Impact of chemotherapy on symptom profile, oxidant-antioxidant balance and nutritional status in non-small cell Lung Cancer

Protective efficacy of pirfenidone in rats with pulmonary fibrosis induced by bleomycin

BACKGROUND

Bleomycin causes increased production of reactive oxygen species, leads to pulmonary toxicity, fibroblast activation, and fibrosis.

OBJECTIVES

This study aimed to evaluate the protective effect of pirfenidone on bleomycin-induced lung toxicity in rats.

METHODS

Twenty-eight adult rats were randomly divided into 3 groups; Bleomycin (B group, n=10), Bleomycin and Pirfenidone (B-PND group, n=13), and the control group (n=5). The bleomycin regimen was administered for 9 weeks. Pirfenidone was administered at 100 mg/kg daily. Total antioxidant level (TAS), total oxidant level (TOS), tumor necrosis factor (TNF-α), transforming growth factor (TGF-β1), matrix metalloproteinase-2 (MMP-2), plasminogen activator inhibitor (PAI) levels were studied. Histopathologically, sections were stained with Hematoxylin-eosin and Masson-trichrome for grading-scoring according to the Ashcroft score.

RESULTS

Stage 3 fibrosis was observed in 50% of the B group rats, stage 3 and higher fibrosis was never detected in the B-PND group and the difference was statistically significant (p=0.003). When evaluating tissue inflammation, the inflammation was higher in the B-PND group than in the other groups (p<0.001). Pleuritis was detected in all rats in group B, while was not observed in B-PND and control group (p<0.001). The TAS level was found to be significantly higher in group B than in group B-PND (p=0.034), while no difference was found between TOS, TNF-α, MMP-2, PAI, TGF-β1.

CONCLUSIONS

Pirfenidone had a statistically significant protective effect in bleomycin-induced lung fibrosis and pleuritis in rats.  Despite the presence of inflammation in the tissue, no significant changes were observed in inflammation markers in the peripheral blood. Novel serum biomarkers are needed to indicate the presence of inflammation and fibrosis in the lung.

Spondias pinnata bark extract- an ameliorator of inflammatory derangement in etoposide induced mucositis: An experimental approach

Background and Aim:

Mucositis, one of the vulnerabilities of chemotherapy, affects the physiological activities and therapeutic strategies of patients because it can affect the normal cell population. Etoposide is a commonly used chemotherapeutic agent for cancers such as oral, lung, and gastrointestinal. In addition to the abnormal metabolic processes in the body caused by tumorigenesis, new metabolic alterations can occur, such as oxidative stress, antioxidant imbalance, and inflammatory reactions, all of which can contribute to existing patient vulnerability. Therapeutic adjuvants can help overcome these toxic effects. Spondias pinnata is a tropical tree omnipresent in the coastal and Western Ghat section of India that is used for culinary purposes and as a local analgesic. Therefore, we aimed to study the anti-inflammatory effects of S. pinnata in an etoposide-induced mucositis rat model.

Materials and Methods:

Small intestinal tissue homogenates from albino Wistar rats were used to estimate the levels of glutathione (GSH) and nitric oxide (NO), and activities of total antioxidant (TAO), myeloperoxidase (MPO) and Na⁺-K⁺ ATPase. The animals were grouped into: (1) normal control, (2) etoposide-induced mucositis (65 mg/kg bodyweight, single IP dose), (3) S. pinnata control group, and (4) etoposide followed by S. pinnata bark extract (200 mg/kg bodyweight, once in a day). Animals were sacrificed after 24, 48, 72, and 96 h and compared with that of the normal control group (n=6). Statistical analysis was performed using EZR software.

Results:

We observed a significant decrease in the TAO and GSH levels with a marked increase in NO, MPO, and Na⁺-K⁺ ATPase activity in the mucositis group. A tendency to recover from the decreased TAO and GSH levels existed in the treated group, showing the protective effects of S. pinnata bark extract against mucositis. In addition, this extract also showed anti-inflammatory effects as reflected by the recovery in MPO levels at the end of 96 h. Maintenance of Na⁺-K⁺ ATPase activity in the treated group demonstrates the protective effects of the extract against the increased levels observed in the etoposide-induced mucositis group.

Conclusion:

This study revealed the protective effects of S. pinnata bark extract against the oxidative and inflammatory changes that occurred during the development ofmucositis. This would decrease the pathological burden during chemotherapy and prevent any hurdles in therapeutic modalities.

Redox imbalance induced by docetaxel in the neuroblastoma SH-SY5Y cells: a study of docetaxel-induced neuronal damage

Objectives

In cancer survivors, chemotherapy-associated adverse neurological effects are described as side effects in non-targeted tissue. We investigated the role of redox-imbalance in neuronal damage by a relative low dose of Docetaxel (DTX).

Methods

The neuroblastoma cells (SH-SY5Y cells) were exposed to DTX at a dose of 1.25 nM for 6 h. Antioxidant defenses (i.e. ascorbic acid, glutathione, and catalase) and lipid oxidation products (i.e. F₂-isoprostanes) were evaluated. To investigate cell ultrastructure and tubulin localisation, transmission electron microscopy (TEM) and immunofluorescence techniques were applied.

Results

In the SH-SY5Y cells, DTX induced a significant reduction of total glutathione (P < 0.001) and ascorbic acid (P < 0.05), and an increase in both total F₂-Isoprostanes (P < 0.05) and catalase activity (P < 0.05), as compared to untreated cells. Additionally, TEM showed a significant increase in cells with apoptotic characteristics. Immunolocalisation of tubulin showed a compromised cytoskeletal organisation.

Discussion

The investigated sublethal dose of DTX, to which non-targeted cells may be exposed throughout the duration of chemotherapy treatment, induces a redox imbalance resulting in a specific modulation of the antioxidant response. This study provides new insights into DTX-induced cellular mechanisms useful for evaluating whether the concomitant use of antioxidants associated with chemotherapy mitigates chemotherapy side effects in cancer survivors.

Effects of Docetaxel Combined with Icotinib on Serum Tumor Markers and Quality of Life of Patients with Advanced Non-Small Cell Lung Cancer

Background

To investigate the effects of docetaxel combined with icotinib on tumor markers in serum and quality of life of patients with advanced non-small cell lung cancer (NSCLC).

Methods

Overall, 121 patients with advanced NSCLC, admitted to the Third Affiliated Hospital of Shandong First Medical University, China from 2017-2018 were selected as subjects. Among them, 58 patients treated with docetaxel combined with icotinib for chemotherapy were considered as study group, and 63 patients treated with paclitaxel combined with carboplatin as control group. The clinical efficacy, adverse reactions, and ECOG scores of the two groups were observed. CEA, CA125, and SCC (Tumor markers) levels of the two groups before and after treatment were detected by chemiluminescence immunoassay (CLIA).

Results

The leukopenia, oral mucosa ulcer and mild numbness in the control group were significantly higher than those in the study group (P<0.05). After treatment, ECOG scores of both groups decreased (P<0.05), and the ECOG score of the study group was significantly higher than that of the control group (P<0.05). The serum CEA, CA125 and SCC levels of the study group and the control group after treatment decreased significantly compared with that before treatment (P<0.05).

Conclusion

Application of docetaxel combined with icotinib for chemotherapy of patients with advanced NSCLC can effectively reduce the serum levels of CEA, SCC, and the CA125. Docetaxel combined with icotinib can significantly reduce adverse reactions and better improve the quality of life of patients compared with paclitaxel combined with carboplatin, which is worthy of clinical promotion.

First-line management of metastatic non-small cell lung cancer: An Indian perspective

Lung cancer has been the most common cancer in the world for several decades. The non-small cell lung cancer (NSCLC) constitutes approximately about 80% of the total cases of lung cancer. Therapeutic interventions in NSCLC have shifted to the target-based approach from histology-based approach, and this has completely changed the face of the management of NSCLC. Developing countries, such as India, have very limited data compiled about the prevalence and treatment practices of lung cancer, despite a large burden of the disease. However, in recent times, there has been a lot of data generated in this regard. This article is an attempt to collate and shine light on the available data for the first-line treatment of NSCLC in India keeping in mind the current standards of care in this area.

Nutritional status in patients with advanced lung cancer undergoing chemotherapy: a prospective observational study

Purpose: The consequences of malnutrition include increased risk of many complications. The assessment and management of nutritional problems are essential in supportive care of patients undergoing therapy. The primary objective of the present study was to assess changes in the nutritional status in lung cancer patients who had undergone chemotherapy.Patients and methods: Preliminary and post-chemotherapy assessments of patients' nutritional status and medical characteristics were conducted using the Patient-Generated Subjective Global Assessment (PG-SGA) from July 2014 to May 2016 at Harbin Medical University Cancer Hospital. Four hundred sixty-five advanced lung cancer patients (51.8% men and 48.2% women with a mean (SD) age of 60.2 ± 9.8 years) participated in the present study. PG-SGA was assessed prior to the initiation of chemotherapy and after four cycles of chemotherapy.Results: We found that 11.4% of the patients were severely malnourished and 65.6% of the patients were moderately malnourished prior to chemotherapy. After chemotherapy, 52.9% of the patients were considered moderately malnourished, whereas 33.8% were severely malnourished. The nutritional status had deteriorated in the majority of patients. After chemotherapy, there was a rise in the prevalence of nutrition impact symptoms.Conclusions: A deteriorated nutritional status was the result of the side effects caused by chemotherapy in the patients of the present study. These findings highlight that more attention should be paid to improve the nutritional status in patients with advanced lung cancer undergoing chemotherapy, and proper nutrition education and nutritional support should be provided to these patients.

Sera total oxidant/antioxidant status in lung cancer patients

We investigated oxidative stress parameters in the sera of patients with lung cancer and healthy individuals to evaluate their correlations with lung cancer.Ninety-four lung cancer patients and 64 healthy controls were enrolled after obtaining informed consent. Their sera oxidative stress parameters were measured.Total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were significantly different between patients and healthy groups (all P < .001). TAS gradually decreased and TOS and OSI gradually increased from stage I to III, but it did not reach statistical significance (all P > .05). TAS and OSI were significantly different between the nonsmoking and smoking groups, radiotherapy and without radiotherapy groups, chemotherapy and without chemotherapy groups (P < .05), but not TOS (P > .05). In a receiver operating characteristic curve analysis comparing patients with lung cancer with healthy controls, the Youden indices of TOS, TAS, and OSI were 0.541, 0.532, and 1, respectively.The oxidative stress may be correlation with lung cancer staging. Smoking, surgery, radiotherapy, and chemotherapy showed correlation with parts oxidative stress parameters.