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Alkhatib O, Miles T, Jones RP, Mair R, Palmer R, Winter H, McDermott FD. Current and future genomic applications for surgeons. Ann R Coll Surg Engl 2024; 106:321-328. [PMID: 38555869 PMCID: PMC10981988 DOI: 10.1308/rcsann.2024.0031] [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] [Accepted: 03/04/2024] [Indexed: 04/02/2024] Open
Abstract
Genomics is a crucial part of managing surgical disease. This review focuses on some of the genomic advances that are available now and looks to the future of their application in surgical practice. Whole-genome sequencing enables unbiased coverage across the entire human genome of approximately three billion base pairs. Newer technologies, such as those that permit long-read sequence analysis, provide additional information in longer phased fragment and base pair epigenomic (methylomic) data. Whole-genome sequencing is currently available in England for cancers in children, teenagers and young adults, central nervous system tumours, sarcoma and haematological malignancies. Circulating tumour DNA (ctDNA), immunotherapy and pharmacogenomics have emerged as groundbreaking approaches in the field of cancer treatment. These are now revolutionising the way oncologists and surgeons approach curative cancer surgery. Cancer vaccines offer an innovative approach to reducing recurrence after surgery by priming the immune system to trigger an immune response. The Cancer Vaccine Launch Pad project facilitates cancer vaccine studies in England. The BNT122-01 trial is recruiting patients with ctDNA-positive high-risk colorectal cancer after surgery to assess the impact of cancer vaccines. The evolving landscape of cancer treatment demands a dynamic and integrated approach from the surgical multidisciplinary team. Immunotherapy, ctDNA, pharmacogenomics, vaccines, mainstreaming and whole-genome sequencing are just some of the innovations that have the potential to redefine the standards of care. The continued exploration of these innovative diagnostics and therapies, the genomic pathway evolution and their application in diverse cancer types highlights the transformative impact of precision medicine in surgery.
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Affiliation(s)
- O Alkhatib
- Liverpool University Teaching Hospitals NHS Foundation Trust, UK
| | - T Miles
- Southwest Genomics Medicine Service Alliance, UK
| | | | | | | | - H Winter
- University Hospitals Bristol and Weston NHS Foundation Trust, UK
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2
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Callon S, Brugel M, Botsen D, Royer B, Slimano F, Feliu C, Gozalo C, Konecki C, Devie B, Carlier C, Daire V, Laurés N, Perrier M, Djerada Z, Bouché O. Renal impairment and abnormal liver function tests in pre-therapeutic phenotype-based DPD deficiency screening using uracilemia: a comprehensive population-based study in 1138 patients. Ther Adv Med Oncol 2023; 15:17588359221148536. [PMID: 36643657 PMCID: PMC9837271 DOI: 10.1177/17588359221148536] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023] Open
Abstract
Background Dihydropyrimidine dehydrogenase (DPD) deficiency screening is a pre-therapeutic standard to prevent severe fluoropyrimidine-related toxicity. Although several screening methods exist, the accuracy of their results remains debatable. In France, the uracilemia measurement is considered the standard in DPD deficiency screening. The objective of this study was to describe the hyperuracilemia (⩾16 ng/mL) rate and investigate the influence of hepatic and renal impairment in uracilemia measurements since the guidelines were implemented. Patients and methods Using a cohort of 1138 patients screened between 18 October 2018 and 18 October 2021, basic demographic characteristics, date of blood sampling, and potential biological confounders including liver function tests [aspartate aminotransaminase (AST), alanine aminotransaminase (ALT), gamma-glutamyl transferase (γGT), alkaline phosphatase (ALP), and bilirubin] and estimated glomerular filtration rate (eGFR) were collected. The second same-patient uracilemia analysis was also performed. Temporal change was graphically represented while potential confounders were stratified to show linearity when suspected. Results Hyperuracilemia was diagnosed in 12.7% (n = 150) samples with 6.7%, 5.4%, 0.5%, and 0.08% between 16 and 20 ng/mL, 20 and 50 ng/mL, 50 and 150 ng/mL, and >150 ng/mL, respectively. The median uracilemia concentration was 9.4 ng/mL (range: 1.2 and 172.3 ng/mL) and the monthly hyperuracilemia rate decreased steadily from >30% to around 9%. Older age, normalized AST, γGT, ALP results, bilirubin levels, and decreased eGFR were linearly associated with higher plasma uracil concentrations (all p < 0.001). In the adjusted multivariate linear model, AST, eGFR, and ALP remained associated with uracilemia (p < 0.05). When measured twice in 39 patients, the median uracilemia rate of change was -2.5%, which subsequently changed the diagnosis in nine patients (23.1%). Conclusions Better respect of pre-analytical conditions may explain the steady decrease in monthly hyperuracilemia rates over the 3 years. Elevated AST, ALP levels, and reduced eGFR could induce a false increase in uracilemia and second uracilemia measurements modified the first DPD deficiency diagnosis in almost 25% of the patients.
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Affiliation(s)
| | | | - Damien Botsen
- Department of Medical Oncology, Godinot Cancer Institute, Reims, France,Department of Digestive Oncology and Gastroenterology, University of Reims Champagne-Ardenne (URCA), CHU Reims, Reims, France
| | - Bernard Royer
- Clinical Pharmacology and Toxicology Laboratory, CHU Besançon, Besançon, France
| | | | - Catherine Feliu
- Pharmacology and Toxicology Department, CHU Reims, Reims, France
| | - Claire Gozalo
- Pharmacology and Toxicology Department, CHU Reims, Reims, France
| | - Céline Konecki
- Pharmacology and Toxicology Department, CHU Reims, Reims, France
| | - Bruno Devie
- Clairmarais Bioxa Medical Biology Laboratory, Reims, France
| | - Claire Carlier
- Department of Medical Oncology, Godinot Cancer Institute, Reims, France,Department of Digestive Oncology and Gastroenterology, University of Reims Champagne-Ardenne (URCA), CHU Reims, Reims, France
| | - Viktor Daire
- Department of Digestive Oncology and Gastroenterology, University of Reims Champagne-Ardenne (URCA), CHU Reims, Reims, France
| | - Nicolas Laurés
- Department of Digestive Oncology and Gastroenterology, University of Reims Champagne-Ardenne (URCA), CHU Reims, Reims, France
| | - Marine Perrier
- Department of Digestive Oncology and Gastroenterology, University of Reims Champagne-Ardenne (URCA), CHU Reims, Reims, France
| | - Zoubir Djerada
- Pharmacology and Toxicology Department, CHU Reims, Reims, France
| | - Olivier Bouché
- Department of Digestive Oncology and Gastroenterology, University of Reims Champagne-Ardenne (URCA), CHU Reims, Reims, France
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Laures N, Konecki C, Brugel M, Giffard AL, Abdelli N, Botsen D, Carlier C, Gozalo C, Feliu C, Slimano F, Djerada Z, Bouché O. Impact of Guidelines Regarding Dihydropyrimidine Dehydrogenase (DPD) Deficiency Screening Using Uracil-Based Phenotyping on the Reduction of Severe Side Effect of 5-Fluorouracil-Based Chemotherapy: A Propension Score Analysis. Pharmaceutics 2022; 14:pharmaceutics14102119. [PMID: 36297556 PMCID: PMC9610761 DOI: 10.3390/pharmaceutics14102119] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
Dihydropyrimidine dehydrogenase (DPD) deficiency is associated with severe fluoropyrimidines-induced toxicity. As of September 2018, French recommendations call for screening for DPD deficiency by plasma uracil quantification prior to all fluoropyrimidine-based chemotherapy. A dose reduction of fluoropyrimidine is recommended when uracil concentration is equal to or greater than 16 ng/mL. This matched retrospective study assessed the impact of DPD screening on the reduction of severe side effects and on the management of DPD-deficient patients. Using a propensity score, we balanced the factors influencing 5-Fluorouracil (5-FU) toxicity. Then, the severity scores (G3 and G4 severity as well as their frequency) of patients who did not benefit from DPD screening were compared with those of patients who benefited from DPD screening for each treatment cycle (from 1 to 4). Among 349 screened patients, 198 treated patients were included. Among them, 31 (15.7%) had DPD deficiency (median uracilemia 19.8 ng/mL (range: 16.1−172.3)). The median toxicity severity score was higher in the unscreened group for each treatment cycle (0 vs. 1, p < 0.001 at each cycle from 1 to 4) as well as the cumulative score during all courses of treatment (p = 0.028). DPD-deficient patients received a significantly lower dose of 5-FU (p < 0.001). This study suggests that pretherapeutic plasmatic uracil assessment, along with 5-FU dosage adjustment, may be beneficial in reducing 5-FU toxicity in real-life patients.
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Affiliation(s)
- Nicolas Laures
- Department of Gastroenterology and Digestive Oncology, CHU Reims, University of Reims Champagne-Ardenne (URCA), 51100 Reims, France
| | - Céline Konecki
- Department of Medical Pharmacology, University of Reims Champagne-Ardenne (URCA), HERVI EA3801, 51097 Reims, France
- Department of Pharmacology and Toxicology, CHU Reims, 51100 Reims, France
| | - Mathias Brugel
- Department of Gastroenterology and Digestive Oncology, CHU Reims, University of Reims Champagne-Ardenne (URCA), 51100 Reims, France
- Department of Hepato-Gastroenterology and Digestive Oncology, Centre Hospitalier Auban-Moët, 51200 Epernay, France
| | - Anne-Lise Giffard
- Department of Gastroenterology and Digestive Oncology, CHU Reims, University of Reims Champagne-Ardenne (URCA), 51100 Reims, France
| | - Naceur Abdelli
- Department of Hepato-Gastroenterology and Digestive Oncology, Centre Hospitalier de Chalons en Champagne, 51000 Chalons en Champagne, France
| | - Damien Botsen
- Department of Gastroenterology and Digestive Oncology, CHU Reims, University of Reims Champagne-Ardenne (URCA), 51100 Reims, France
| | - Claire Carlier
- Department of Gastroenterology and Digestive Oncology, CHU Reims, University of Reims Champagne-Ardenne (URCA), 51100 Reims, France
| | - Claire Gozalo
- Department of Medical Pharmacology, University of Reims Champagne-Ardenne (URCA), HERVI EA3801, 51097 Reims, France
- Department of Pharmacology and Toxicology, CHU Reims, 51100 Reims, France
| | - Catherine Feliu
- Department of Medical Pharmacology, University of Reims Champagne-Ardenne (URCA), HERVI EA3801, 51097 Reims, France
- Department of Pharmacology and Toxicology, CHU Reims, 51100 Reims, France
| | - Florian Slimano
- Department of Pharmacy, CHU Reims, University of Reims Champagne-Ardenne (URCA), 51100 Reims, France
| | - Zoubir Djerada
- Department of Medical Pharmacology, University of Reims Champagne-Ardenne (URCA), HERVI EA3801, 51097 Reims, France
- Department of Pharmacology and Toxicology, CHU Reims, 51100 Reims, France
- Correspondence:
| | - Olivier Bouché
- Department of Medical Pharmacology, University of Reims Champagne-Ardenne (URCA), HERVI EA3801, 51097 Reims, France
- Department of Pharmacology and Toxicology, CHU Reims, 51100 Reims, France
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Zou Y, Liu S, Wu J, Sun Z. Severe ileum bleeding following adjuvant capecitabine chemotherapy for locally advanced colon cancer: a case report and review of the literature. World J Surg Oncol 2021; 19:332. [PMID: 34809643 PMCID: PMC8609886 DOI: 10.1186/s12957-021-02443-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/02/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Capecitabine is a prodrug that is enzymatically converted to its active form, fluorouracil (also called 5-fluorouracil), which is commonly used as adjuvant chemotherapy in colorectal cancer patients. Severe gastrointestinal bleeding induced by capecitabine is rare. Here, we are presenting the first case report of surgery specimen assisted diagnosis of this uncommon condition. CASE PRESENTATION A 63-year-old Chinese male with a history of colon adenocarcinoma and right hemicolectomy presented with severe lower gastrointestinal bleeding 2 days after finishing capecitabine administration during the first cycle of XELOX adjuvant chemotherapy. Because of the negative findings of active bleeding points by digital subtraction angiography (DSA) or colonoscopy, emergency laparotomy and partial enterectomy were performed. The bloody diarrhea had resolved after surgery and a terminal ileitis was diagnosed after pathological examination of the surgical specimen. CONCLUSIONS Terminal ileitis induced by capecitabine is likely to be underreported. It should be considered more often as a cause of severe gastrointestinal bleeding during or after treatment with capecitabine agents. Emergency surgery may achieve satisfactory outcomes if endoscopic hemostasis is ineffective. HIGHLIGHTS OF THIS CASE 1. Gastrointestinal bleeding following capecitabine treatment in colorectal cancer patients might be life-threatening. 2. Terminal ileitis induced by capecitabine should always be considered in the differential diagnosis of severe gastrointestinal bleeding. 3. Awareness of the risk factors such as deficiency of dihydropyrimidine dehydrogenase, advanced age, or right colectomy may aid in reducing capecitabine-related morbidity. 4. When severe bleeding occurs, emergency surgery may achieve satisfactory outcomes if medical and endoscopic interventions are ineffective.
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Affiliation(s)
- You Zou
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College in Huazhong University of Science and Technology, Wuhan, Hubei, China.,Tongji Cancer Research Institute, Tongji Hospital, Tongji Medical College in Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shuang Liu
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College in Huazhong University of Science and Technology, Wuhan, Hubei, China.,Tongji Cancer Research Institute, Tongji Hospital, Tongji Medical College in Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jianhong Wu
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College in Huazhong University of Science and Technology, Wuhan, Hubei, China.,Tongji Cancer Research Institute, Tongji Hospital, Tongji Medical College in Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhen Sun
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College in Huazhong University of Science and Technology, Wuhan, Hubei, China. .,Tongji Cancer Research Institute, Tongji Hospital, Tongji Medical College in Huazhong University of Science and Technology, Wuhan, Hubei, China.
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5
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Shibata T, Shimamura R, Yamamoto Y, Sakurai H, Fujita J, Yamayoshi A, Nemoto T, Kabashima T. A Facile Method for the Quantification of Urinary Uracil Concentration by a Uracil-Specific Fluorescence Derivatization Reaction. Chem Pharm Bull (Tokyo) 2021; 69:768-772. [PMID: 34334520 DOI: 10.1248/cpb.c21-00221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A facile and reliable fluorescence method for the quantification of urinary uracil concentration is proposed herein. The assay utilizes a specific fluorescence (FL) derivatization reaction for uracil using 3-methylbenzamidoxime as a fluorogenic reagent. Although the presence of urine inhibited the FL reaction, 10 µL of urine was sufficient for the detection of urinary uracil. The uracil derivative was successfully separated from other fluorescent impurities using simple reversed-phase LC with FL detection. Urinary uracil concentrations from 16 people were compared with the concentrations obtained by the traditional column-switching liquid chromatographic analysis with UV detection. The FL derivative of uracil appeared as a single peak in the chromatograms of all samples. However, several samples showed an additional peak overlapping the uracil peak when using the column-switching method because of UV-active impurities. These results indicated that that the present method is not affected by interfering substances in urine and affords a precise determination of urinary uracil. We expect the proposed method to be applicable for diagnosing dihydropyrimidine dehydrogenase deficiency in 5-fluorouracil chemotherapy.
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Affiliation(s)
- Takayuki Shibata
- Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences.,Graduate School of Biomedical Sciences, Nagasaki University
| | | | - Yuji Yamamoto
- Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences
| | - Hiroki Sakurai
- Graduate School of Biomedical Sciences, Nagasaki University
| | - Junya Fujita
- Graduate School of Biomedical Sciences, Nagasaki University
| | | | - Toshimitsu Nemoto
- Department of Otorhinolaryngology, Japanese Red Cross Society Narita Hospital
| | - Tsutomu Kabashima
- Graduate School of Pharmaceutical Sciences, Nagasaki International University
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6
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Deac AL, Burz CC, Bocşe HF, Bocşan IC, Buzoianu AD. A review on the importance of genotyping and phenotyping in fluoropyrimidine treatment. Med Pharm Rep 2020; 93:223-230. [PMID: 32832886 PMCID: PMC7418836 DOI: 10.15386/mpr-1564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/24/2020] [Accepted: 03/20/2019] [Indexed: 12/23/2022] Open
Abstract
Fluoropyrimidines, after more than 50 years from their discovery, are still the treatment of many types of cancer, and it is estimated that two million patients receive fluoropyrimidine therapy annually. The toxicity associated with fluoropyrimidines affects 30–40% of patients and some adverse effects can be lethal. Dihydroypyrimidine dehydrogenase is the main enzyme in the catabolism of 5-FU and DPD activity deficiency can cause important toxicity. This is an important reason to determine DPD activity in order to improve patient safety and to limit potential life-threating toxicity. At presentmultiple phenotypic and genotypic methods are available for the determination of DPD activity, some of these methods have proven their usefulness in practice, and yet they are not routinely recommended in clinical practice. This review is another statement of the importance of the determination of DPD status, the phenotypic and genotypic methods that are available and can be used.
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Affiliation(s)
| | - Claudia Cristina Burz
- "Prof. Dr. Ion Chiricuţă" Oncology Institute, Cluj-Napoca, Romania.,Immunology and Allergology, Department 2 - Functional Sciences, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Horea Florin Bocşe
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 3 General Surgery Clinic, Cluj-Napoca, Romania
| | - Ioana Corina Bocşan
- Pharmacology, Toxicology and Clinical Pharmacology, Department 2 - Functional Biosciences, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anca-Dana Buzoianu
- Pharmacology, Toxicology and Clinical Pharmacology, Department 2 - Functional Biosciences, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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7
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Affiliation(s)
- Auston Gillis
- South Shore Dermatology Physicians, PC, North Easton, Massachusetts
| | - Lindsay Eminger
- South Shore Dermatology Physicians, PC, North Easton, Massachusetts
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8
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Marin C, Krache A, Palmaro C, Lucas M, Hilaire V, Ugdonne R, De Victor B, Quaranta S, Solas C, Lacarelle B, Ciccolini J. A Simple and Rapid UPLC-UV Method for Detecting DPD Deficiency in Patients With Cancer. Clin Transl Sci 2020; 13:761-768. [PMID: 32058656 PMCID: PMC7359930 DOI: 10.1111/cts.12762] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/20/2019] [Indexed: 12/20/2022] Open
Abstract
Detecting patients with dihydropyrimidine dehydrogenase (DPD) deficiency is becoming a major concern in clinical oncology. Monitoring physiologic plasma uracil and/or plasma uracil‐to‐dihydrouracil metabolic ratio is a common surrogate frequently used to determine DPD phenotype without direct measurement of the enzymatic activity. With respect to the increasing number of patients rquiring analysis, it is critical to develop simple, rapid, and affordable methods suitable for routine screening. We have developed and validated a simple and robust ultraperformance liquid chromatography‒ultraviolet (UPLC‐UV) method with shortened (i.e., 12 minutes) analytical run‐times, compatible with the requirements of large‐scale upfront screening. The method enables detection of uracil (U) over a range of 5–500 ng/ml (265 nm) and of dihydrouracil (UH2) over a range of 40–500 ng/ml (210 nm) in plasma with no chromatographic interference. When used as part of routine screening for DPD deficiency, this method was fully able to discriminate nondeficient patients (i.e., with U levels < 16 ng/ml) from deficient patients at risk of severe toxicity (i.e., U > 16 ng/ml). Results from 1 month of routine testing are presented and, although no complete deficits were detected, 10.7% of the screened patients presented DPD deficiency and would thus require s decresed dose. Overall, this new method, using a simple preanalytical solid‐phase extraction procedure, and based on use of a standard UPLC apparatus, is both cost‐ and time‐effective and can be easily implemented in any laboratory aiming to begin routine DPD testing.
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Affiliation(s)
- Clémence Marin
- Laboratoire de Pharmacologie et Toxicologie, La Timone University Hospital of Marseille, Assistance Publique Hôpitaux de Marseille, Marseille, France.,SMARTc Unit, Center de Recherche en Cancérologie de Marseille UMR Inserm U1068, Aix Marseille Universitaire, Marseille, France
| | - Anis Krache
- SMARTc Unit, Center de Recherche en Cancérologie de Marseille UMR Inserm U1068, Aix Marseille Universitaire, Marseille, France
| | - Chloé Palmaro
- Laboratoire de Pharmacologie et Toxicologie, La Timone University Hospital of Marseille, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Mathilde Lucas
- Laboratoire de Pharmacologie et Toxicologie, La Timone University Hospital of Marseille, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Valentin Hilaire
- Laboratoire de Pharmacologie et Toxicologie, La Timone University Hospital of Marseille, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Renée Ugdonne
- Laboratoire de Pharmacologie et Toxicologie, La Timone University Hospital of Marseille, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Bénédicte De Victor
- Laboratoire de Pharmacologie et Toxicologie, La Timone University Hospital of Marseille, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Sylvie Quaranta
- Laboratoire de Pharmacologie et Toxicologie, La Timone University Hospital of Marseille, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Caroline Solas
- Laboratoire de Pharmacologie et Toxicologie, La Timone University Hospital of Marseille, Assistance Publique Hôpitaux de Marseille, Marseille, France.,SMARTc Unit, Center de Recherche en Cancérologie de Marseille UMR Inserm U1068, Aix Marseille Universitaire, Marseille, France
| | - Bruno Lacarelle
- Laboratoire de Pharmacologie et Toxicologie, La Timone University Hospital of Marseille, Assistance Publique Hôpitaux de Marseille, Marseille, France.,SMARTc Unit, Center de Recherche en Cancérologie de Marseille UMR Inserm U1068, Aix Marseille Universitaire, Marseille, France
| | - Joseph Ciccolini
- Laboratoire de Pharmacologie et Toxicologie, La Timone University Hospital of Marseille, Assistance Publique Hôpitaux de Marseille, Marseille, France.,SMARTc Unit, Center de Recherche en Cancérologie de Marseille UMR Inserm U1068, Aix Marseille Universitaire, Marseille, France
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9
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Barin-Le Guellec C, Lafay-Chebassier C, Ingrand I, Tournamille JF, Boudet A, Lanoue MC, Defossez G, Ingrand P, Perault-Pochat MC, Etienne-Grimaldi MC. Toxicities associated with chemotherapy regimens containing a fluoropyrimidine: A real-life evaluation in France. Eur J Cancer 2020; 124:37-46. [PMID: 31715555 DOI: 10.1016/j.ejca.2019.09.028] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 12/14/2022]
Abstract
AIMS Despite fluoropyrimidines (FPs) constituting the main component of the chemotherapy combination protocols in 50% of chemotherapies for solid tumour treatments, incidence data for FP-related toxicity are poorly documented in real life. This study evaluated the number of patients receiving FP-based chemotherapies in France, along with the true incidence of FP-related serious adverse effects (SAEs) before the recent mandatory dihydropyrimidine dehydrogenase (DPD)-screening was introduced by French health authorities, DPD being the rate-limiting enzyme of 5-fluorouracil (5-FU) catabolism. METHODS Exhaustive data on the number of patients treated with FP-based chemotherapy in 2013-2014 were collected in the Centre-Val de Loire region of France. True incidence of SAEs was extracted from a cohort of 513 patients with incident solid tumours receiving first-line FP-based chemotherapy. RESULTS After extrapolation at national level, we estimated that 76,200 patients are currently treated annually with 5FU (53,100 patients, 62% digestive system-related versus 26% breast cancers versus 12% head and neck cancers) or capecitabine (23,100 patients, 45% digestive system-related versus 37% breast cancers versus 18% non-documented). Earlier (in the first two cycles) the SAE incidence rate was 19.3% (95% confidence interval (CI) 16-23%) including one toxic death (0.2%, 95%CI 0-1%). SAE incidence rate was 32.2% (95%CI 28-36%) over the first 6 months of treatment. Incidence of death, life-threatening prognosis or incapacity/disability was 1.4% (95%CI 0.4-2.4%) and 1.6% (95%CI 0.5-2.6%) during first two cycles and first 6 months, respectively. CONCLUSION These data highlight the significant public health issue related to FP toxicity, with around 1200 patients developing FP-related life-threatening prognosis or incapacity/disability annually in France, including 150 toxic deaths. It is hoped that DPD-deficiency screening will reduce such iatrogenic events and eradicate toxic deaths.
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Affiliation(s)
- Chantal Barin-Le Guellec
- Laboratoire de Biochimie et Biologie Moléculaire, Unité de Pharmacogénétique, CHU de Tours, France; INSERM U1248-IPPRIT, Université, CHU de Limoges, France.
| | - Claire Lafay-Chebassier
- Service de Pharmacologie Clinique et Vigilances, Université, CHU de Poitiers, France; INSERM U1084-LNEC/ INSERM CIC 1402, Université, CHU de Poitiers, France
| | - Isabelle Ingrand
- Service de Pharmacologie Clinique et Vigilances, Université, CHU de Poitiers, France; Unité d'Epidémiologie et Biostatistique, Registre Général des Cancers Poitou-Charentes, INSERM CIC 1402, Université, CHU de Poitiers, France
| | | | | | | | - Gautier Defossez
- Unité d'Epidémiologie et Biostatistique, Registre Général des Cancers Poitou-Charentes, INSERM CIC 1402, Université, CHU de Poitiers, France
| | - Pierre Ingrand
- Unité d'Epidémiologie et Biostatistique, Registre Général des Cancers Poitou-Charentes, INSERM CIC 1402, Université, CHU de Poitiers, France
| | - Marie-Christine Perault-Pochat
- Service de Pharmacologie Clinique et Vigilances, Université, CHU de Poitiers, France; INSERM U1084-LNEC/ INSERM CIC 1402, Université, CHU de Poitiers, France
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10
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Mohammadian M, Zeynali-Moghaddam S, Khadem Ansari MH, Rasmi Y, Fathi Azarbayjani A, Kheradmand F. Dihydropyrimidine Dehydrogenase Levels in Colorectal Cancer Cells Treated with a Combination of Heat Shock Protein 90 Inhibitor and Oxaliplatin or Capecitabine. Adv Pharm Bull 2019; 9:439-444. [PMID: 31592113 PMCID: PMC6773945 DOI: 10.15171/apb.2019.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 04/27/2019] [Accepted: 05/20/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose: Dihydropyrimidine dehydrogenase (DPD) is the principal enzyme in the catabolism of fluoropyrimidine drugs including capecitabine. A recent report has suggested that oxaliplatin chemotherapy is associated with elevated DPD levels and chemoresistance pattern. As a newly developed chemotherapeutic agent, 17-allyloamino-17-demethoxy-geldanamycin (17-AAG) can be effective in combination therapy with oxaliplatin and capecitabine in colorectal cancer (CRC). DPD expression level can be a predictive factor in oxaliplatin and capecitabine-based chemotherapy. We evaluated DPD in mRNA and protein levels with new treatments: 17-AAG in combination with oxaliplatin and capecitabine in HT-29 and HCT-116 cell lines. Methods: Drug sensitivity was determined by the water-soluble tetrazolium-1 assay in a previous survey. Then, we evaluated the expression levels of DPD and its relationship with the chemotherapy response in capecitabine, oxaliplatin, and 17-AAG treated cases in single and combination cases in two panels of CRC cell lines. DPD gene and protein expression levels were determined by real-time polymerase chain reaction and western blotting assay, respectively. Results: DPD gene expression levels insignificantly increased in single-treated cases versus untreated controls in both cell lines versus controls. Then, the capecitabine and oxaliplatin were added in double combinations, where DPD gene and protein expression increased in combination cases compared to pre-chemotherapy and single drug treatments. Conclusion: The elevated levels of cytotoxicity in more effective combinations could be related to a different mechanism apart from DPD mediating effects or high DPD level in the remaining resistance cells (drug-insensitive cells), which should be investigated in subsequent studies.
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Affiliation(s)
- Mahshid Mohammadian
- Department of Clinical Biochemistry, School of Medicine, Urmia University of Medical sciences, Urmia, I.R. Iran
| | - Shima Zeynali-Moghaddam
- Department of Clinical Biochemistry, School of Medicine, Urmia University of Medical sciences, Urmia, I.R. Iran
| | | | - Yousef Rasmi
- Department of Clinical Biochemistry, School of Medicine, Urmia University of Medical sciences, Urmia, I.R. Iran
| | - Anahita Fathi Azarbayjani
- Department of Pharmaceutics, School of Pharmacy, Urmia University of Medical sciences, Urmia, I.R. Iran
| | - Fatemeh Kheradmand
- Department of Clinical Biochemistry, School of Medicine, Urmia University of Medical sciences, Urmia, I.R. Iran.,Solid Tumor Research Center and Cellular and Molecular Research Center, Urmia University of Medical sciences, Urmia, I.R. Iran
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11
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Determination of Endogenous Concentrations of Uracil and Dihydrouracil in Dried Saliva Spots by LC-MS/MS: Method Development, Validation, and Clinical Application. Ther Drug Monit 2019; 41:383-390. [DOI: 10.1097/ftd.0000000000000615] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Mukherji D, Massih SA, Tfayli A, Kanso M, Faraj W. Three different polymorphisms of the DPYD gene associated with severe toxicity following administration of 5-FU: a case report. J Med Case Rep 2019; 13:76. [PMID: 30898145 PMCID: PMC6429833 DOI: 10.1186/s13256-019-2013-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 02/07/2019] [Indexed: 12/27/2022] Open
Abstract
Background Dihydropyrimidine dehydrogenase deficiency secondary to polymorphisms in the DPYD gene can lead to significant toxicity associated with the administration of fluoropyrimidine chemotherapy. Case presentation We report a case of a 59-year-old Lebanese woman with metastatic pancreatic cancer who received FOLFIRINOX therapy and developed severe 5-fluorouracil toxicity after a single cycle. The entire DPYD gene was sequenced, and the patient was found to be heterozygous for three different polymorphisms that have reportedly been associated with dihydropyrimidine dehydrogenase deficiency. Conclusion Because data regarding the prevalence and clinical significance of several heterozygous polymorphisms in a single DPYD gene are very limited, we suggest that full gene sequencing should be carried out, at least in populations in which the allele frequencies are unknown.
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Affiliation(s)
- Deborah Mukherji
- Division of Hematology-Oncology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Sarah Abdel Massih
- Division of Hematology-Oncology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Arafat Tfayli
- Division of Hematology-Oncology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Mariam Kanso
- Department of Surgery, HPB and Liver Transplant Unit, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Walid Faraj
- Department of Surgery, HPB and Liver Transplant Unit, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon.
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13
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Liu D, Li X, Li X, Zhang M, Zhang J, Hou D, Tong Z, Dong M. CDA and MTHFR polymorphisms are associated with clinical outcomes in gastroenteric cancer patients treated with capecitabine-based chemotherapy. Cancer Chemother Pharmacol 2019; 83:939-949. [DOI: 10.1007/s00280-019-03809-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/06/2019] [Indexed: 12/30/2022]
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14
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García-González X, López-Tarruella S, García MI, González-Haba E, Blanco C, Salvador-Martin S, Jerez Y, Thomas F, Jarama M, Sáez MS, Martín M, López-Fernández LA. Severe toxicity to capecitabine due to a new variant at a donor splicing site in the dihydropyrimidine dehydrogenase (DPYD) gene. Cancer Manag Res 2018; 10:4517-4522. [PMID: 30349384 PMCID: PMC6190816 DOI: 10.2147/cmar.s174470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Severe, life-threatening adverse reactions to capecitabine sometimes occur in the treatment of solid tumors. Screening for dihydropyrimidine dehydrogenase (DPYD) deficiency is encouraged before start of treatment, but the genetic variants that are commonly analyzed often fail to explain toxicities seen in clinical practice. Here we describe the case of a 79-year-old Caucasian female with breast cancer who presented with life-threatening, rapidly increasing toxicity after 1 week of treatment with capecitabine and for whom routine genetic DPYD test resulted negative. DPYD exon sequencing found variant c.2242+1G>T at the donor splicing site of exon 19. This variant is responsible for skipping of exon 19 and subsequent generation of a non-functional DPYD enzyme. This variant has not been described previously but was found in three other members of the patient's family. With this case, we show that exon sequencing of DPYD in patients who experience marked toxicity to fluoropyrimidines and test negative for commonly evaluated variants can prove extremely useful for identifying new genetic variants and better explain adverse reactions causality.
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Affiliation(s)
- Xandra García-González
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,
| | - Sara López-Tarruella
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María Isabel García
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,
| | - Eva González-Haba
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,
| | - Carolina Blanco
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,
| | - Sara Salvador-Martin
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,
| | - Yolanda Jerez
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Fabienne Thomas
- Department of Pharmacology, Institut Claudius-Regaud, CRCT, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - María Jarama
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,
| | - María Sanjurjo Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,
| | - Miguel Martín
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Luis Andrés López-Fernández
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,
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15
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Tsutsui M, Yamamoto S, Yoshikawa Y, Nakanishi R, Takano K, Osumi K, Akatsu T, Yoneyama K, Nakagawa M, Kanai T. Severe adverse events due to dihydropyrimidine dehydrogenase deficiency in a Japanese patient with colon cancer taking capecitabine: a case report. Int Cancer Conf J 2018; 7:125-129. [PMID: 31149530 PMCID: PMC6498256 DOI: 10.1007/s13691-018-0334-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022] Open
Abstract
Fluoropyrimidine has been commonly used not only in unresectable cases of metastatic colorectal cancer, but also in adjuvant therapy. Dihydropyrimidine dehydrogenase (DPD) is an enzyme encoded by the DPYD gene, which is responsible for the rate-limiting step in pyrimidine catabolism and breaks down more than 80% of standard doses of 5-fluorouracil (5-FU) and capecitabine, an oral prodrug of 5-FU. The lack of enzymatic activity increases the half-life of the drug, resulting in excess drug accumulation and toxicity which may lead to life-threatening side effects. There have been several published case reports about DPD deficiency in patients with colorectal cancer in Western countries. However, case reports of DPD deficiency in Japanese patients with colorectal cancer are rare because measuring DPD activity is not covered by public medical insurance in Japan, and it is not examined in our daily clinical practice currently. Therefore, we think that it is important to accumulate such case reports for further understanding. This report describes the case of a Japanese patient with colon cancer who experienced severe side effects while taking capecitabine, due to DPD deficiency. A 68-year-old man with ascending colon cancer underwent curative laparoscopic right hemicolectomy. Because final pathologic staging was Stage IIIa, standard adjuvant chemotherapy with capecitabine (3600 mg/body/day, days 1-14, every 3 weeks) was started on postoperative day 50. After 2 weeks, he started to experience Grade 3 diarrhea and was admitted to the hospital on postoperative day 66. On day 70, the patient had Grade 4 febrile neutropenia. Antibiotics and granulocyte-colony-stimulating factor were administered until his blood tests recovered to the normal degree. After 1 week of diarrhea, antidiarrheal agents were administered, and the patient gradually recovered. During the occurrence of diarrhea, specimen cultures were negative for infection. He was discharged on day 21 of the hospital stay. DPD deficiency was suspected, and 2 weeks later the DPD activity of the peripheral blood mononucleocytes was examined. The result was 10.3 U/mg protein which was remarkedly low (reference range 22.6-183.6 U/mg protein), and DPD deficiency was diagnosed. We always must consider the possibility of DPD deficiency in patients who experience severe side effects while taking capecitabine.
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Affiliation(s)
- Mai Tsutsui
- Department of Surgery, Hiratsuka City Hospital, 1-19-1, Minamihara, Hiratsuka, Kanagawa 254-0065 Japan
| | - Seiichiro Yamamoto
- Department of Surgery, Hiratsuka City Hospital, 1-19-1, Minamihara, Hiratsuka, Kanagawa 254-0065 Japan
| | - Yusuke Yoshikawa
- Department of Surgery, Hiratsuka City Hospital, 1-19-1, Minamihara, Hiratsuka, Kanagawa 254-0065 Japan
| | - Ryo Nakanishi
- Department of Surgery, Hiratsuka City Hospital, 1-19-1, Minamihara, Hiratsuka, Kanagawa 254-0065 Japan
| | - Kiminori Takano
- Department of Surgery, Hiratsuka City Hospital, 1-19-1, Minamihara, Hiratsuka, Kanagawa 254-0065 Japan
| | - Koji Osumi
- Department of Surgery, Hiratsuka City Hospital, 1-19-1, Minamihara, Hiratsuka, Kanagawa 254-0065 Japan
| | - Tomotaka Akatsu
- Department of Surgery, Hiratsuka City Hospital, 1-19-1, Minamihara, Hiratsuka, Kanagawa 254-0065 Japan
| | - Kimiyasu Yoneyama
- Department of Surgery, Hiratsuka City Hospital, 1-19-1, Minamihara, Hiratsuka, Kanagawa 254-0065 Japan
| | - Motohito Nakagawa
- Department of Surgery, Hiratsuka City Hospital, 1-19-1, Minamihara, Hiratsuka, Kanagawa 254-0065 Japan
| | - Toshio Kanai
- Department of Surgery, Hiratsuka City Hospital, 1-19-1, Minamihara, Hiratsuka, Kanagawa 254-0065 Japan
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16
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Pellicer M, García-González X, García MI, Robles L, Grávalos C, García-Alfonso P, Pachón V, Longo F, Martínez V, Blanco C, Iglesias I, Sanjurjo M, López-Fernández LA. Identification of new SNPs associated with severe toxicity to capecitabine. Pharmacol Res 2017; 120:133-137. [DOI: 10.1016/j.phrs.2017.03.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/10/2017] [Accepted: 03/23/2017] [Indexed: 01/19/2023]
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17
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Ma WW, Saif MW, El‐Rayes BF, Fakih MG, Cartwright TH, Posey JA, King TR, von Borstel RW, Bamat MK. Emergency use of uridine triacetate for the prevention and treatment of life-threatening 5-fluorouracil and capecitabine toxicity. Cancer 2017; 123:345-356. [PMID: 27622829 PMCID: PMC5248610 DOI: 10.1002/cncr.30321] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/03/2016] [Accepted: 08/08/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Increased susceptibility to 5-fluorouracil (5-FU)/capecitabine can lead to rapidly occurring toxicity caused by impaired clearance, dihydropyrimidine dehydrogenase deficiency, and other genetic variations in the enzymes that metabolize 5-FU. Life-threatening 5-FU overdoses occur because of infusion pump errors, dosage miscalculations, and accidental or suicidal ingestion of capecitabine. Uridine triacetate (Vistogard) was approved in 2015 for adult and pediatric patients who exhibit early-onset severe or life-threatening 5-FU/capecitabine toxicities or present with an overdose. Uridine triacetate delivers high concentrations of uridine, which competes with toxic 5-FU metabolites. METHODS In 2 open-label clinical studies, patients who presented with a 5-FU/capecitabine overdose or an early onset of severe toxicities were treated. Patients received uridine triacetate as soon as possible (most within the first 96 hours after 5-FU/capecitabine). Outcomes included survival, resumption of chemotherapy, and safety. Their survival was compared with the survival of a historical cohort of overdose patients who received only supportive care. RESULTS A total of 137 of 142 overdose patients (96%) treated with uridine triacetate survived and had a rapid reversal of severe acute cardiotoxicity and neurotoxicity; in addition, mucositis and leukopenia were prevented, or the patients recovered from them. In the historical cohort, 21 of 25 patients (84%) died. Among the 141 uridine triacetate-treated overdose patients with a diagnosis of cancer (the noncancer patients included 6 intentional or accidental pediatric overdoses), 53 resumed chemotherapy in < 30 days (median time after 5-FU, 19.6 days), and this indicated a rapid recovery from toxicity. Adverse reactions in patients receiving uridine triacetate included vomiting (8.1%), nausea (4.6%), and diarrhea (3.5%). CONCLUSIONS In these studies, uridine triacetate was a safe and effective lifesaving antidote for capecitabine and 5-FU overexposure, and it facilitated the rapid resumption of chemotherapy. Cancer 2017;123:345-356. © 2016 American Cancer Society.
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Affiliation(s)
- Wen Wee Ma
- Department of OncologyMayo ClinicRochesterMinnesota
| | | | - Bassel F. El‐Rayes
- Department of Hematology and Oncology, Winship Cancer InstituteEmory UniversityAtlantaGeorgia
| | - Marwan G. Fakih
- Department of Medical OncologyCity of Hope Medical CenterDuarteCalifornia
| | | | - James A. Posey
- Department of Medical OncologyThomas Jefferson UniversityPhiladelphiaPennsylvania
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18
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Lou Y, Wang Q, Zheng J, Hu H, Liu L, Hong D, Zeng S. Possible Pathways of Capecitabine-Induced Hand–Foot Syndrome. Chem Res Toxicol 2016; 29:1591-1601. [PMID: 27631426 DOI: 10.1021/acs.chemrestox.6b00215] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Yan Lou
- The
First Affiliated Hospital, College of Medicine, Zhejiang University, 79 QingChun Road, Hangzhou, Zhejiang 310000, People’s Republic of China
| | - Qian Wang
- The
First Affiliated Hospital, College of Medicine, Zhejiang University, 79 QingChun Road, Hangzhou, Zhejiang 310000, People’s Republic of China
| | - Jinqi Zheng
- Zhejiang Institute for Food and Drug Control, Hangzhou, Zhejiang 310004, People’s Republic of China
| | - Haihong Hu
- Laboratory
of Pharmaceutical Analysis and Drug Metabolism, Zhejiang Province
Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical
Sciences, Zhejiang University, Hangzhou, Zhejiang 310058, People’s Republic of China
| | - Lin Liu
- The
First Affiliated Hospital, College of Medicine, Zhejiang University, 79 QingChun Road, Hangzhou, Zhejiang 310000, People’s Republic of China
| | - Dongsheng Hong
- The
First Affiliated Hospital, College of Medicine, Zhejiang University, 79 QingChun Road, Hangzhou, Zhejiang 310000, People’s Republic of China
| | - Su Zeng
- Laboratory
of Pharmaceutical Analysis and Drug Metabolism, Zhejiang Province
Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical
Sciences, Zhejiang University, Hangzhou, Zhejiang 310058, People’s Republic of China
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19
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Latchman J, Guastella A, Tofthagen C. 5-Fluorouracil toxicity and dihydropyrimidine dehydrogenase enzyme: implications for practice. Clin J Oncol Nurs 2016; 18:581-5. [PMID: 25253112 DOI: 10.1188/14.cjon.581-585] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
5-fluorouracil (5-FU) is a fluorinated pyrimidine analog, which is commonly used in combination chemotherapy for treating solid tumors. Dihydropyrimidine dehydrogenase plays an important role in catabolism and clearance of 5-FU. Any alteration in that sequence of enzymatic activity can lead to toxicity and even death in some patients. The most common loss of a functional allele of the dihydropyrimidine gene is the splice-site mutation c.1905+1G>A, which leads to deficiency of the enzyme. However, because of the small percentage of the population in which the deficiency occurs, routine screening is not recommended, and commercial testing is costly. Treatment measures for 5-FU toxicity are mainly supportive, including palliation of symptoms. Good patient assessment and education are imperative to early treatment of 5-FU-induced toxicity. Advanced oncology practitioners and oncology nurses should thoroughly educate patients and their caregivers on both the common and adverse side effects of 5-FU-based therapy and when it may be necessary to immediately contact their healthcare provider.
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Affiliation(s)
| | - Ann Guastella
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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20
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Galarza AFA, Linden R, Antunes MV, Hahn RZ, Raymundo S, da Silva ACC, Staggemeier R, Spilki FR, Schwartsmann G. Endogenous plasma and salivary uracil to dihydrouracil ratios and DPYD genotyping as predictors of severe fluoropyrimidine toxicity in patients with gastrointestinal malignancies. Clin Biochem 2016; 49:1221-1226. [PMID: 27399164 DOI: 10.1016/j.clinbiochem.2016.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 06/20/2016] [Accepted: 07/06/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the use of plasma and saliva uracil (U) to dihydrouracil (UH2) metabolic ratio and DPYD genotyping, as a means to identify patients with dihydropyrimidine dehydrogenase (DPD) deficiency and fluoropyrimidine toxicity. METHODS Paired plasma and saliva samples were obtained from 60 patients with gastrointestinal cancer, before fluoropyrimidine treatment. U and UH2 concentrations were measured by LC-MS/MS. DPYD was genotyped for alleles *7, *2A, *13 and Y186C. Data on toxicity included grade 1 to 4 neutropenia, mucositis, diarrhea, nausea/vomiting and cutaneous rash. RESULTS 35% of the patients had severe toxicity. There was no variant allele carrier for DPYD. The [UH2]/[U] metabolic ratios were 0.09-26.73 in plasma and 0.08-24.0 in saliva, with higher correlation with toxicity grade in saliva compared to plasma (rs=-0.515 vs rs=-0.282). Median metabolic ratios were lower in patients with severe toxicity as compared to those with absence of toxicity (0.59 vs 2.83 saliva; 1.62 vs 6.75 plasma, P<0.01). A cut-off of 1.16 for salivary ratio was set (AUC 0.842), with 86% sensitivity and 77% specificity for the identification of patients with severe toxicity. Similarly, a plasma cut-off of 4.0 (AUC 0.746), revealed a 71% sensitivity and 76% specificity. CONCLUSIONS DPYD genotyping for alleles 7, *2A, *13 and Y186C was not helpful in the identification of patients with severe DPD deficiency in this series of patients. The [UH2]/[U] metabolic ratios, however, proved to be a promising functional test to identify the majority of cases of severe DPD activity, with saliva performing better than plasma.
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Affiliation(s)
- Andrés Fernando Andrade Galarza
- Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Serviço de Oncologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Rafael Linden
- Instituto de Ciências da Saúde, Universidade Feevale, Novo Hamburgo, RS, Brazil
| | | | - Roberta Zilles Hahn
- Instituto de Ciências da Saúde, Universidade Feevale, Novo Hamburgo, RS, Brazil
| | - Suziane Raymundo
- Instituto de Ciências da Saúde, Universidade Feevale, Novo Hamburgo, RS, Brazil
| | | | - Rodrigo Staggemeier
- Instituto de Ciências da Saúde, Universidade Feevale, Novo Hamburgo, RS, Brazil
| | | | - Gilberto Schwartsmann
- Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Serviço de Oncologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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21
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Ison G, Beaver JA, McGuinn WD, Palmby TR, Dinin J, Charlab R, Marathe A, Jin R, Liu Q, Chen XH, Ysern X, Stephens O, Bai G, Wang Y, Dorff SE, Cheng J, Tang S, Sridhara R, Pierce W, McKee AE, Ibrahim A, Kim G, Pazdur R. FDA Approval: Uridine Triacetate for the Treatment of Patients Following Fluorouracil or Capecitabine Overdose or Exhibiting Early-Onset Severe Toxicities Following Administration of These Drugs. Clin Cancer Res 2016; 22:4545-9. [PMID: 27401247 DOI: 10.1158/1078-0432.ccr-16-0638] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/10/2016] [Indexed: 01/24/2023]
Abstract
On December 11, 2015, the FDA approved uridine triacetate (VISTOGARD; Wellstat Therapeutics Corporation) for the emergency treatment of adult and pediatric patients following a fluorouracil or capecitabine overdose regardless of the presence of symptoms, and of those who exhibit early-onset, severe, or life-threatening toxicity affecting the cardiac or central nervous system, and/or early onset, unusually severe adverse reactions (e.g., gastrointestinal toxicity and/or neutropenia) within 96 hours following the end of fluorouracil or capecitabine administration. Uridine triacetate is not recommended for the nonemergent treatment of adverse reactions associated with fluorouracil or capecitabine because it may diminish the efficacy of these drugs, and the safety and efficacy of uridine triacetate initiated more than 96 hours following the end of administration of these drugs has not been established. The approval is based on data from two single-arm, open-label, expanded-access trials in 135 patients receiving uridine triacetate (10 g or 6.2 g/m(2) orally every 6 hours for 20 doses) for fluorouracil or capecitabine overdose, or who exhibited severe or life-threatening toxicities within 96 hours following the end of fluorouracil or capecitabine administration. Ninety-six percent of patients met the major efficacy outcome measure, which was survival at 30 days or survival until the resumption of chemotherapy, if prior to 30 days. The most common adverse reactions were vomiting, nausea, and diarrhea. This article summarizes the FDA review of this New Drug Application, the data supporting approval of uridine triacetate, and the unique regulatory situations encountered by this approval. Clin Cancer Res; 22(18); 4545-49. ©2016 AACR.
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Affiliation(s)
- Gwynn Ison
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland.
| | - Julia A Beaver
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - W David McGuinn
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Todd R Palmby
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Jeannette Dinin
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Rosane Charlab
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Anshu Marathe
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Runyan Jin
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Qi Liu
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Xiao Hong Chen
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Xavier Ysern
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Olen Stephens
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Ge Bai
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Yaning Wang
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Sarah E Dorff
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Joyce Cheng
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Shenghui Tang
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Rajeshwari Sridhara
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - William Pierce
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Amy E McKee
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Amna Ibrahim
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Geoffrey Kim
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
| | - Richard Pazdur
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland
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Cortejoso L, García-González X, García MI, García-Alfonso P, Sanjurjo M, López-Fernández LA. Cost-effectiveness of screening for DPYD polymorphisms to prevent neutropenia in cancer patients treated with fluoropyrimidines. Pharmacogenomics 2016; 17:979-84. [PMID: 27248859 DOI: 10.2217/pgs-2016-0006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AIM To compare the cost of screening for three mutations in the dihydropyrimidine dehydrogenase gene and the costs of treating severe fluoropyrimidine-induced neutropenia. MATERIALS & METHODS The polymorphisms rs3918290 (DPYD*2A), rs67376798 (DPYD 2846A>T) and rs55886062 (1679T>G, DPYD*13) were genotyped using real-time PCR, TaqMan probes and a rapid cell lysis to provide PCR-ready DNA. RESULTS We found that genotyping 1000 patients in our center cost €6400 and that the mean cost of treating severe neutropenia was €3044. Therefore, if severe fluoropyrimidine-induced neutropenia is reduced by genotyping the three DPYD variations in at least 2.21 cases per 1000 treated patients, then DPYD genotyping will prove cost effective. CONCLUSION We demonstrated that real-time DPYD genotyping using TaqMan probes is cost effective in all fluoropyrimidine-based treatments.
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Affiliation(s)
- Lucía Cortejoso
- Department of Pharmacy, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Xandra García-González
- Department of Pharmacy, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - María I García
- Department of Pharmacy, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Pilar García-Alfonso
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - María Sanjurjo
- Department of Pharmacy, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Luis A López-Fernández
- Department of Pharmacy, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain
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DPYD gene polymorphisms are associated with risk and chemotherapy prognosis in pediatric patients with acute lymphoblastic leukemia. Tumour Biol 2016; 37:10393-402. [DOI: 10.1007/s13277-016-4908-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/22/2016] [Indexed: 01/13/2023] Open
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Prospective DPYD genotyping to reduce the risk of fluoropyrimidine-induced severe toxicity: Ready for prime time. Eur J Cancer 2016; 54:40-48. [DOI: 10.1016/j.ejca.2015.11.008] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/05/2015] [Accepted: 11/07/2015] [Indexed: 01/29/2023]
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Camadan Y, Özdemir H, Gulcin İ. Purification and characterization of dihydropyrimidine dehydrogenase enzyme from sheep liver and determination of the effects of some anaesthetic and antidepressant drugs on the enzyme activity. J Enzyme Inhib Med Chem 2016; 31:1335-41. [DOI: 10.3109/14756366.2015.1132710] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Yasemin Camadan
- Vocational School of Health Services, Pharmacy Services Program, Artvin Coruh University, Artvin, Turkey,
- Faculty of Sciences, Department of Chemistry, Atatürk University, Erzurum, Turkey, and
| | - Hasan Özdemir
- Faculty of Sciences, Department of Chemistry, Atatürk University, Erzurum, Turkey, and
| | - İlhami Gulcin
- Faculty of Sciences, Department of Chemistry, Atatürk University, Erzurum, Turkey, and
- College of Science, Department of Zoology, King Saud University, Riyadh, Saudi Arabia
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Capecitabine-Induced Severe Toxicity Secondary to DPD Deficiency and Successful Treatment with Low Dose 5-Fluorouracil. J Gastrointest Cancer 2016; 48:66-69. [PMID: 26744322 DOI: 10.1007/s12029-015-9797-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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FOLFOX chemotherapy can safely be given to neutropenic patients with early-stage colorectal cancer for higher dose intensity and fewer visits. Support Care Cancer 2015; 24:2533-9. [PMID: 26694717 DOI: 10.1007/s00520-015-3059-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/14/2015] [Indexed: 01/25/2023]
Abstract
PURPOSE How does giving adjuvant FOLFOX chemotherapy to patients with early-stage colorectal cancer (ESCRC) regardless of the day-before absolute neutrophil counts (ANC) effect chemotherapy-induced febrile neutropenia (CIFN) rates, received dose intensity (RDI), and chemotherapy cycle delay? Does an ANC level predict future neutropenia? METHODS A retrospective chart review was conducted on all patients receiving adjuvant chemotherapy for ESCRC at a mid-sized community hospital in Toronto, Ontario, Canada between April 2005 and May 2014. All patients were under one medical oncologist. Day-before CBC data were collected along with other patient characteristics. CIFN was confirmed by hospital records. Inclusion criteria were met by 132 patients. Overall, 1074 cycles of chemotherapy were analyzed. RESULTS Six episodes of CIFN were observed. There was a significant difference in the average day-before ANC between patients who developed CIFN (1.4 × 10(9)/L, 95 % CI 0.76-2.0 × 10(9)/L) and those who did not (2.9 × 10(9)/L, 95 % CI 2.8-3.0 × 10(9)/L, p = 0.03). The RDI for oxaliplatin was 0.95 and for 5-fluorouracil (5-FU) was 0.96. A total of 170 cycles were given at day-before ANC <1.5 × 10(9)/L (range 0.1 × 10(9)/L-1.4 × 10(9)/L), and 24 were delayed for 1 week for hematologic reasons. Cycles given with grade 2 neutropenia predicted higher grades of neutropenia with a sensitivity of 0.22 (95 % CI 0.12-0.38). CONCLUSIONS Adjuvant FOLFOX chemotherapy may be given in the setting of low day-before ANC to patients with ESCRC. The benefits include higher RDI and a reduced number of clinic visits for the patient.
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Launay M, Dahan L, Duval M, Rodallec A, Milano G, Duluc M, Lacarelle B, Ciccolini J, Seitz JF. Beating the odds: efficacy and toxicity of dihydropyrimidine dehydrogenase-driven adaptive dosing of 5-FU in patients with digestive cancer. Br J Clin Pharmacol 2015; 81:124-30. [PMID: 26392323 DOI: 10.1111/bcp.12790] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/07/2015] [Accepted: 09/20/2015] [Indexed: 12/26/2022] Open
Abstract
AIMS 5-FU is the backbone of most regimens in digestive oncology. Administration of standard 5-FU leads to 15-30% of severe side effects, and lethal toxicities are regularly reported with fluoropyrimidine drugs. Dihydropyrimidine dehydrogenase (DPD) deficiency is a pharmacogenetic syndrome responsible for most cases of life-threatening toxicities upon 5-FU intake, and pre-treatment checking for DPD status should help to reduce both incidence and severity of side effects through adaptive dosing strategies. METHODS We have used a simple method for rapidly establishing the DPD phenotype of patients with cancer and used it prospectively in 59 routine patients treated with 5-FU-based therapy for digestive cancers. No patient with total DPD deficiency was found but 23% of patients exhibited poor metabolizer phenotype, and one patient was phenotyped as profoundly deficient. Consequently, 5-FU doses in poor metabolizer patients were cut by an average 35% as compared with non deficient patients (2390 ± 1225 mg vs. 3653 ± 1371 mg, P < 0.003, t-test). RESULTS Despite this marked reduction in 5-FU dosing, similar efficacy was achieved in the two subsets (clinical benefit: 40 vs. 43%, stable disease: 40 vs. 37%, progressive disease: 20% in both subsets, P = 0.893, Pearson's chi-square). No difference in toxicities was observed (P = 0.104, Fisher's exact test). Overall, only 3% of early severe toxicities were recorded, a value markedly lower than the 15-30% ones usually reported with 5-FU. CONCLUSIONS This feasibility study shows how simplified DPD-based adaptive dosing of 5-FU can reduce sharply the incidence of treatment-related severe toxicities while maintaining efficacy as part of routine clinical practice in digestive oncology.
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Affiliation(s)
- Manon Launay
- Laboratoire de Pharmacocinétique La Timone University Hospital of Marseille, Marseille
| | - Laetitia Dahan
- Digestive Oncology Unit, La Timone University Hospital of Marseille, Marseille
| | - Manon Duval
- Laboratoire de Pharmacocinétique La Timone University Hospital of Marseille, Marseille
| | - Anne Rodallec
- Laboratoire de Pharmacocinétique La Timone University Hospital of Marseille, Marseille
| | - Gérard Milano
- Oncopharmacology Unit, Centre Antoine Lacassagne, Nice
| | - Muriel Duluc
- Digestive Oncology Unit, La Timone University Hospital of Marseille, Marseille
| | - Bruno Lacarelle
- Laboratoire de Pharmacocinétique La Timone University Hospital of Marseille, Marseille.,SMARTc Unit, U911 Cro2 Aix-Marseille Univ., Marseille, France
| | - Joseph Ciccolini
- Laboratoire de Pharmacocinétique La Timone University Hospital of Marseille, Marseille.,SMARTc Unit, U911 Cro2 Aix-Marseille Univ., Marseille, France
| | - Jean-Francois Seitz
- Digestive Oncology Unit, La Timone University Hospital of Marseille, Marseille
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Matsusaka S, Lenz HJ. Pharmacogenomics of fluorouracil -based chemotherapy toxicity. Expert Opin Drug Metab Toxicol 2015; 11:811-21. [PMID: 25800061 DOI: 10.1517/17425255.2015.1027684] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION 5- fluorouracil (5-FU), alone or in combination, is the most prevalent and effective chemotherapeutic agent for the treatment of cancers of the head and neck, breast, pancreas and gastrointestinal tract. AREAS COVERED Three rare DPYD mutations, a splice mutation in intron 14 (c.1905+1G>A) and two nonsynonymous coding variants (c.1679T>G, c.2846A>T), have consistently been associated with severe 5-FU toxicity. A relatively common haplotype, hapB3, containing three intronic polymorphisms (c.483+18G>A; c.680+139G>A; c.959-51T>C) and a synonymous mutation c.1236G>A linked to c.1129-5923C>G, is a major contributor to early onset severe toxicity. TYMS VNTR 2R and TYMS-3'-UTR 6-bp ins-del variants were associated with global toxicity in capecitabine-treated patients. A candidate gene study of capecitabine-related toxicity reported that the s12132152 were strongly associated with hand-foot syndrome (HFS), whereas rs7548189 was associated with diarrhea. The rs2612091 and rs2741171, which are downstream of TYMS and intronic for ENOSF1, were associated with increased global toxicity and HFS. EXPERT OPINION Sex-dependent differences, ethnicity, cancer types and 5-FU-based chemotherapy regimens might affect the heterogeneity of genetic variants for predictive 5-FU-related toxicity. Future approaches using genome-wide association analyses may help in identifying additional candidate genes causally involved in the path mechanisms of 5-FU-related toxicity.
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Affiliation(s)
- Satoshi Matsusaka
- University of Southern California, Keck School of Medicine, Norris Comprehensive Cancer Center, Division of Medical Oncology , Los Angeles, CA , USA
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Improved pharmacodynamic assay for dihydropyrimidine dehydrogenase activity in peripheral blood mononuclear cells. Bioanalysis 2015; 7:519-29. [DOI: 10.4155/bio.14.304] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Dihydropyrimidine dehydrogenase (DPD) activity determination in peripheral blood mononuclear cells of DPD deficient patients was hitherto inaccurate due to hemoglobin (Hb) contamination. We developed an improved method for accurate measurement of DPD activity in patients. Results: DPD activity was determined by HPLC with online radioisotope detection using liquid scintillation counting. Hb was determined spectrophotometrically. Method accuracy and precision were significantly improved by using cumulative area of all peaks as IS. Peripheral blood mononuclear cell lysates from DPD deficient patients were highly contaminated with on average 23.3% (range 2.7–51%) of Hb resulting in up to twofold underestimated DPD activity. DPD activities were corrected for Hb contamination. The method was validated and showed good long-term sample stability. Conclusion: This method has increased specificity allowing accurate identification of DPD deficient patients.
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Ciccolini J, Fanciullino R, Serdjebi C, Milano G. Pharmacogenetics and breast cancer management: current status and perspectives. Expert Opin Drug Metab Toxicol 2015; 11:719-29. [PMID: 25690018 DOI: 10.1517/17425255.2015.1008447] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Breast cancer has benefited from a number of innovative therapeutics over the last decade. Cytotoxics, hormone therapy, targeted therapies and biologics can now be given to ensure optimal management of patients. As life expectancy of breast cancer patients has been significantly stretched and that several lines of treatment are now made available, determining the best drug or drug combinations to be primarily given and the best dosing and scheduling for each patient is critical for ensuring an optimal toxicity/efficacy balance. AREAS COVERED Defining patient's characteristics at the tumor level (pharmacogenomics) and the constitutional level (pharmacogenetics) is a rising trend in oncology. This review covers the latest strategies based upon the search of relevant biomarkers for efficacy, resistance and toxicity to be undertaken at the bedside to shift towards precision medicine in breast cancer patients. EXPERT OPINION In the expanding era of bioguided medicine, identifying relevant and clinically validated biomarkers from the plethora of published material remains an uneasy task. Sorting the variety of genetic and molecular markers that have been investigated over the last decade on their level of evidence and addressing the issue of drug exposure should help to improve the management of breast cancer therapy.
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Affiliation(s)
- Joseph Ciccolini
- SMARTc Pharmacokinetics Unit, UMR S_911 CRO2, AMU , Marseille , France
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Abstract
Case Study Mr. D., a 55-year-old male, presented to the medical oncology service with a diagnosis of stage III adenocarcinoma of the
sigmoid colon. He presented 7 weeks post sigmoid colectomy with lymph node resection and was initiated on adjuvant
chemotherapy with CAPOX (capecitabine [Xeloda] and oxaliplatin [Eloxatin]). Standard dosing was used: oxaliplatin at 130 mg/m2
on day 1 and capecitabine at approximately 2,000 mg/m2/day (rounded to the nearest 500-mg tablet size) for 14 days on and 7
days off (1 cycle = 21 days). A capped body surface area of 2.4 m2 was used, due to the patient’s body habitus. Adverse Effects Mr. D. did not report any complications of therapy during cycle 1, days 1–7, other than grade 1 diarrhea, which was amenable
to diphenoxylate/atropine when taken. The next week, he reported significant malaise and fatigue associated with persistent
diarrhea occurring every 30 minutes for 5 days. Mr. D. was instructed to go to the emergency room for an immediate evaluation,
but he refused. Mr. D. presented to the clinic in poor condition on day 14 of cycle 1. His diarrhea had increased to grade 3 and was not
controlled with either loperamide or diphenoxylate/atropine, though he was not taking his medications as directed. He had been
instructed to take two 2-mg loperamide tablets after the first loose stool, followed by 1 tablet of diphenoxylate/atropine 2 hours
later. He could then alternate this with loperamide every 2 hours as needed, not to exceed 8 tablets of loperamide per day. Instead,
he had taken 2 tablets of loperamide after the first loose stool, but either waited 6 hours to take 1 tablet of diphenoxylate/atropine
or otherwise chose not to alternate the medications at all despite continued diarrhea, depending on the day. Mr. D.’s timing in taking his supportive medications was inconsistent, and his explanations of this timing were not exact. He also
reported persistent grade 3 nausea with vomiting for 5 days, which did not improve with ondansetron and prochlorperazine,
though he again did not take these consistently. He was advised to alternate ondansetron and prochlorperazine every 4 hours as
needed, but only took one or the other medication approximately 3 times per day. According to Mr. D., his adverse effects initially began on day 9 of cycle 1. He had lost approximately 14 kg (31 lb) during cycle
1. Clinically, he was found to have grade 2 mucositis and grade 1 hand-foot syndrome. At the time of this visit, his absolute
neutrophil count was 3,000/ìL, his hemoglobin was 14.4 g/dL, his hematocrit 42.2%, and his platelet count was 139,000/ìL. His
kidney function was within the normal range. Mr. D. refused hospitalization despite the primary team’s recommendation. He also refused to undergo stool sampling for
Clostridium difficile. He was given IV fluids along with adjustments in supportive medications, including a prescription for 10%
tincture of opium. He was instructed to use 0.6 mL every 6 hours in addition to alternating loperamide with diphenoxylate/atropine
as noted previously. He was advised to rinse his mouth with a baking soda solution for relief of his grade 1 mucositis, and
alternation of antiemetics every 4 hours was reiterated. He was to return prior to initiation of cycle 2 for further evaluation. Worsening Symptoms The next day, Mr. D.’s wife called the clinic to report that her husband’s diarrhea continued despite the use of tincture of opium
and that it was associated with hematochezia. He was also experiencing a worsening of his mucositis, with an associated swelling of
the tongue. He was instructed to present to the emergency center, which he did on day 16 of cycle 1. By then, he was found to be
febrile at 39.5°C. He was tachycardic, with a heart rate of 126, and he was experiencing significant abdominal pain associated with
the diarrhea. The mucositis was worsening, with new odynophagia. At this time, Mr. D.’s absolute neutrophil count had dropped dramatically to 160/ìL, his hemoglobin was 13.1 g/dL, his
hematocrit was 39.2%, and his platelet count was 68,000/ìL. He was admitted to the inpatient service and started on empiric
antibiotics. His blood cultures remained negative during hospitalization, but stool cultures were positive for C. difficile. His
antimicrobial regimen was deescalated to oral vancomycin once his stool volume decreased. He was treated with an institutional
compounded mouthwash of diphenhydramine, aluminum/magnesium hydroxide, and viscous lidocaine for the mucositis, which
also slowly improved. He was given a dose of growth factor. Neutropenia eventually resolved, with an absolute neutrophil count of
4,820/ìL on the day of discharge. He was discharged 26 days after initiating cycle 1, at which time his myelosuppression and
mucositis were also resolved. Throughout his course, he did not report any neurotoxicity. DPD Testing Due to his severe symptoms of neutropenia, mucositis, and diarrhea, Mr. D. was tested for dihydropyrimidine dehydrogenase
(DPD) deficiency. Testing confirmed a heterozygous IVS14+IG>A mutation. For this reason, all further adjuvant therapy was
withheld, and he was followed on clinical surveillance only.
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Affiliation(s)
- Lindsey Law
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jane Rogers
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cathy Eng
- University of Texas MD Anderson Cancer Center, Houston, Texas
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Terrazzino S, Cargnin S, Del Re M, Danesi R, Canonico PL, Genazzani AA. DPYD IVS14+1G>A and 2846A>T genotyping for the prediction of severe fluoropyrimidine-related toxicity: a meta-analysis. Pharmacogenomics 2014; 14:1255-72. [PMID: 23930673 DOI: 10.2217/pgs.13.116] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AIM In the present study we conducted a systematic review and meta-analysis of published data to quantify the impact of the DPYD IVS14+1G>A and 2846A>T variants on the risk of fluoropyrimidine-related toxicities and to determine sensitivity and specificity testing for DPYD variants. METHODS Relevant studies were identified through PubMed and Web of Knowledge databases, studies included were those published up until to May 2012. Study quality was assessed according to the HuGENET guidelines and Strengthening the Reporting of Genetic Association (STREGA) recommendations. RESULTS Random-effects meta-analysis provided evidence that carriers of DPYD IVS14+1G>A are at higher risk of ≥3 degrees of overall grade toxicity, hematological toxicity, mucositis and diarrhea. In addition, a strong association was also found between carriers of the DPYD 2846T allele and overall grade ≥3 toxicity or grade ≥3 diarrhea. An inverse linear relationship was found in prospective studies between the odds ratio of DPYD IVS14+1G>A and the incidence of overall grade ≥3 toxicity, indicating an higher impact in cohorts in which the incidence of severe toxicity was lower. CONCLUSION The results of this meta-analysis confirm clinical validity of DPYD IVS14+1G>A and 2846A>T as risk factors for the development of severe toxicities following fluoropyrimidine treatment. Furthermore, the sensitivity and specificity estimates obtained could be useful in establishing the cost-effectiveness of testing for DPYD variants.
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Affiliation(s)
- Salvatore Terrazzino
- Dipartimento di Scienze del Farmaco & Centro di Ricerca Interdipartimentale di Farmacogenetica e Farmacogenomica-CRIFF, Università del Piemonte Orientale "A. Avogadro", Largo Donegani 2, 28100 Novara, Italy.
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Ciccolini J. Déterminants moléculaires et génétiques d’efficacité et de toxicité du 5-fluoro-uracile. ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2372-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Magnani E, Farnetti E, Nicoli D, Casali B, Savoldi L, Focaccetti C, Boni C, Albini A, Banzi M. Fluoropyrimidine toxicity in patients with dihydropyrimidine dehydrogenase splice site variant: the need for further revision of dose and schedule. Intern Emerg Med 2013; 8:417-23. [PMID: 23585145 DOI: 10.1007/s11739-013-0936-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 03/26/2013] [Indexed: 01/05/2023]
Abstract
Dihydropyrimidine dehydrogenase (DPD) is a key enzyme in the metabolic catabolism of 5-fluorouracil (5-FU) and its derivatives (capecitabine and tegafur). Complete or partial deficiency of DPD activity has been demonstrated to induce severe toxicities in cancer patients treated with fluoropyrimidine therapy. We analyzed 180 individuals that were candidates for a treatment with 5-FU class drugs for the most common DPD mutation, IVS14+1G>A, and detected four heterozygous patients. We recorded the toxicities for all 180 individuals after the first two chemotherapy cycles and found that three of the four patients, although they were treated with a dose reduction in 50 % on the basis of the genetic analysis, all showed severe toxicities that resulted in hospitalization of patient and premature discontinuation of treatment. One patient with mutated DPD was not treated with chemotherapy upon the clinician's decision because of his DPD mutated genotype and the presence of microsatellite instability. Our data suggest that greater dose reductions or alternative therapies are needed for patients with DPD IVS14+1G>A mutations.
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Affiliation(s)
- Elena Magnani
- Department of Medical Oncology, Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia, Italy
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Borràs E, Dotor E, Arcusa A, Gamundi MJ, Hernan I, de Sousa Dias M, Mañé B, Agúndez JAG, Blanca M, Carballo M. High-resolution melting analysis of the common c.1905+1G>A mutation causing dihydropyrimidine dehydrogenase deficiency and lethal 5-fluorouracil toxicity. Front Genet 2013; 3:312. [PMID: 23335937 PMCID: PMC3547229 DOI: 10.3389/fgene.2012.00312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 12/19/2012] [Indexed: 01/13/2023] Open
Abstract
Dihydropyrimidine dehydrogenase (DPD) deficiency is a pharmacogenetic syndrome associated with life-threatening toxicity following exposure to the fluoropyrimidine drugs 5-fluorouracil (5-FU) and capecitabine (CAP), widely used for the treatment of colorectal cancer and other solid tumors. The most prominent loss-of-function allele of the DPYD gene is the splice-site mutation c.1905+1G>A. In this study we report the case of a 73-year old woman with metastatic colorectal cancer who died from drug-induced toxicity after the first cycle of 5-FU-containing chemotherapy. Her symptoms included severe neutropenia, thrombocytopenia, mucositis and diarrhea; she died 16 days later despite intensive care measures. Post-mortem genetic analysis revealed that the patient was homozygous for the c.1905+1G>A deleterious allele and several family members consented to being screened for this mutation. This is the first report in Spain of a case of 5-FU-induced lethal toxicity associated with a genetic defect that results in the complete loss of the DPD enzyme. Although the frequency of c.1905+1G>A carriers in the white population ranges between 1 and 2%, the few data available for the Spanish population and the severity of this case prompted us to design a genotyping procedure to prevent future toxic effects of 5-FU/CAP. Since our group had previously developed a high-resolution melting (HRM) assay for the simultaneous detection of KRAS, BRAF, and/or EGFR somatic mutations in colorectal and lung cancer patients considered for EGFR-targeted therapies, we included the DPYD c.1905+1G>A mutation in the screening test that we describe herein. HRM provides a rapid, sensitive, and inexpensive method that can be easily implemented in diagnostic settings for the routine pre-therapeutic testing of a gene mutation panel with implications in the pharmacologic treatment.
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Affiliation(s)
- Emma Borràs
- Molecular Genetics Unit, Hospital de Terrassa Terrassa, Spain
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Dehydrogenation, oxidative denitration and ring contraction of N,N-dimethyl-5-nitrouracil by a Bacillus nitroreductase Nfr-A1. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.molcatb.2011.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cordier PY, Nau A, Ciccolini J, Oliver M, Mercier C, Lacarelle B, Peytel E. 5-FU-induced neurotoxicity in cancer patients with profound DPD deficiency syndrome: a report of two cases. Cancer Chemother Pharmacol 2011; 68:823-6. [PMID: 21553285 DOI: 10.1007/s00280-011-1666-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 04/27/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE 5-Fluorouracil (5-FU) is a mainstay for treating various solid tumours in adults, including digestive and head and neck cancers. 5-FU-related toxicities usually include haematological, digestive and cutaneous features. Additionally, 5-FU has been described as being potentially neurotoxic in patients, but these side effects are quite rare in clinical practice. Here, we report two cases of sudden and unpredictable drug-induced neurotoxicities that occurred in patients undergoing their first course of 5-FU-based chemotherapy. PATIENTS AND METHODS None of these patients had any previous neurological disorder history, and both were treated following standard regimen (LV-5-FU2 and TPF for patient 1 and 2, respectively). Neurotoxicity included drowsiness, acute confusion plus dysarthria for the first patient and seizure, confusion and signs of metabolic encephalopathy for the second one. In addition, typical 5-FU-related severe toxicities (e.g. neutropenia and mucosities) were observed. Both patients slowly recovered from these neurological toxicities under supportive treatment. It was assumed that overexposure to 5-FU could explain the severe toxicities encountered. To test this hypothesis, we retrospectively evaluated the dihydropyrimidine dehydrogenase (DPD) activity of these patients on a phenotypic basis. RESULTS Evaluation of the uracil-to-di-hydrouracil (U/UH2) ratio in plasma revealed a profound DPD deficiency syndrome in both patients. CONCLUSION These cases suggest that 5-FU standard dosage administration may lead to strong overexposure, responsible for the severe toxicities observed, including the neurological features. It implies that DPD deficiency can cause neurotoxicity in 5-FU-treated patients and advocates for the prospective screening of DPD deficiency before starting any 5-FU-containing chemotherapy so as to prevent such side effects in the future.
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Ciccolini J, Gross E, Dahan L, Lacarelle B, Mercier C. Routine dihydropyrimidine dehydrogenase testing for anticipating 5-fluorouracil-related severe toxicities: hype or hope? Clin Colorectal Cancer 2011; 9:224-8. [PMID: 20920994 DOI: 10.3816/ccc.2010.n.033] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
5-Fluorouracil (5-FU) is a mainstay for treating colorectal cancer, alone or more frequently as part of combination therapies. However, its efficacy/toxicity balance is often limited by the occurrence of severe toxicities, showing in about 15%-20% of patients. Several clinical reports have shown the deleterious effect of dihydropyrimidine dehydrogenase (DPD) genetic polymorphism, a condition that reduces the liver detoxification step of standard dosages of 5-FU, in patients undergoing fluoropyrimidine-based therapy. Admittedly, DPD deficiency accounts for 50%-75% of the severe and sometimes life-threatening toxicities associated with 5-FU (or oral 5-FU). However, technical consensus on the best way to identify patients with DPD deficiency before administrating 5-FU is far from being achieved. Consequently, no regulatory step has been undertaken yet to recommend DPD testing as part of routine clinical practice for securing the administration of 5-FU. This review covers the limits and achievements of the various strategies proposed so far for determining DPD status in patients scheduled for 5-FU therapy.
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Ciccolini J, Dahan L, André N, Evrard A, Ouafik L, Duffaud F, Seitz JF, Mercier C. Reply to E. Giovannetti et al. J Clin Oncol 2010. [DOI: 10.1200/jco.2009.27.5859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Joseph Ciccolini
- Pole Oncologie, Assistance Publique Hôpitaux de Marseille, University-Hospital of Marseille, Marseille France
| | - Laetitia Dahan
- Pole Oncologie, Assistance Publique Hôpitaux de Marseille, University-Hospital of Marseille, Marseille France
| | - Nicolas André
- Pole Oncologie, Assistance Publique Hôpitaux de Marseille, University-Hospital of Marseille, Marseille France
| | | | - L'Houcine Ouafik
- Pole Oncologie, APHM, University-Hospital of Marseille, Marseille France
| | - Florence Duffaud
- Pole Oncologie, APHM, University-Hospital of Marseille, Marseille France
| | | | - Cédric Mercier
- Pole Oncologie, APHM, University-Hospital of Marseille, Marseille France
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DPD-based adaptive dosing of 5-FU in patients with head and neck cancer: impact on treatment efficacy and toxicity. Cancer Chemother Pharmacol 2010; 67:49-56. [DOI: 10.1007/s00280-010-1282-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 02/09/2010] [Indexed: 10/19/2022]
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Contribution of dihydropyrimidinase gene alterations to the development of serious toxicity in fluoropyrimidine-treated cancer patients. Cancer Chemother Pharmacol 2009; 65:661-9. [DOI: 10.1007/s00280-009-1071-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 07/07/2009] [Indexed: 01/22/2023]
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Pharmacology and therapeutic efficacy of capecitabine: focus on breast and colorectal cancer. Anticancer Drugs 2009; 20:217-29. [PMID: 19247178 DOI: 10.1097/cad.0b013e3283293fd4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Capecitabine (N -pentyloxycarbonyl-5-deoxy-5-fluorocytidine), an oral prodrug of 5-fluorouracil, has provided compelling efficacy data for the treatment of metastatic breast cancer and stage III or IV colorectal cancer, both as monotherapy and in combination regimens. The preferential conversion of capecitabine to 5-fluorouracil in neoplastic tissues renders this fluoropyrimidine particularly appealing for clinical use. The enzyme thymidine phosphorylase, which mediates the final step of the capecitabine activation pathway, is expressed in higher concentration in neoplastic than in healthy tissues. This makes capecitabine more tumor specific than other chemotherapeutic agents. Accordingly, capecitabine is generally well tolerated. In particular, the incidence of myelosuppression and alopecia is low, and the most common side effects, hand-foot syndrome and diarrhea, are usually manageable. Given its good toxicity profile, capecitabine was assessed in combination with several chemotherapeutic or biologic agents. In addition, the observation that thymidine phosphorylase is upregulated after treatment with other anticancer drugs, namely taxanes, provided a rationale for the prominent antitumor activity recently observed for the combination of capecitabine with these agents. This review provides an evidence-based update of clinical trials investigating the role of capecitabine in the treatment of breast and colorectal cancer, with special emphasis on pharmacological and safety issues that form the basis of currently used schedules.
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Ticha I, Kleiblova P, Fidlerova J, Novotny J, Pohlreich P, Kleibl Z. Lack of large intragenic rearrangements in dihydropyrimidine dehydrogenase (DPYD) gene in fluoropyrimidine-treated patients with high-grade toxicity. Cancer Chemother Pharmacol 2009; 64:615-8. [DOI: 10.1007/s00280-009-0970-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 02/20/2009] [Indexed: 10/21/2022]
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Mercier C, Dupuis C, Blesius A, Fanciullino R, Yang CG, Padovani L, Giacometti S, Frances N, Iliadis A, Duffaud F, Ciccolini J. Early severe toxicities after capecitabine intake: possible implication of a cytidine deaminase extensive metabolizer profile. Cancer Chemother Pharmacol 2008; 63:1177-80. [DOI: 10.1007/s00280-008-0889-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 11/22/2008] [Indexed: 12/28/2022]
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Saif MW, Sandoval A. Atypical Hand-and-Foot syndrome in an African American Patient treated with Capecitabine with normal DPD activity: Is there an ethnic disparity? Cutan Ocul Toxicol 2008; 27:311-5. [DOI: 10.1080/15569520802355774] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bocci G, Di Paolo A, Barbara C, Masi G, Fornaro L, Loupakis F, Allegrini G, Falcone A, Del Tacca M, Danesi R. Pharmacokinetics, a main actor in a many-sided approach to severe 5-FU toxicity prediction. Br J Clin Pharmacol 2008; 67:132-4. [PMID: 19006547 DOI: 10.1111/j.1365-2125.2008.03307.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Danesi R, Di Paolo A, Bocci G, Crea F, Del Tacca M. Pharmacogenetics in oncology. EJC Suppl 2008. [DOI: 10.1016/j.ejcsup.2008.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Cherny NI. Evaluation and management of treatment-related diarrhea in patients with advanced cancer: a review. J Pain Symptom Manage 2008; 36:413-23. [PMID: 18411014 DOI: 10.1016/j.jpainsymman.2007.10.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 10/17/2007] [Accepted: 10/31/2007] [Indexed: 01/27/2023]
Abstract
Diarrhea is a common and significant problem among patients with advanced cancer. Treatment-induced diarrhea can be severe and be associated with life-threatening dehydration and electrolyte abnormalities. The causes of diarrhea among patients with advanced cancer are diverse and some causes of diarrhea require specific therapies. Thus, careful evaluation of the underlying cause is necessary. Palliative care clinicians, particularly those dealing with patients receiving ongoing disease-modifying therapies, must be familiar with the common causes of diarrhea among cancer patients and the strategies to evaluate and manage these common and distressing symptoms. This article addresses four major issues: 1) a review of the causes of treatment-related diarrhea, focusing on diarrhea caused by chemotherapy, targeted therapies, and radiotherapy; 2) differential diagnosis and an approach to evaluation; 3) general management considerations; and 4) cause-specific issues in management.
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Affiliation(s)
- Nathan I Cherny
- Cancer Pain and Palliative Medicine Service, Department of Oncology, Shaare Zedek Medical Center, Jerusalem, Israel.
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Zuckerman DS, Clark JW. Systemic therapy for metastatic colorectal cancer: current questions. Cancer 2008; 112:1879-91. [PMID: 18338815 DOI: 10.1002/cncr.23409] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A proliferation of new cytotoxic and biologic agents has led to improved survival in patients with metastatic colorectal cancer (mCRC). The ability of surgery to increase long-term survival in patients with liver and/or lung metastases also has been firmly established. It has become increasingly difficult as the numbers and types of treatment options have expanded to identify optimal drug combinations, sequences, and duration and the best way to integrate systemic chemotherapy with potentially curative surgery for metastatic lesions. For this review, the authors examined how recent clinical trials have addressed some pertinent questions regarding the use of systemic chemotherapy and biologic agents in patients with mCRC.
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Affiliation(s)
- Dan S Zuckerman
- Division of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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