Chemotherapy-induced neurotoxicity in the treatment of gynecological cancers: State of art and an innovative approach for prevention

MiR-34b promotes oxidative stress and induces cellular senescence through TWIST1 in human cervical cancer

PURPOSE

The aim of this research was to elucidate the role of miR-34b in cervical cancer progression and the underlying mechanism behind the miR-34b-mediated tumor suppression. The study revealed the role of miR-34b as a senescence inducer and serves as a potential therapeutic target in developing combination therapy with senotherapeutics.

METHODS

MiR-34b was ectopically expressed in cervical cancer cell lines using a tetracycline inducible system and its effects on cell viability, apoptosis, senescence, DNA damage and oxidative stress were studied using MTT assay, acridine orange/ ethidium bromide staining, senescence associated β-galactosidase assay, gamma H2AX foci staining assay, western blotting and specific dyes for the detection of total and individual ROS species.

RESULTS

Ectopic expression of miR-34b promoted cellular senescence but no significant induction of apoptosis was observed in cervical cancer cell lines. MiR-34b promoted increase in oxidative stress through increase in total and individual ROS species and contributed to increase in cellular senescence. Mechanistically, miR-34b mediates its action by targeting TWIST1 as evidenced by the similar actions of TWIST1 shRNA in cervical cancer cell lines. Furthermore, our study revealed TWIST1 is one of the most significant targets of miR-34b targetome and identified RITA as a novel senolytic agent for use in combination therapy with miR-34b.

CONCLUSION

MiR-34b promotes cellular senescence and oxidative stress by targeting TWIST1, a known oncogene and EMT regulator. This study delved into the mechanism of miR-34b-mediated tumor suppression and provided novel insights for development of miR-34b based therapeutics for cervical cancer.

A. T. Agbor F, Jenkins A, Lavoie Smith EM. Exploring social determinants of health on chemotherapy-induced peripheral neuropathy severity in ovarian cancer: An integrative review

Ovarian cancer remains a significant public health concern for women despite advancements in cancer management. Despite comprising only 2.5 % of cancers in women, ovarian cancer ranks as the fifth leading cause of cancer-related deaths among women, with patients frequently receiving late diagnoses. Chemotherapy, a primary treatment, frequently causes chemotherapy-induced peripheral neuropathy (CIPN), affecting over 60 % of patients and leading to severe sensory, motor, and autonomic nerve impairments. This often necessitates dosage reduction or discontinuation of treatment, thereby increasing mortality. While CIPN's impact on patients is well-documented, there is a paucity of knowledge of how structural and intermediary social determinants of health factors (SDOH), such as socioeconomic and political context, material circumstances such as living and walking conditions, area deprivation, and food availability, affect CIPN severity. The aim of this article was to explore the association between various SDOH and CIPN severity in ovarian cancer, identifying potential research gaps and future research directions. This article seeks to inform targeted interventions to mitigate CIPN's impact by elucidating these associations.

Cropsi study: Efficacy and safety of cryotherapy and cryocompression in the prevention of chemotherapy-induced peripheral neuropathy in patients with breast and gynecological cancer-A prospective, randomized trial

OBJECTIVE

This study aimed to demonstrate the superiority of cryocompression over cryotherapy alone in the prevention of chemotherapy-induced peripheral neuropathy (CIPN) grade 2 or above.

METHODS

This prospective randomized study was conducted between May 2020 and January 2023 in Innsbruck. Eligible patients had a diagnosis of gynecological cancer and received a minimum of 3 cycles of taxane-based CT (neoadjuvant, adjuvant or palliative therapy). Patients were randomized 1:1 to receive either cryotherapy or cryocompression on their upper extremities during chemotherapy (CT). We performed temperature measurements, two QoL questionnaires and neurological tests during CT and at follow-up 3 and 6-9 months after the completion of CT. CIPN was assessed using the CTCAE score.

RESULTS

Of 200 patients recruited, both groups showed a lower prevalence of CIPN in this study compared to recent literature. In the group receiving cryotherapy, the prevalence of grade 1 CIPN was 30.1 %, and that of grade 2 CIPN or above was 13.7 %; in the group treated with cryocompression, the prevalence of grade 1 CIPN was 32.8 %, and that of grade 2 or above CIPN was 17.2 %. We found a significant reduction in temperature in the cryotherapy and cryocompression groups. Regarding the two QOL questionnaires as well as the neurological tests no significant differences were found between the two groups.

CONCLUSION

Our study suggests that cryotherapy as well as cryocompression is a safe and effective way to cool patients' extremities to lower the prevalence of CIPN. Cryocompression was not more effective than cryotherapy alone in the prevention of CIPN.

Neurotoxicity induced by taxane-derived drugs: analysis of the FAERS database 2017-2021

OBJECTIVES

Taxane-related neurotoxicity is a frequent clinical problem but lacks postmarketing data regarding neurological disorders. This study aimed to evaluate the potential association between neurological adverse events and several taxanederived drugs via the Food and Drug Administration Adverse Event Reporting System (FAERS).

METHODS

Disproportionality analysis was applied to data mining of the suspected cases of neurological disorders after using different taxanes based on the FAERS data from January 2017 and December 2021. We also investigated the times to onset, fatality, and hospitalization proportions of taxanerelated neurotoxicity.

RESULTS

In total, 3,940 cases were screened out, which were more prevalent in elderly patients and females. Peripheral neuropathy was a common adverse event among all taxanes with relatively strong association. Generally, the median time to neurological adverse effect onset was 27 days (interquartile range, 11.0 ~ 78.0 days) following taxane regimens, and the majority of cases were detected within the first 30 days. Among cases of neurological adverse events treated with taxane, the fatality and hospitalization proportions were 6.13% and 28.63%, respectively.

CONCLUSION

By analyzing the FAERS data, we provided a detailed profile of neurotoxicity and different taxanes in detail in terms of clinical characteristics, time to onset, and patient outcomes.

Survival Outcomes With Reduced Doses of Adjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer

BACKGROUND/AIM

There have not been enough recent studies investigating the incidence or efficacy of dose reduction in adjuvant chemotherapy for epithelial ovarian cancer. This study examined whether patients who needed dose reduction showed poorer survival outcomes.

PATIENTS AND METHODS

From 2011 to 2021, 102 patients were included in the study. Patients who underwent neoadjuvant chemotherapy and those with early-stage disease were excluded. Patients were divided into two groups: those who had a ≥60% dose reduction during the whole period of first-line adjuvant chemotherapy, and those with dose reductions <60%. Of the 102 patients, 38 (37.3%) underwent dose reduction ≥60%.

RESULTS

PFS was significantly longer in the group whose dose reductions were ≥60%, whereas OS was not significant.

CONCLUSION

A dose reduction of ≥60%, determined by patients' medical conditions, during first-line of adjuvant chemotherapy does not negatively influence survival outcomes, such as OS and PFS, in advanced epithelial ovarian cancer.

Olaparib and paclitaxel in combination with carboplatin in treatment of ovarian cancer: influence on disease control

OBJECTIVE

To investigate the efficacy and safety of olaparib and paclitaxel combined with carboplatin in the treatment of ovarian cancer and its impact on disease control.

METHODS

The medical data of 120 patients with ovarian cancer admitted to our hospital from February 2019 to February 2020 were retrospectively analyzed. According to different treatment methods, the enrolled patients were divided into two groups: a control group (n=60) treated with paclitaxel combined with carboplatin, and an experimental group (n=60) additionally treated with olaparib on the basis of the control group. The short-term efficacy, serum levels of carbohydrate antigen 125 (CA125), tumor necrosis factor (TNF-α), interleukin-6 (IL-6), and human epididymis protein 4 (HE4), and the incidence of adverse effects and tumor metastasis were compared between the two groups.

RESULTS

There was no difference in the baseline data between the two groups (P>0.05). The objective remission rate (ORR) and disease control rate (DCR) of the experimental group were higher than those of the control group (P<0.05). The experimental group had lower levels of serum CA125, TNF-α, IL-6, and HE4 than the control group after treatment (P<0.05). The two groups showed no significant difference in the incidence of adverse reactions (P>0.05). The one-year follow-up identified a lower tumor metastasis rate in the experimental group compared to the control group (P<0.05).

CONCLUSION

Olaparib and paclitaxel combined with carboplatin improve the serum indexes of patients with ovarian cancer, enhance the disease control, and reduce the recurrence rate, without extra toxic side effects.