047173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Oral anticancer drugs (OADs) have rapidly expanded with more than 70 OADs targeting several molecular targets. Many of the OADs exert an exposure-response relationship but still, a 'one-size fits-all' dose is used, ignoring interindividual variability. Several of these OADs share similar mechanisms of actions and thus target the same cancer and has resulted in a substantial research focus on comparing the health benefit of each. However, significantly less is known about the cost-benefit associated with OADs. This paper will provide a protocol to systematically review studies that have evaluated the cost-effectiveness of OADs and their associated individualised dosing interventions. METHODS AND ANALYSIS Systematic review methodology will be applied to identify, select and extract data from published economic evaluation (costs and outcomes/benefits) studies of OADs and their associated individualised dosing interventions. Bibliographic databases (eg, Ovid EMBASE, Ovid MEDLINE) will be used to perform the systematic literature search (between 1 January 2000 and October 2020). Only full economic evaluations will be included, but no restrictions on study outcomes will be applied. The quality of included primary studies will be assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist for reporting economic evaluations. Studies with low-quality evidence will be excluded. A narrative synthesis of the results from the included studies will be undertaken, with a subgroup analysis where appropriate. ETHICS AND DISSEMINATION This systematic review will not require ethics approval as there will not be any collection of primary data. Findings of this review will be disseminated through publications in peer-reviewed journals, presentations at workshops or conferences and sharing through a media release. Findings from this review will provide evidence to direct and inform policy-makers where cost-neutral strategies may be effective or where dose individualising strategies may be economically beneficial. Additionally, gaps will be identified in the current literature to inform future-related research. PROSPERO REGISTRATION NUMBER CRD42020218170. ELECTRONIC SUPPLEMENTAL MATERIAL The online version of this article contains supplemental material, which is available to authorised users.
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Affiliation(s)
- Madelé van Dyk
- Flinders Health & Medical Research Institute- Cancer, Flinders University College of Medicine and Public Health, Bedford Park, South Australia, Australia
- Flinders Centre for Innovation in Cancer, Flinders University College of Medicine and Public Health, Bedford Park, South Australia, Australia
| | - Norma Bulamu
- Flinders Centre for Innovation in Cancer, Flinders University College of Medicine and Public Health, Bedford Park, South Australia, Australia
- Health Economics, Flinders University College of Medicine and Public Health, Bedford Park, South Australia, Australia
| | - Chelsea Boylan
- Flinders Health & Medical Research Institute- Cancer, Flinders University College of Medicine and Public Health, Bedford Park, South Australia, Australia
- Flinders Centre for Innovation in Cancer, Flinders University College of Medicine and Public Health, Bedford Park, South Australia, Australia
| | - Anna M Mc Laughlin
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
- Postdam/Berlin, PharMetrX Graduate Research Training Program, Postdam/Berlin, Germany
| | - Ganessan Kichenadasse
- Flinders Health & Medical Research Institute- Cancer, Flinders University College of Medicine and Public Health, Bedford Park, South Australia, Australia
- Medical Oncology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Nikki May
- SA Health Library Service, Bedford Park, South Australia, Australia
| | - Robin Michelet
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
- PharMetrX Graduate Research Training Program, Postdam/Berlin, Germany
| | - Charlotte Kloft
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
- PharMetrX Graduate Research Training Program, Postdam/Berlin, Germany
| | - Billingsley Kaambwa
- Health Economics, Flinders University College of Medicine and Public Health, Bedford Park, South Australia, Australia
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Kirschner M, do Ó Hartmann N, Parmentier S, Hart C, Henze L, Bisping G, Griesshammer M, Langer F, Pabinger-Fasching I, Matzdorff A, Riess H, Koschmieder S. Primary Thromboprophylaxis in Patients with Malignancies: Daily Practice Recommendations by the Hemostasis Working Party of the German Society of Hematology and Medical Oncology (DGHO), the Society of Thrombosis and Hemostasis Research (GTH), and the Austrian Society of Hematology and Oncology (ÖGHO). Cancers (Basel) 2021; 13:2905. [PMID: 34200741 PMCID: PMC8230401 DOI: 10.3390/cancers13122905] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/20/2022] Open
Abstract
Patients with cancer, both hematologic and solid malignancies, are at increased risk for thrombosis and thromboembolism. In addition to general risk factors such as immobility and major surgery, shared by non-cancer patients, cancer patients are exposed to specific thrombotic risk factors. These include, among other factors, cancer-induced hypercoagulation, and chemotherapy-mediated endothelial dysfunction as well as tumor-cell-derived microparticles. After an episode of thrombosis in a cancer patient, secondary thromboprophylaxis to prevent recurrent thromboembolism has long been established and is typically continued as long as the cancer is active or actively treated. On the other hand, primary prophylaxis, even though firmly established in hospitalized cancer patients, has only recently been studied in ambulatory patients. This recent change is mostly due to the emergence of direct oral anticoagulants (DOACs). DOACs have a shorter half-life than vitamin K antagonists (VKA), and they overcome the need for parenteral application, the latter of which is associated with low-molecular-weight heparins (LMWH) and can be difficult for the patient to endure in the long term. Here, first, we discuss the clinical trials of primary thromboprophylaxis in the population of cancer patients in general, including the use of VKA, LMWH, and DOACs, and the potential drug interactions with pre-existing medications that need to be taken into account. Second, we focus on special situations in cancer patients where primary prophylactic anticoagulation should be considered, including myeloma, major surgery, indwelling catheters, or immobilization, concomitant diseases such as renal insufficiency, liver disease, or thrombophilia, as well as situations with a high bleeding risk, particularly thrombocytopenia, and specific drugs that may require primary thromboprophylaxis. We provide a novel algorithm intended to aid specialists but also family practitioners and nurses who care for cancer patients in the decision process of primary thromboprophylaxis in the individual patient.
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Affiliation(s)
- Martin Kirschner
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (M.K.); (N.d.Ó.H.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany
| | - Nicole do Ó Hartmann
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (M.K.); (N.d.Ó.H.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany
| | - Stefani Parmentier
- Oncology and Hematology, Tumor Center, St. Claraspital, 4058 Basel, Switzerland;
| | - Christina Hart
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Larissa Henze
- Department of Medicine, Clinic III—Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, 18057 Rostock, Germany;
| | - Guido Bisping
- Department of Medicine I, Mathias Spital Rheine, 48431 Rheine, Germany;
| | - Martin Griesshammer
- University Clinic for Hematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, 32429 Minden, Germany;
| | - Florian Langer
- II.Medical Clinic and Polyclinic, Center for Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Ingrid Pabinger-Fasching
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria;
| | - Axel Matzdorff
- Department of Internal Medicine II, Asklepios Clinic Uckermark, 16303 Schwedt, Germany;
| | - Hanno Riess
- Medical Department, Division of Oncology and Hematology, Campus Charité Mitte, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Steffen Koschmieder
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (M.K.); (N.d.Ó.H.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany
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Schlichtig K. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:222-223. [PMID: 32343664 PMCID: PMC7196843 DOI: 10.3238/arztebl.2020.0222b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Katja Schlichtig
- *Apotheke des Universitätsklinikums Erlangen Lehrstuhl für Klinische Pharmakologie und Klinische Toxikologie Friedrich-Alexander-Universität Erlangen-Nürnberg
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Matzdorff A. Unanswered Questions. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:222. [PMID: 32343663 PMCID: PMC7196846 DOI: 10.3238/arztebl.2020.0222a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Axel Matzdorff
- *Asklepios Klinikum Uckermark GmbH Klinik für Innere Medizin II Gastroenterologie, Nephrologie, Hämato-Onkologie und Palliativmedizin Schwedt/Oder
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