1
|
Sharma A, Bahl A, Frazer R, Godhania E, Halfpenny N, Hartl K, Heldt D, McGrane J, Şahbaz Gülser S, Venugopal B, Ritchie A, Crichton K. Axitinib after Treatment Failure with Sunitinib or Cytokines in Advanced Renal Cell Carcinoma-Systematic Literature Review of Clinical and Real-World Evidence. Cancers (Basel) 2024; 16:2706. [PMID: 39123435 PMCID: PMC11312084 DOI: 10.3390/cancers16152706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND We conducted a systematic literature review (SLR) to identify clinical evidence on treatments in advanced renal cell carcinoma (aRCC) after the failure of prior therapy with cytokines, tyrosine kinase inhibitors, or immune checkpoint inhibitors. Herein, we summarise the evidence for axitinib in aRCC after the failure of prior therapy with cytokines or sunitinib. METHODS This SLR was registered with PROSPERO (CRD42023492931) and followed the 2020 PRISMA statement and the Cochrane guidelines. Comprehensive searches were conducted in MEDLINE and Embase as well as for conference proceedings. Study eligibility was defined according to population, intervention, comparator, outcome, and study design. RESULTS Of 1252 titles/abstracts screened, 266 peer-reviewed publications were reviewed, of which 182 were included. In addition, 28 conference abstracts were eligible. Data on axitinib were reported in 55 publications, of which 16 provided efficacy and/or safety outcomes on axitinib after therapy with sunitinib or cytokines. In these patients, median progression-free and overall survival ranged between 5.5 and 8.7 months and 11.0 and 69.5 months, respectively. CONCLUSIONS Axitinib is commonly used in clinical practice and has a well-characterised safety and efficacy profile in the treatment of patients with aRCC after the failure of prior therapy with sunitinib or cytokines.
Collapse
Affiliation(s)
- Anand Sharma
- Mount Vernon Cancer Centre, Northwood HA6 2RN, UK
| | - Amit Bahl
- University Hospitals Bristol & Weston NHS Trust, Bristol BS2 8ED, UK
| | | | | | | | | | | | - John McGrane
- Royal Cornwall Hospitals NHS Trust (Treliske), Truro TR1 3LJ, UK
| | | | | | | | | |
Collapse
|
2
|
Badiola LB, Milagro NL, Lavín DC, Peraita SL, Ibarbia MA, Kareaga MM, Fernández Del Rivero TDP, Otero DSDP, López VA, Fernández CÁ, Emborujo AL, Arnaiz IG, Rodríguez RF, Verdún-Aguilar J, Sagastibeltza N, Duran I. RENO Study: Clinical characteristics, treatment patterns and survival results in patients with metastatic renal cell carcinoma in Northern Spain. Semin Oncol 2024; 51:77-86. [PMID: 38604897 DOI: 10.1053/j.seminoncol.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND The current available evidence on the management of metastatic renal cell cancer (mRCC) in real life is scarce in our environment. We present a summary of the existing real-world data and the results of an analysis describing the clinical characteristics, treatments, and health outcomes of patients with mRCC in northern Spain. METHODS Retrospective observational study. Adult patients diagnosed with mRCC between Jan 2007 and Dec 2019 were included. Epidemiological, efficacy and toxicity data were collected. Median overall survival (OS) and progression-free survival (PFS) were determined using the Kaplan-Meier method. RESULTS A total of 829 patients were included (median age at diagnosis:63 years;73% men). Median follow-up was 180 months. The preponderant histology was clear cell (85%). In 50% the initial diagnosis was advanced disease. The distribution according to IMDC prognosis was good (24%), intermediate (50%) and poor (26%). The most frequent metastatic locations were lung (68.3%) and lymph node (41.0%). Most patients (95%) received a first line (1L) systemic treatment, 60% were treated with a second line (2L) of therapy and 37% received third line (3L). A VEGFR-TKIs was the most common treatment (1L: 90%, n = 507; 2L: 49%, n = 233; 3L: 54%, n = 156) followed by mTOR inhibitors (1L: 2%, n = 4; 2L: 27%, n = 126; 3L: 23%, n = 68) and immunotherapy (1L: 3.7%, n = 25; 2L: 27%, n = 126). Median OS was 24.5 months in the general population. According to IMDC prognostic groups, OS was 52.5, 25.7 and 9 months respectively. From the start of the 1L, 2L, and 3L treatment, median PFS was: 1L: 7.8 (6.8-9.0); 2L: 4.9 (4.3-5.5); 3L: 4.3 (3.8-4.8) months. No unexpected toxicity was reported. CONCLUSIONS The Real-World Data on the management of mRCC in Northern Spain are comparable in epidemiology, efficacy, and safety to studies conducted in other areas of the world. The significant reduction in the number of patients receiving second and subsequent lines of therapy hampers the access to new therapies developed in this context.
Collapse
Affiliation(s)
| | | | - Diego Cacho Lavín
- Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | | | | | | | | | | | | | | | | | - Ricardo Fernández Rodríguez
- Hospital Universitario de Cruces e Instituto Oncológico IMQ Bilbao, Bilbao, Spain - Clínica IMQ Zorrotzaurre, Bizkaia, Spain
| | | | - Naiara Sagastibeltza
- Medical Oncology Departments: Hospital Universitario Donostia-OSI Donostialdea, Gipuzkoa, Spain
| | - Ignacio Duran
- Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
| |
Collapse
|
3
|
Albigès L, Bellera C, Branchoux S, Arnaud M, Gouverneur A, Néré S, Gaudin AF, Durand-Zaleski I, Négrier S. Real-World Treatment Patterns and Effectiveness of Patients With Advanced Renal Cell Carcinoma: A Nationwide Observational Study. Clin Genitourin Cancer 2024; 22:295-304.e6. [PMID: 38105152 DOI: 10.1016/j.clgc.2023.11.012] [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: 07/21/2023] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Treatment landscape for advanced renal cell carcinoma (aRCC) has evolved quickly and few data about the real-world treatment patterns are available. This study aimed at describing the real-world treatment patterns and effectiveness of all systemic treatments available for aRCC in first and second-line treatment. MATERIALS AND METHODS A cohort of patients initiating a first-line systemic treatment for aRCC in 2016 was extracted from the French nationwide healthcare insurance system database (SNDS). The first-line treatment initiation date constituted the index date and patients were followed until death, loss to follow-up, or December 31, 2019, whichever occurred first. aRCC was identified using hospital diagnosis, long-term disease, or renal biopsy before index date. All analyses were performed for first and second-line treatment. Overall survival (OS) and time-to-next treatment or death (TNT-D) were estimated using Kaplan-Meier approach. RESULTS In 2016, 1629 patients initiated a first-line treatment for aRCC. Most of them were male (75.9%) and the median age was 67 years. Most of patients (91.7%) had received a tyrosine kinase inhibitor as first-line treatment, mainly sunitinib (64.4%), and 53.5% received a second-line, among which 43.7% nivolumab. Median OS (95% confidence interval [CI]) was 20.7 (95% CI:18.2-22.4) months from first-line treatment initiation and 15.4 (13.9-17.5) months from second-line treatment initiation. Median TNT-D were respectively 9.3 (9.7-12.1) months and 6.9 (5.9-7.7) months. CONCLUSION This study highlights the limited survival of aRCC patients These results provide a valuable baseline and highlight the need for innovation, such as immune checkpoint inhibitor-based combinations that have recently became first-line standard of care.
Collapse
Affiliation(s)
| | - Carine Bellera
- Department of Clinical Epidemiology and Clinical Research, Institut Bergonié, Bordeaux, France
| | - Sébastien Branchoux
- Department of Health Economics & Outcomes Research, Bristol Myers Squibb, Rueil-Malmaison, France
| | | | | | - Sonia Néré
- Department of Medical Affairs, Bristol Myers Squibb, Rueil-Malmaison, France
| | - Anne-Françoise Gaudin
- Department of Health Economics & Outcomes Research, Bristol Myers Squibb, Rueil-Malmaison, France
| | | | | |
Collapse
|
4
|
Uhlig A, Bergmann L, Bögemann M, Fischer T, Goebell PJ, Leitsmann M, Reichert M, Rink M, Schlack K, Trojan L, Uhlig J, Woike M, Strauß A. Sunitinib for Metastatic Renal Cell Carcinoma: Real-World Data from the STAR-TOR Registry and Detailed Literature Review. Urol Int 2024; 108:198-210. [PMID: 38310863 DOI: 10.1159/000536563] [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: 08/03/2023] [Accepted: 01/15/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION We evaluated the effectiveness and safety profile of the tyrosine kinase inhibitor sunitinib in patients with advanced or metastatic renal cell carcinoma (a/mRCC) in a real-world setting. METHODS We analyzed data of adult a/mRCC patients treated with sunitinib. Data were derived from the German non-interventional post-approval multicenter STAR-TOR registry (NCT00700258). Progression-free survival (PFS), overall survival (OS), and adverse events (AEs) were evaluated using descriptive statistics and survival analyses for the entire cohort and patient subgroups. RESULTS A total of 116 study sites recruited 702 patients treated with sunitinib (73.1% male; median age 68.0 years; median Karnofsky index 90%) between November 2010 and May 2020. The most frequent histological subtype was clear cell RCC (81.6%). Sunitinib was administered as first-line treatment in 83.5%, as second line in 11.7%, and as third line or beyond in 4.8% of the patients. Drug-related AEs and serious AEs were reported in 66.3% and 13.9% of the patients, respectively (most common AE: gastrointestinal disorders; 39.7% of all patients). CONCLUSIONS This study adds further real-world evidence of the persisting relevance of sunitinib for patients with a/mRCC who cannot receive or tolerate immune checkpoint inhibitors. The study population includes a high proportion of patients with unfavorable MSKCC poor-risk score, but shows still good PFS and OS results, while the drug demonstrates a favorable safety profile. The STAR-TOR registry is also registered in the database of US library of medicine (NCT00700258).
Collapse
Affiliation(s)
- Annemarie Uhlig
- Department of Urology, University Medical Center Göttingen, Göttingen, Germany
| | - Lothar Bergmann
- Medical Clinic II, J.W. Goethe University, Frankfurt, Germany
| | - Martin Bögemann
- Department of Urology, University of Münster, Münster, Germany
| | | | - Peter J Goebell
- Department of Urology, University Clinic of Erlangen, Erlangen, Germany
| | | | - Mathias Reichert
- Department of Urology, University Medical Center Göttingen, Göttingen, Germany
| | - Michael Rink
- Department of Urology, Kath. Marienkrankenhaus gGmbH, Hamburg, Germany
| | - Katrin Schlack
- Department of Urology, University Hospital Münster, Münster, Germany
| | - Lutz Trojan
- Department of Urology, University Medical Center Göttingen, Göttingen, Germany
| | - Johannes Uhlig
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Arne Strauß
- Department of Urology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
5
|
Cesas A, Urbonas V, Tulyte S, Janciauskiene R, Liutkauskiene S, Grabauskyte I, Gaidamavicius I. Sequential treatment of metastatic renal cell carcinoma patients after first-line vascular endothelial growth factor targeted therapy in a real-world setting: epidemiologic, noninterventional, retrospective-prospective cohort multicentre study. J Cancer Res Clin Oncol 2023; 149:6979-6988. [PMID: 36847839 PMCID: PMC10374746 DOI: 10.1007/s00432-023-04645-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/08/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE The purpose of our study was to determine whether data on the clinical effectiveness of second-line therapy collected in a real-world setting provide additional valuable information on the optimal sequence of metastatic renal cell carcinoma (mRCC) treatment. METHODS Patients diagnosed with mRCC who were treated with at least one dose of first-line vascular endothelial growth factor (VEGF)-targeted therapy with either sunitinib or pazopanib and with at least one dose of second-line everolimus, axitinib, nivolumab, or cabozantinib were included. The efficacy of different treatment sequences was analyzed based on the time to the second objective disease progression (PFS2) and the time to the first objective disease progression (PFS). RESULTS Data from 172 subjects were available for analysis. PFS2 was 23.29 months. The 1-year PFS2 rate was 85.3%, and the 3-year PFS2 rate was 25.9%. The 1-year overall survival rate was 97.0%, and the 3-year overall survival rate was 78.6%. Patients with a lower IMDC prognostic risk group had a significantly (p < 0.001) longer PFS2. Patients with metastases in the liver had a shorter PFS2 than patients with metastases in the other sites (p = 0.024). Patients with metastases in the lungs and lymph nodes (p = 0.045) and patients with metastases in the liver and bones (p = 0.030) had lower PFS2 rates than patients with metastases in other sites. CONCLUSIONS Patients with a better IMDC prognosis have a longer PFS2. Metastases in the liver lead to a shorter PFS2 than metastases in other sites. One metastasis site means a longer PFS2 than 3 or more metastasis sites. Nephrectomy performed in an earlier stage of disease or metastatic setting means higher PFS and higher PFS2. No PFS2 difference was found between different treatment sequences of TKI-TKI or TKI-immune therapy.
Collapse
Affiliation(s)
| | | | - Skaiste Tulyte
- Clinic of Internal Diseases, Family Medicine and Oncology, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Rasa Janciauskiene
- Clinic of Oncology and Hematology, Institute of Oncology, Lithuanian University of Health Sciences Hospital of Lithuania, Kaunas Clinics Hospital, Kaunas, Lithuania
| | - Sigita Liutkauskiene
- Hospital of Oncology, Affiliate Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ingrida Grabauskyte
- Department of Physics, Mathematics and Biophysics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | |
Collapse
|
6
|
Mrdenovic S, Wang Y, Yin L, Chu GCY, Ou Y, Lewis MS, Heffer M, Posadas EM, Zhau HE, Chung LWK, Edderkaoui M, Pandol SJ, Wang R, Zhang Y. A cisplatin conjugate with tumor cell specificity exhibits antitumor effects in renal cancer models. BMC Cancer 2023; 23:499. [PMID: 37268911 PMCID: PMC10236852 DOI: 10.1186/s12885-023-10878-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/24/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Clear cell renal cell carcinoma (ccRCC) is the most common type of kidney cancer and is notorious for its resistance to both chemotherapy and small-molecule inhibitor targeted therapies. Subcellular targeted cancer therapy may thwart the resistance to produce a substantial effect. METHODS We tested whether the resistance can be circumvented by subcellular targeted cancer therapy with DZ-CIS, which is a chemical conjugate of the tumor-cell specific heptamethine carbocyanine dye (HMCD) with cisplatin (CIS), a chemotherapeutic drug with limited use in ccRCC treatment because of frequent renal toxicity. RESULTS DZ-CIS displayed cytocidal effects on Caki-1, 786-O, ACHN, and SN12C human ccRCC cell lines and mouse Renca cells in a dose-dependent manner and inhibited ACHN and Renca tumor formation in experimental mouse models. Noticeably, in tumor-bearing mice, repeated DZ-CIS use did not cause renal toxicity, in contrast to the CIS-treated control animals. In ccRCC tumors, DZ-CIS treatment inhibited proliferation markers but induced cell death marker levels. In addition, DZ-CIS at half maximal inhibitory concentration (IC50) sensitized Caki-1 cells to small-molecule mTOR inhibitors. Mechanistically, DZ-CIS selectively accumulated in ccRCC cells' subcellular organelles, where it damages the structure and function of mitochondria, leading to cytochrome C release, caspase activation, and apoptotic cancer cell death. CONCLUSIONS Results from this study strongly suggest DZ-CIS be tested as a safe and effective subcellular targeted cancer therapy.
Collapse
Affiliation(s)
- Stefan Mrdenovic
- Division of Hematology, Department of Internal Medicine, University Hospital Osijek, Osijek, Croatia
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Yanping Wang
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Lijuan Yin
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Gina Chia-Yi Chu
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yan Ou
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael S Lewis
- Departments of Pathology, Cedars-Sinai Medical Center and the VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Marija Heffer
- Department of Medical Biology and Genetics, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Edwin M Posadas
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Haiyen E Zhau
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Leland W K Chung
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mouad Edderkaoui
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephen J Pandol
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ruoxiang Wang
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Departments of Pathology, Cedars-Sinai Medical Center and the VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Yi Zhang
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Davis 3059, 90048, Los Angeles, CA, USA.
| |
Collapse
|
7
|
The Role of CT Imaging in Characterization of Small Renal Masses. Diagnostics (Basel) 2023; 13:diagnostics13030334. [PMID: 36766439 PMCID: PMC9914376 DOI: 10.3390/diagnostics13030334] [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: 11/30/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
Small renal masses (SRM) are increasingly detected incidentally during imaging. They vary widely in histology and aggressiveness, and include benign renal tumors and renal cell carcinomas that can be either indolent or aggressive. Imaging plays a key role in the characterization of these small renal masses. While a confident diagnosis can be made in many cases, some renal masses are indeterminate at imaging and can present as diagnostic dilemmas for both the radiologists and the referring clinicians. This review focuses on CT characterization of small renal masses, perhaps helping us understand small renal masses. The following aspects were considered for the review: (a) assessing the presence of fat, (b) assessing the enhancement, (c) differentiating renal tumor subtype, and (d) identifying valuable CT signs.
Collapse
|
8
|
van Laar SA, Kapiteijn E, Gombert-Handoko KB, Guchelaar HJ, Zwaveling J. Application of Electronic Health Record Text Mining: Real-World Tolerability, Safety, and Efficacy of Adjuvant Melanoma Treatments. Cancers (Basel) 2022; 14:5426. [PMID: 36358844 PMCID: PMC9657798 DOI: 10.3390/cancers14215426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 08/13/2023] Open
Abstract
Introduction: Nivolumab (N), pembrolizumab (P), and dabrafenib plus trametinib (D + T) have been registered as adjuvant treatments for resected stage III and IV melanoma since 2018. Electronic health records (EHRs) are a real-world data source that can be used to review treatments in clinical practice. In this study, we applied EHR text-mining software to evaluate the real-world tolerability, safety, and efficacy of adjuvant melanoma treatments. Methods: Adult melanoma patients receiving adjuvant treatment between January 2019 and October 2021 at the Leiden University Medical Center, the Netherlands, were included. CTcue text-mining software (v3.1.0, CTcue B.V., Amsterdam, The Netherlands) was used to construct rule-based queries and perform context analysis for patient inclusion and data collection from structured and unstructured EHR data. Results: In total, 122 patients were included: 54 patients treated with nivolumab, 48 with pembrolizumab, and 20 with D + T. Significantly more patients discontinued treatment due to toxicity on D + T (N: 16%, P: 6%, D + T: 40%), and X2 (6, n = 122) = 14.6 and p = 0.024. Immune checkpoint inhibitors (ICIs) mainly showed immune-related treatment-limiting adverse events (AEs), and chronic thyroid-related AE occurred frequently (hyperthyroidism: N: 15%, P: 13%, hypothyroidism: N: 20%, P: 19%). Treatment-limiting toxicity from D + T was primarily a combination of reversible AEs, including pyrexia and fatigue. The 1-year recurrence-free survival was 70.3% after nivolumab, 72.4% after pembrolizumab, and 83.0% after D + T. Conclusions: Text-mining EHR is a valuable method to collect real-world data to evaluate adjuvant melanoma treatments. ICIs were better tolerated than D + T, in line with RCT results. For BRAF+ patients, physicians must weigh the higher risk of reversible treatment-limiting AEs of D + T against the risk of long-term immune-related AEs.
Collapse
Affiliation(s)
- Sylvia A. van Laar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Kim B. Gombert-Handoko
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Juliette Zwaveling
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| |
Collapse
|