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Rikos D, Vikelis M, Dermitzakis EV, Soldatos P, Rallis D, Rudolf J, Andreou AP, Argyriou AA. Reporting Quality and Risk of Bias Analysis of Published RCTs Assessing Anti-CGRP Monoclonal Antibodies in Migraine Prophylaxis: A Systematic Review. J Clin Med 2024; 13:1964. [PMID: 38610729 PMCID: PMC11012539 DOI: 10.3390/jcm13071964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Objective: Phase II/III randomized clinical trials (RCTs) are vulnerable to many types of bias beyond randomization. Insights into the reporting quality of RCTs involving migraine patients treated with monoclonal antibodies targeting the calcitonin gene-related peptide system (anti-CGRP MAbs) are currently lacking. Our aim was to analyze the reporting quality of phase II/III RCTs involving migraine patients treated with anti-CGRP MAbs. Methods: A systematic search was performed on the PubMed and EMBASE databases, according to PRISMA guidelines, for relevant RCTs in either episodic or chronic migraine prevention. Additionally, an adapted version of the 2010 CONSORT statement checklist was utilized. The ROBvis online tool was used to document the risk of bias. Results: From the initially identified 179 articles, we finally found 31 RCTs that were eligible for evaluation. The average CONSORT compliance was 88.7% (69.7-100%), while 93.5% (N = 29) of the articles had a compliance greater than 75%. Twenty-eight CONSORT items were reported in more than 75% of the articles. The average compliance of the analyzed RCTs was 93.9% for Galcanezumab, 91.3% for Fremanezumab, followed by 85.4% for Erenumab and Eptinezumab studies. Implementation of the ROB2 tool showed some concerning "missing information" arising from the inadequate reporting. Specifically, 50% of the studies (N = 16) were categorized as having inadequate information regarding the randomization process. Conclusions: Adequate reporting quality was disclosed in the evaluated RCTs with anti-CGRP MAbs in migraine prevention. However, some methodological issues need to be highlighted to be addressed in future studies assessing the efficacy of new molecules targeting CGRP or other candidate pathways implicated in migraine pathophysiology.
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Affiliation(s)
| | - Michail Vikelis
- Headache Clinic, Mediterraneo Hospital, 16675 Athens, Greece;
| | | | | | - Dimitrios Rallis
- Department of Neurology, Tzaneio General Hospital of Piraeus, 18536 Athens, Greece;
| | - Jobst Rudolf
- Department of Neurology, Papageorgiou General Hospital of Thessaloniki, 54645 Thessaloniki, Greece;
| | - Anna P. Andreou
- Headache Centre, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK;
- Headache Research-Wolfson Sensory, Pain and Regeneration Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE1 1LU, UK
| | - Andreas A. Argyriou
- Headache Outpatient Clinic, Department of Neurology, Agios Andreas General Hospital of Patras, 26335 Patras, Greece;
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Argyriou AA, Bruna J, Kalofonou F, Velasco R, Litsardopoulos P, Alemany M, Anastopoulou GG, Kalofonos HP. Incidence and risk factors for developing chemotherapy-induced neuropathic pain in 500 cancer patients: A file-based observational study. J Peripher Nerv Syst 2024; 29:38-46. [PMID: 38311337 DOI: 10.1111/jns.12616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/04/2024] [Accepted: 01/22/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To define the incidence and risk factors for developing chemotherapy-induced neuropathic pain (CINP). METHODS Retrospective, file-based analysis on cancer patients who received any type of conventional chemotherapy and for whom neurological evaluation was asked to reveal the extent of chemotherapy-induced peripheral neurotoxicity (CIPN) with or without CINP. CINP was assessed by means of the PI-NRS and Douleur Neuropathique-4 questionnaire. The total neuropathy score-clinical version graded the severity of CIPN. RESULTS The medical files of 500 chemotherapy-treated cancer patients were reviewed. Any grade chronic CIPN was disclosed in 343 (68.6%) patients and CINP in 127 (37%) of them, corresponding to an overall percentage of 25.4% among all 500 included patients. The logistic regression analysis identified as independent predictors for CINP development the presence of uncomplicated diabetes (OR: 2.17; p = .039) and grade 2-3 chronic CIPN (OR: 1.61; p < .001) as also the administration of combined paclitaxel plus cisplatin (reference variable), compared to oxaliplatin (OR: 0.18; p = .001) and taxanes (OR: 0.16; p < .001). The increased severity of acute OXAIPN was associated with CINP (OR: 4.51; p < .001). OXA-treated patients with persistent CINP presented a worst likelihood to improve after chemotherapy discontinuation, than patients receiving combined paclitaxel plus cisplatin (OR: 50; p < .001). CONCLUSION The incidence of CINP in our cohort was comparable to previous reports, with severities fluctuating upwards during chemotherapy and declined post-chemotherapy. Uncomplicated diabetes, the combined paclitaxel plus cisplatin treatment and the increased severity of acute oxaliplatin neurotoxicity mostly increase the risk for developing CINP. OXA-treated patients present less possibilities to recover from CINP after chemotherapy discontinuation, than other chemotherapies.
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Affiliation(s)
- Andreas A Argyriou
- Neurological Department, "Agios Andreas" General Hospital of Patras, Patras, Greece
| | - Jordi Bruna
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet, IDIBELL, Barcelona, Spain
| | | | - Roser Velasco
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet, IDIBELL, Barcelona, Spain
| | | | - Montse Alemany
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet, IDIBELL, Barcelona, Spain
| | | | - Haralabos P Kalofonos
- Department of Medicine, Division of Oncology, University Hospital of Patras, Patras, Greece
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Alberti P, Argyriou AA, Bruna J, Damaj MI, Faithfull S, Harding A, Hoke A, Knoerl R, Kolb N, Li T, Park SB, Staff NP, Tamburin S, Thomas S, Smith EL. Correction to: Considerations for establishing and maintaining international research collaboration: the example of chemotherapy‑induced peripheral neurotoxicity (CIPN)-a white paper. Support Care Cancer 2024; 32:175. [PMID: 38381222 PMCID: PMC10881766 DOI: 10.1007/s00520-024-08382-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Paola Alberti
- University of Milano-Bicocca, School of Medicine and Surgery, Monza, Italy
- Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Jordi Bruna
- Hospital Universitari de Bellvitge, Neuro-Oncology Unit, Institut Catala d'Oncologia (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - M Imad Damaj
- Department of Pharmacology and Toxicology and Translational Research Initiative for Pain and Neuropathy, Virginia Commonwealth University, Richmond, VA, USA
| | - Sara Faithfull
- Trinity College Dublin, School of Medicine, Dublin, Ireland
- University of Dublin, Trinity Centre for Health Sciences St. James's Hospital Campus, Dublin, Ireland
| | - Alice Harding
- University of Alabama at Birmingham, Office of Sponsored Programs, Birmingham, AL, USA
| | - Ahmet Hoke
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Robert Knoerl
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Noah Kolb
- Department of Neurological Sciences, University of Vermont Robert Larner College of Medicine, Burlington, VT, USA
| | - Tiffany Li
- Faculty of Medicine and Health, University of Sydney, Brain and Mind Centre and School of Medical Sciences, Sydney, Australia
| | - Susanna B Park
- Faculty of Medicine and Health, University of Sydney, Brain and Mind Centre and School of Medical Sciences, Sydney, Australia
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Simone Thomas
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ellen Lavoie Smith
- Department of Acute, Chronic & Continuing Care, University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA.
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Argyriou AA, Dermitzakis EV, Rikos D, Xiromerisiou G, Soldatos P, Litsardopoulos P, Vikelis M. Effects of OnabotulinumtoxinA on Allodynia and Interictal Burden of Patients with Chronic Migraine. Toxins (Basel) 2024; 16:106. [PMID: 38393184 PMCID: PMC10891839 DOI: 10.3390/toxins16020106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND We primarily aimed to ascertain whether treatment with OnabotulinumtoxinA (BoNTA) might influence the extent of the interictal burden and cutaneous allodynia in patients with chronic migraine (CM). METHODS Seventy CM patients, who received three consecutive cycles of BoNTA, were studied. The interictal burden was assessed with the Migraine Interictal Burden Scale (MIBS-4), while cutaneous allodynia was examined with the Allodynia Symptom Checklist (ASC-12) together with PI-NRS VAS to obtain hair brushing scores, and then these were compared from baseline (T0) to the last efficacy evaluation follow-up (T1). Efficacy outcomes, mostly mean headache days (MHD) and "Headache Impact Test" scores, were also assessed between T0 and T1. RESULTS BONTA improved the interictal burden, with a decrease in MIBS-4 scoring by an average of -7 at T1, compared to baseline (p < 0.001). The percentage of patients with a moderate/severe interictal burden was substantially decreased. Likewise, BoNTA reduced the extent of cutaneous allodynia, with a significant reduction in both the ASC-12 (1 vs. 6; p < 0.001) and PI-NRS VAS (1 vs. 5; p < 0.001) to hair brushing median scores at T1, compared to baseline. Reduced MHD rates were significantly associated with a smaller interictal burden at T1. The efficacy of BoNTA, with a significant reduction in MHD and HIT-6 scores at T1 compared to T0, was re-confirmed. CONCLUSIONS BoNTA resulted in a statistically significant reduction in the interictal burden and also improved cutaneous allodynia. The reduction in ictal burden was associated with the down-scaling of the interictal burden. Hence, BoNTA improved the full spectrum of migraine impairment by diminishing the clinical expression of central sensitization.
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Affiliation(s)
- Andreas A Argyriou
- Headache Outpatient Clinic, Department of Neurology, Agios Andreas General Hospital of Patras, 26335 Patras, Greece
| | | | | | - Georgia Xiromerisiou
- Department of Neurology, University Hospital of Larissa, University of Thessaly, 41110 Larissa, Greece
| | | | - Pantelis Litsardopoulos
- Headache Outpatient Clinic, Department of Neurology, Agios Andreas General Hospital of Patras, 26335 Patras, Greece
| | - Michail Vikelis
- Headache Clinic, Mediterraneo Hospital, 16675 Athens, Greece
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Alberti P, Argyriou AA, Bruna J, Damaj MI, Faithfull S, Harding A, Hoke A, Knoerl R, Kolb N, Li T, Park SB, Staff NP, Tamburin S, Thomas S, Smith EL. Considerations for establishing and maintaining international research collaboration: the example of chemotherapy-induced peripheral neurotoxicity (CIPN)-a white paper. Support Care Cancer 2024; 32:117. [PMID: 38244122 PMCID: PMC10799817 DOI: 10.1007/s00520-023-08301-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/28/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE This white paper provides guidance regarding the process for establishing and maintaining international collaborations to conduct oncology/neurology-focused chemotherapy-induced peripheral neurotoxicity (CIPN) research. METHODS An international multidisciplinary group of CIPN scientists, clinicians, research administrators, and legal experts have pooled their collective knowledge regarding recommendations for establishing and maintaining international collaboration to foster advancement of CIPN science. RESULTS Experts provide recommendations in 10 categories: (1) preclinical and (2) clinical research collaboration; (3) collaborators and consortiums; (4) communication; (5) funding; (6) international regulatory standards; (7) staff training; (8) data management, quality control, and data sharing; (9) dissemination across disciplines and countries; and (10) additional recommendations about feasibility, policy, and mentorship. CONCLUSION Recommendations to establish and maintain international CIPN research collaboration will promote the inclusion of more diverse research participants, increasing consideration of cultural and genetic factors that are essential to inform innovative precision medicine interventions and propel scientific discovery to benefit cancer survivors worldwide. RELEVANCE TO INFORM RESEARCH POLICY Our suggested guidelines for establishing and maintaining international collaborations to conduct oncology/neurology-focused chemotherapy-induced peripheral neurotoxicity (CIPN) research set forth a challenge to multinational science, clinical, and policy leaders to (1) develop simple, streamlined research designs; (2) address logistical barriers; (3) simplify and standardize regulatory requirements across countries; (4) increase funding to support international collaboration; and (5) foster faculty mentorship.
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Affiliation(s)
- Paola Alberti
- University of Milano-Bicocca, School of Medicine and Surgery, Monza, Italy
- Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Jordi Bruna
- Hospital Universitari de Bellvitge, Neuro-Oncology Unit, Institut Catala d'Oncologia (IDIBELL), L'Hospitalet del Llobregat, Barcelona, Spain
| | - M Imad Damaj
- Department of Pharmacology and Toxicology and Translational Research Initiative for Pain and Neuropathy, Virginia Commonwealth University, Richmond, VA, USA
| | - Sara Faithfull
- Trinity College Dublin, School of Medicine, Dublin, Ireland
- University of Dublin, Trinity Centre for Health Sciences St. James's Hospital Campus, Dublin, Ireland
| | - Alice Harding
- University of Alabama at Birmingham, Office of Sponsored Programs, Birmingham, AL, USA
| | - Ahmet Hoke
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Robert Knoerl
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Noah Kolb
- Department of Neurological Sciences, University of Vermont Robert Larner College of Medicine, Burlington, VT, USA
| | - Tiffany Li
- Faculty of Medicine and Health, University of Sydney, Brain and Mind Centre and School of Medical Sciences, Sydney, Australia
| | - Susanna B Park
- Faculty of Medicine and Health, University of Sydney, Brain and Mind Centre and School of Medical Sciences, Sydney, Australia
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Simone Thomas
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ellen Lavoie Smith
- Department of Acute, Chronic & Continuing Care, University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA.
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Dermitzakis EV, Vikelis M, Xiromerisiou G, Rallis D, Soldatos P, Litsardopoulos P, Rikos D, Argyriou AA. Nine-Month Continuous Fremanezumab Prophylaxis on the Response to Triptans and Also on the Incidence of Triggers, Hypersensitivity and Prodromal Symptoms of Patients with High-Frequency Episodic Migraine. J Clin Med 2024; 13:386. [PMID: 38256516 PMCID: PMC10816996 DOI: 10.3390/jcm13020386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Objective: To investigate whether the incidence of triggers, prodromal symptoms, hypersensitivity symptoms accompanying headache and responses to triptans were modified during a continuous 9-month fremanezumab therapy for migraine prophylaxis. Patients and methods: We studied 63 patients with high-frequency episodic migraine (HFEM). Enrolled patients received fremanezumab for nine consecutive months before defining the response rates and being stratified into treatment responders (≥50-74% reduction in monthly headache days (MHDs)), super responders (≥75%), partial non-responders (<50%) and super non-responders (<30%). Through headache diaries, patients provided data in order to document the impact of fremanezumab on the incidence of triggers, associated symptoms followed by headache and response to triptans (the use of the migraine treatment optimization questionnaire-4 (mTOQ-4)) during the 9-month treatment period. Results: Fremanezumab had early (after 3 monthly cycles) beneficial effects on the response to triptans in the majority of responders with relevant increases in mTOQ-4 scoring, but also in half of partial non-responders. A significant reduction in median days with migraine-associated symptoms was seen in responders after 6 months of therapy with fremanezumab, mostly for osmophobia, photophobia, phonophobia and nausea/vomiting, but partial non-responders also benefited. Likewise, the incidence of self-reported prodromal symptoms was significantly reduced in responders and was modestly diminished in partial non-responders. Triggers remained unaffected in both responders and non-responders. Conclusions: Fremanezumab given for at least 6-9 months may exert neuromodulatory effects in the migraine brain. These effects could result both in the inhibition of migraine chronification, but also in the diminishing of the magnitude of migraine-associated symptoms, mostly in responders and in partial non-responders.
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Affiliation(s)
| | - Michail Vikelis
- Headache Clinic, Mediterraneo Hospital, 16675 Athens, Greece;
| | - Georgia Xiromerisiou
- Department of Neurology, University Hospital of Larissa, University of Thessaly, 41110 Larissa, Greece;
| | - Dimitrios Rallis
- Department of Neurology, Tzaneio General Hospital of Piraeus, 18536 Athens, Greece;
| | | | - Pantelis Litsardopoulos
- Headache Outpatient Clinic, Department of Neurology, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece; (P.L.); (A.A.A.)
| | | | - Andreas A. Argyriou
- Headache Outpatient Clinic, Department of Neurology, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece; (P.L.); (A.A.A.)
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Park SB, Cetinkaya-Fisgin A, Argyriou AA, Höke A, Cavaletti G, Alberti P. Axonal degeneration in chemotherapy-induced peripheral neurotoxicity: clinical and experimental evidence. J Neurol Neurosurg Psychiatry 2023; 94:962-972. [PMID: 37015772 PMCID: PMC10579520 DOI: 10.1136/jnnp-2021-328323] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 02/15/2023] [Indexed: 04/06/2023]
Abstract
Multiple pathological mechanisms are involved in the development of chemotherapy-induced peripheral neurotoxicity (CIPN). Recent work has provided insights into the molecular mechanisms underlying chemotherapy-induced axonal degeneration. This review integrates evidence from preclinical and clinical work on the onset, progression and outcome of axonal degeneration in CIPN. We review likely triggers of axonal degeneration in CIPN and highlight evidence of molecular pathways involved in axonal degeneration and their relevance to CIPN, including SARM1-mediated axon degeneration pathway. We identify potential clinical markers of axonal dysfunction to provide early identification of toxicity as well as present potential treatment strategies to intervene in axonal degeneration pathways. A greater understanding of axonal degeneration processes in CIPN will provide important information regarding the development and progression of axonal dysfunction more broadly and will hopefully assist in the development of successful interventions for CIPN and other neurodegenerative disorders.
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Affiliation(s)
- Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, School of Medical Sciences, University of Sydney, Camperdown, New South Wales, Australia
| | - Aysel Cetinkaya-Fisgin
- Department of Neurology, Neuromuscular Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Andreas A Argyriou
- Department of Neurology, "Agios Andreas" State General Hospital of Patras, Patras, Greece
| | - Ahmet Höke
- Department of Neurology, Neuromuscular Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Guido Cavaletti
- Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Paola Alberti
- Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, Monza, Italy
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Xiromerisiou G, Lampropoulos IC, Dermitzakis EV, Vikelis M, Marogianni C, Mysiris D, Argyriou AA. Single OnabotulinumtoxinA Session Add-On to Carbamazepine or Oxcarbazepine in Treatment-Refractory Trigeminal Neuralgia: A Case Series with 24-Week Follow Up. Toxins (Basel) 2023; 15:539. [PMID: 37755965 PMCID: PMC10534438 DOI: 10.3390/toxins15090539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/09/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
We sought to assess the efficacy of combining onabotulinumtoxinA (BoNTA) as add-on therapy to carbamazepine or oxcarbazepine in treatment-refractory patients with trigeminal neuralgia (TGN) who failed to respond (less than 30% response rate) to adequate monotherapy. We conducted a retrospective study on 15 patients with a definite diagnosis of TGN, according to the established criteria, and underwent BoNTA as part of their treatment plan. A single BoNTA session was administered subcutaneously, according to patients' perceived zone of pain, at different dosages ranging from 30 to 200 units (mean ± standard deviation: 87.3 ± 39.2). All patients (15/15; 100%) reported large reductions in the severity of their TGN-related neuropathic pain. The mean pain score on the VAS scale significantly decreased from 9.3 ± 1.1 to 3.7 ± 1.2 at 2 weeks after injecting BoNTA (p < 0.001) and remained stable at 4 and 24 weeks post-injection. Regarding the impact of BoNTA on patients' health-related quality of life, there were significant improvements in both the physical and mental health domains (p < 0.05) of SF-36 tool. BoNTA may be a safe and effective treatment option for patients with refractory TGN when added on to carbamazepine or oxcarbazepine. The use of a single BoNTA session for TGN treatment may be an alternative to surgical interventions and as add-on treatment to oral medications, providing patients with a minimally invasive, effective, safe and well-tolerated option.
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Affiliation(s)
- Georgia Xiromerisiou
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, 41110 Larissa, Greece
| | - Ioannis C. Lampropoulos
- Respiratory Medicine Department, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece;
| | | | - Michail Vikelis
- Headache Clinic, Mediterraneo Hospital, 16675 Glyfada, Greece;
| | - Chrysoula Marogianni
- Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, 41110 Larissa, Greece; (C.M.); (D.M.)
| | - Dimitrios Mysiris
- Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, 41110 Larissa, Greece; (C.M.); (D.M.)
| | - Andreas A. Argyriou
- Headache Outpatient Clinic, Department of Neurology, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece;
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Vikelis M, Dermitzakis EV, Xiromerisiou G, Rallis D, Soldatos P, Litsardopoulos P, Rikos D, Argyriou AA. Effects of Fremanezumab on Psychiatric Comorbidities in Difficult-to-Treat Patients with Chronic Migraine: Post Hoc Analysis of a Prospective, Multicenter, Real-World Greek Registry. J Clin Med 2023; 12:4526. [PMID: 37445560 DOI: 10.3390/jcm12134526] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE this post hoc analysis aimed to evaluate the efficacy of fremanezumab in difficult-to-treat chronic migraine (CM) patients with and without psychiatric comorbidities (PCs), mainly anxiety and/or depression. METHODS We assessed data from CM patients with and without PCs who failed at least 3 preventives and eventually received at least 3 consecutive monthly doses of fremanezumab 225 mg. Outcomes included the crude response (≥50% reduction in monthly headache days (MHDs)) rates to fremanezumab from the baseline to the last clinical follow-up. The changes in MHDs; MHDs of moderate/greater severity; monthly days with intake of abortive medication; and the proportion of patients' changing status from with PCs to decreased/without PCs were also compared. Disability and quality of life (QOL) outcomes were also assessed. RESULTS Of 107 patients enrolled, 65 (60.7%) had baseline PCs. The percentage of patients with (n = 38/65; 58.5%) and without (n = 28/42; 66.6%) PCs that achieved a ≥50% reduction in MHDs with fremanezumab was comparable (p = 0.41), whereas MHDs were significantly reduced (difference vs. baseline) in both patients with PCs (mean -8.9 (standard error: 6.8); p < 0.001) and without PCs (-9.8 (7.5); p < 0.001). Both groups experienced significant improvements in all other efficacy, disability, and QOL outcomes at comparable rates, including in MHD reduction. A significant proportion of fremanezumab-treated patients with baseline PCs de-escalated in corresponding severities or even reverted to no PCs (28/65; 43.1%) post-fremanezumab. CONCLUSIONS fremanezumab appears to be effective as a preventive treatment in difficult-to-treat CM patients with and without PCs while also being beneficial in reducing the severity of comorbid anxiety and/or depression.
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Affiliation(s)
- Michail Vikelis
- Headache Clinic, Mediterraneo Hospital, 16675 Athens, Greece
| | | | - Georgia Xiromerisiou
- Department of Neurology, University Hospital of Larissa, University of Thessaly, 41110 Larissa, Greece
| | - Dimitrios Rallis
- Department of Neurology, Tzaneio General Hospital of Piraeus, 18536 Athens, Greece
| | | | - Pantelis Litsardopoulos
- Headache Outpatient Clinic, Department of Neurology, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece
| | | | - Andreas A Argyriou
- Headache Outpatient Clinic, Department of Neurology, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece
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Argyriou AA, Dermitzakis EV, Xiromerisiou G, Rallis D, Soldatos P, Litsardopoulos P, Vikelis M. Predictors of Response to Fremanezumab in Migraine Patients with at Least Three Previous Preventive Failures: Post Hoc Analysis of a Prospective, Multicenter, Real-World Greek Registry. J Clin Med 2023; 12:jcm12093218. [PMID: 37176658 PMCID: PMC10179256 DOI: 10.3390/jcm12093218] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVE To define, in a real-world population of patients with high-frequency episodic (HFEM) or chronic migraine (CM), the predictive role of socio-demographic or phenotypic profiling of responders to fremanezumab. PATIENTS AND METHODS Two-hundred and four adult fremanezumab-treated patients with either HFEM or CM, who failed to at least three preventive treatments, provided data at baseline on several individual socio-demographic and phenotypic variables. These variables were analyzed for their ability to independently predict the response (50-74% response rates) or super-response (≥ 75% response rates) to fremanezumab. Patients were followed from 3-18 months of fremanezumab exposure. RESULTS The main finding to emerge from univariate analyses was that three baseline socio-demographic/clinical variables, i.e., age group 41-70 years (p = 0.02); female gender (p = 0.03); patients with HFEM (p = 0.001), and three clinical phenotypic variables, i.e., strict unilateral pain (p = 0.05); pain in the ophthalmic trigeminal branch (p = 0.04); and the "imploding" quality of pain (p = 0.05), were significantly related to fremanezumab response. However, in multivariate analysis, only HFEM (p = 0.02), the presence of strict unilateral (p = 0.03), and pain location in the ophthalmic trigeminal branch (p = 0.036) were independently associated with good fremanezumab response. Allodynia (p = 0.04) was the only clinical predictive variable of super-responsiveness to fremanezumab. CONCLUSIONS A precise phenotypic profiling with identification of pain characteristics consistent with peripheral and/or central sensitization might reliably predict the responsiveness to fremanezumab in migraine prophylaxis.
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Affiliation(s)
- Andreas A Argyriou
- Headache Outpatient Clinic, Neurology Department, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece
| | | | - Georgia Xiromerisiou
- Department of Neurology, School of Medicine, University of Thessaly, 41221 Larissa, Greece
| | - Dimitrios Rallis
- Department of Neurology, Tzaneio General Hospital of Piraeus, 18536 Athens, Greece
| | | | - Pantelis Litsardopoulos
- Headache Outpatient Clinic, Neurology Department, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece
| | - Michail Vikelis
- Headache Clinic, Mediterraneo Hospital, 16673 Glyfada, Greece
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Vikelis M, Argyriou AA, Antoniou A, Spingos KC, Skliros AE, Bilias K, Kouroudi A, Dermitzakis EV, Skliros EA. A Survey of Greek Primary Care Physicians on Their Likeability in Treating Migraines and Other Common Diseases. Medicina (Kaunas) 2023; 59:medicina59040734. [PMID: 37109692 PMCID: PMC10143091 DOI: 10.3390/medicina59040734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023]
Abstract
Background and objectives: Migraine is considered the most clinically important primary headache due to its high prevalence and significant burden. Although globally categorized as one of the leading causes of disability, it is still largely underdiagnosed and undertreated. Worldwide, migraine care is in most cases provided by primary care physicians. The aim of our study was to assess the attitudes of Greek primary care physicians toward treating migraine compared to other common neurological and general medical disorders. Methods: We surveyed 182 primary care physicians with the use of a 5-point questionnaire regarding their preference in treating ten common medical conditions, including migraine, hypertension, hyperlipidemia, upper respiratory tract infections, diabetes mellitus, lower back pain, dizziness, transient ischemic attack, diabetic peripheral neuropathy, and fibromyalgia. Results: Overall, with regards to preference to treat, migraine scored very low (3.6 ± 1.0), next to diabetic peripheral neuropathy (3.6 ± 1.0), and third from the bottom to fibromyalgia (3.25 ± 1.06). In contrast, physicians reported a much higher preference to treat hypertension (4.66 ± 0.60) and hyperlipidemia (4.6 ± 1.0). Conclusions: Our results indicate that Greek primary care physicians dislike treating migraines but also other neurological diseases. Topics for further investigation include the reasons for this dislike, any associations with poor patient satisfaction, treatment results, or both.
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Affiliation(s)
- Michail Vikelis
- Headache Clinic, Mediterraneo Hospital, 16673 Glyfada, Greece
| | - Andreas A Argyriou
- Neurology Department, Agios Andreas State General Hospital of Patras, 26332 Patras, Greece
| | - Anastasia Antoniou
- 2nd Department of Psychiatry, "Attikon" University General Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | | | - Athanasios E Skliros
- Hellenic Society for Primary Care Research and Continuing Education, 11528 Athens, Greece
| | | | | | | | - Efstathios A Skliros
- Hellenic Society for Primary Care Research and Continuing Education, 11528 Athens, Greece
- Nemea Health Center, 20500 Corinthia, Greece
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Argyriou AA, Dermitzakis EV, Xiromerisiou G, Rallis D, Soldatos P, Litsardopoulos P, Vikelis M. Efficacy and safety of fremanezumab for migraine prophylaxis in patients with at least three previous preventive failures: Prospective, multicenter, real-world data from a Greek registry. Eur J Neurol 2023; 30:1435-1442. [PMID: 36773011 DOI: 10.1111/ene.15740] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE To prospectively assess the efficacy and safety of fremanezumab for migraine prophylaxis in patients with failure of at least three previous preventive treatments. Changes in disability as quality-of-life outcomes after fremanezumab treatment were also examined. METHODS Two hundred and four patients with either high-frequency EM (HFEM) or chronic migraine (CM), who attained at least three consecutive monthly sessions with fremanezumab 225 mg and otherwise met the inclusion criteria, were included in the study. The crude response (at least 50% reduction in monthly headache days [MHD]) rates to fremanezumab were assessed. Scores in the following efficacy outcomes were then compared from baseline to the last efficacy evaluation follow-up: (i) MHD, (ii) monthly days with moderate/severe peak headache intensity, and (iii) monthly days with intake of abortive medication. The disability was evaluated with the Migraine Disability Assessment; the quality of life (QOL) status was assessed with the Headache Impact-6 Test, and the EQ-5D questionnaire. RESULTS In the majority of HFEM cases (n = 81/97; 83.5%) and CM patients (n = 67/107; 62.6%), fremanezumab proved effective in reducing the MHDs by at least 50% and was associated with clinically meaningful improvement in all other efficacy variables. The migraine-related disability experienced by our patients decreased and their QOL increased. We recorded just 36 cases reporting mild adverse events, including pain, rash or pruritus (n = 26), flu-like symptoms (n = 8), and hair loss (n = 2). CONCLUSION With our prospective results, we provide further real-world data to support the favorable benefit/risk profile of fremanezumab in the prophylaxis of both HFEM and CM.
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Affiliation(s)
- Andreas A Argyriou
- Headache Outpatient Clinic, Neurology Department, Agios Andreas State General Hospital of Patras, Patras, Greece
| | | | - Georgia Xiromerisiou
- Department of Neurology, School of Medicine, University of Thessaly, Larissa, Greece
| | - Dimitrios Rallis
- Department of Neurology, Tzaneio General Hospital of Piraeus, Athens, Greece
| | | | - Pantelis Litsardopoulos
- Headache Outpatient Clinic, Neurology Department, Agios Andreas State General Hospital of Patras, Patras, Greece
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Velasco R, Argyriou AA, Marco C, Mariotto S, Stradella A, Hernández J, Pernas S, Ferrari S, Bruna J. Serum neurofilament levels correlate with electrodiagnostic evidence of axonal loss in paclitaxel-induced peripheral neurotoxicity. J Neurol 2023; 270:531-537. [PMID: 36094631 DOI: 10.1007/s00415-022-11377-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Paclitaxel-induced peripheral neurotoxicity (PIPN) typically manifests as a predominantly sensory axonopathy. Nerve conduction studies (NCS) represent the gold standard method to quantify axonal impairment in PIPN. Serum neurofilament light chain (sNfL) levels are emerging biomarkers for quantifying axonal damage in peripheral neuropathies. To date, the association between NCS abnormalities and sNfL levels during paclitaxel-based chemotherapy has not been specifically addressed. METHODS We prospectively conducted longitudinal measurement of sNfL levels in 27 chemotherapy-naïve breast cancer patients and correlated conventional NCS recordings with sNfL in 22 of them, before (T0) and after (T1) 12 cycles of weekly paclitaxel-based therapy. RESULTS PIPN was diagnosed in 24/27 patients (88%) after completion of the 12-week paclitaxel-based chemotherapy regimen. Serum NfL levels (pg/mL) were significantly higher at T1 compared to T0 (T0: 18.50 ± 12.88 vs T1: 255.80 ± 194.16; p < 0.001). The increase of sNfL levels at T1 significantly correlated with the decrease or abolishment of amplitudes recorded from the sural nerve (r = 0.620; p = 0.0035), sensory radial (r = 0.613; p = 0.005), sensory ulnar (r = 0.630; p = 0.005), and peroneal motor (r = 0.568; p = 0.024) nerves. CONCLUSION sNfL levels proportionally increase during chemotherapy administration and significantly correlate with NCS axonal abnormalities in patients with PIPN. A multimodal testing approach employing both sNfL and NCS might improve the PIPN diagnostic accuracy.
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Affiliation(s)
- R Velasco
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge. Catalan Institute of Oncology-L'Hospitalet, Carrer de La Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. .,Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology, Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - A A Argyriou
- Neurology Department, Agios Andreas General Hospital of Patras, Patras, Greece
| | - C Marco
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge. Catalan Institute of Oncology-L'Hospitalet, Carrer de La Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - S Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - A Stradella
- Department of Medical Oncology, Breast Cancer Unit, ICO L'Hospitalet (IDIBELL), Barcelona, Spain
| | - J Hernández
- Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology, Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - S Pernas
- Department of Medical Oncology, Breast Cancer Unit, ICO L'Hospitalet (IDIBELL), Barcelona, Spain
| | - S Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - J Bruna
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge. Catalan Institute of Oncology-L'Hospitalet, Carrer de La Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.,Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology, Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Mantovani E, Zucchella C, Argyriou AA, Tamburin S. Treatment for cognitive and neuropsychiatric non-motor symptoms in Parkinson's disease: current evidence and future perspectives. Expert Rev Neurother 2023; 23:25-43. [PMID: 36701529 DOI: 10.1080/14737175.2023.2173576] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Non-motor symptoms (NMS) affect patients with Parkinson's disease (PD) from the prodromal to the advanced stages. NMS phenotypes greatly vary and have a huge impact on patients' and caregivers' quality of life (QoL). The management of cognitive and neuropsychiatric NMS remains an unmet need. AREAS COVERED The authors, herein, review the dopaminergic and non-dopaminergic pathogenesis, clinical features, assessment, and pharmacological and non-pharmacological treatments of cognitive and neuropsychiatric NMS in PD. They discuss the current evidence and report the findings of an overview of ongoing trials on pharmacological and selected non-pharmacological strategies. EXPERT OPINION The treatment of cognitive and neuropsychiatric NMS in PD is poorly explored, and therapeutic options are unsatisfactory. Pharmacological treatment of cognitive NMS is based on symptomatic active principles used in Alzheimer's disease. Dopamine agonists, selective serotonin, and serotonin-norepinephrine reuptake inhibitors have some evidence on PD-related depression. Clozapine, quetiapine, and pimavanserin may be considered for psychosis in PD. Evidence on the treatment of other neuropsychiatric NMS is limited or lacking. Addressing pathophysiological and clinical issues, which hamper solid evidence on the treatment of cognitive and neuropsychiatric NMS, may reduce the impact on QoL for PD patients and their caregivers.
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Affiliation(s)
- Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Chiara Zucchella
- Section of Neurology, Department of Neurosciences, Verona University Hospital, Verona, Italy
| | - Andreas A Argyriou
- Department of Neurology, "Agios Andreas" State General Hospital of Patras, Patras, Greece
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Alberti P, Salvalaggio A, Argyriou AA, Bruna J, Visentin A, Cavaletti G, Briani C. Neurological Complications of Conventional and Novel Anticancer Treatments. Cancers (Basel) 2022; 14:cancers14246088. [PMID: 36551575 PMCID: PMC9776739 DOI: 10.3390/cancers14246088] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Various neurological complications, affecting both the central and peripheral nervous system, can frequently be experienced by cancer survivors after exposure to conventional chemotherapy, but also to modern immunotherapy. In this review, we provide an overview of the most well-known adverse events related to chemotherapy, with a focus on chemotherapy induced peripheral neurotoxicity, but we also address some emerging novel clinical entities related to cancer treatment, including chemotherapy-related cognitive impairment and immune-mediated adverse events. Unfortunately, efficacious curative or preventive treatment for all these neurological complications is still lacking. We provide a description of the possible mechanisms involved to drive future drug discovery in this field, both for symptomatic treatment and neuroprotection.
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Affiliation(s)
- Paola Alberti
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- NeuroMI (Milan Center for Neuroscience), 20126 Milan, Italy
| | | | - Andreas A. Argyriou
- Neurology Department, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece
| | - Jordi Bruna
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO Hospitalet, Bellvitge Institute for Biomedical Research (IDIBELL), 08908 Barcelona, Spain
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35131 Padova, Italy
| | - Guido Cavaletti
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neurosciences, University of Padova, 35131 Padova, Italy
- Correspondence:
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Argyriou AA, Dermitzakis EV, Xiromerisiou G, Vikelis M. OnabotulinumtoxinA Add-On to Monoclonal Anti-CGRP Antibodies in Treatment-Refractory Chronic Migraine. Toxins (Basel) 2022; 14:toxins14120847. [PMID: 36548744 PMCID: PMC9785576 DOI: 10.3390/toxins14120847] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/23/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
We sought to assess the effectiveness of combining dual therapy with onabotulinumtoxinA (BTX) add-on to anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (anti-CGRP MAbs) in treatment-refractory patients with chronic migraine (CM). We retrospectively reviewed the medical files of 19 treatment-refractory patients with CM who had failed to two oral migraine preventatives, at least three consecutive BTX cycles (less than 30% response rate), at least three consecutive sessions with either fremanezumab or erenumab (less than 30% response rate), and were eventually switched to dual therapy with BTX add-on to any of the already-given anti-CGRP MAbs. We then assessed from baseline to each monotherapy or dual intervention predefined efficacy follow-up the changes in the following efficacy outcomes: (i) monthly headache days (MHD), (ii) monthly days with moderate/severe peak headache intensity, and (iii) monthly days with intake of any acute headache medication. Response (50% reduction in MHD) rates, safety, and tolerability were also determined. In the majority of cases (n = 14), dual targeting proved effective and was associated with clinically meaningful improvement in all efficacy variables; 50% response rates (also disability and QOL outcomes) coupled with favorable safety/tolerability. Our results advocate in favor of the view that dual therapy is effective and should be considered in difficult-to-treat CM patients who have failed all available monotherapies.
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Affiliation(s)
- Andreas A. Argyriou
- Headache Outpatient Clinic, Neurology Department, Agios Andreas State General Hospital of Patras, 26352 Patras, Greece
- Correspondence:
| | | | - Georgia Xiromerisiou
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, 41110 Larissa, Greece
| | - Michail Vikelis
- Headache Clinic, Mediterraneo Hospital, 16675 Glyfada, Greece
- Glyfada Headache Clinic, 16675 Glyfada, Greece
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17
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Dermitzakis EV, Kouroudi A, Argyriou AA, Spingos KC, Bilias K, Vikelis M. Results of a Web-based survey of 2105 Greek migraine patients in 2020: demographics, clinical characteristics, burden and the effects of the COVID-19 pandemic on the course of migraine. BMC Neurol 2022; 22:440. [PMCID: PMC9676849 DOI: 10.1186/s12883-022-02968-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022] Open
Abstract
AbstractThe Greek Society of Migraine and Headache Patients (GSMHP), maintaining a strong commitment to research and information, conducted its second web-based online survey named "Migraine in Greece—2020", following its first one conducted in 2018. The 2020 study included 2,105 migraine patients who were called to answer 151 questions. The purposes of the current research were to record the demographic and clinical characteristics of migraine patients in Greece, including the severity and effects of migraine on respondents' quality of life, as well as to survey the effects of the coronavirus pandemic on the course of migraine. Our population, internet-based study provides data that will hopefully contribute to better comprehend the clinical phenotype and course of migraine during the COVID-19 pandemic.
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Mantovani E, Demrozi F, Hertz DL, Turetta C, Ferro O, Argyriou AA, Pravadelli G, Tamburin S. Wearables, sensors, and smart devices for the detection and monitoring of chemotherapy-induced peripheral neurotoxicity: systematic review and directions for future research. J Peripher Nerv Syst 2022; 27:238-258. [PMID: 36224713 DOI: 10.1111/jns.12518] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/18/2022] [Accepted: 10/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Chemotherapy-induced peripheral neurotoxicity (CIPN) diagnosis is largely based on patient reported outcomes. Wearables, sensors, and smart devices may potentially provide early detection and monitoring of CIPN. We systematically reviewed data on wearables, sensors, and smart devices to detect and/or monitor signs and symptoms of CIPN. Moreover, we provide directions and recommendations for future studies. METHODS A literature search using PubMed/MEDLINE, Web of Science, IEEE Xplore and CINHAL databases was conducted from database inception until March 2021. The search was further updated in July 2022 to ensure currency of results. RESULTS 1885 records were title-abstract screened, 33 full texts were assessed, and 16 were included. The retrieved papers were heterogeneous in terms of study design, sample size, CIPN severity, chemotherapy agents, type of wearable/sensor/device applied, parameters of interest and purpose. INTERPRETATION Data are promising and provide preliminary evidence on wearables, sensors, and smart devices for CIPN detection and monitoring. There are several issues and knowledge gaps that should be addressed. We propose a framework for future studies. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | | | - Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | | | - Omar Ferro
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Andreas A Argyriou
- Department of Neurology, "Agios Andreas" State General Hospital of Patras, Patras, Greece
| | | | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
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Velasco R, Marco C, Mariotto S, Stradella A, Hernández J, Argyriou AA, Ferrari S, Bruna J. P14.02.A Serum neurofilaments correlate with axonal loss in paclitaxel-induced peripheral neurotoxicity. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Paclitaxel-induced peripheral neuropathy (PIPN) is a dose-limiting axonal polyneuropathy. Nerve conduction studies (NCS) are unique for the assessment of axonal impairment in PIPN. Neurofilaments (NFs), constituent of the neuronal cytoskeleton, are emerging as axonal damage biomarker. To date, the association between changes in NCS and NfL quantification across paclitaxel treatment in breast cancer patients has not been specifically addressed.
MATERIAL AND METHODS: Prospective longitudinal measurement of sNfL levels and NCS in 27 chemotherapy-naïve breast cancer patients before (V0) and after completion (V1) of 12 cycles of weekly paclitaxel-based therapy.
Results
Serum NfL levels (in pg/mL) increased over the course of treatment in the whole of patients (T0: 18,509 +/- 12,886 vs T1:255,805 +/- 194,165, p<0.001). The increase in sNfL levels at T1 showed a significant moderate correlation with the percentage of decrease in the amplitude of the sural (ρ = 0.6205 (p=0.0035), radial (r=0.6134, p=0.005)), ulnar (ρ = 0.6298 (p=0.005)) and peroneal motor (ρ = 0.5676, p=0.024)) nerve in NCS across treatment.
Conclusion
sNfL levels increase proportionally to the degree of paclitaxel-induced neuroaxonal damage, revealing being a promising blood biomarker able to detect the severity of large nerve fiber degeneration and, therefore, improving the diagnostic accuracy in PIPN.
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Affiliation(s)
- R Velasco
- Neuro-Oncology Unit, Institut Català d′Oncologia-IDIBELL, L′Hospitalet , Barcelona , Spain
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Barcelona, Spain , Barcelona , Spain
| | - C Marco
- Neuro-Oncology Unit, Institut Català d′Oncologia-IDIBELL, L′Hospitalet , Barcelona , Spain
| | - S Mariotto
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona , Italy
| | - A Stradella
- Breast Cancer Unit, Institut Català d′Oncologia-IDIBELL, L′Hospitalet , Barcelona , Spain
| | - J Hernández
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Barcelona, Spain , Barcelona , Spain
| | - A A Argyriou
- Department of Neurology, "Saint Andrew's" State General Hospital of Patras, Patras, Greece. , Patras , Greece
| | - S Ferrari
- Department of Neuroscience, Biomedicine and Movement Sciences , Verona , Italy
| | - J Bruna
- Neuro-Oncology Unit, Institut Català d′Oncologia-IDIBELL, L′Hospitalet , Barcelona , Spain
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Barcelona, Spain , Barcelona , Spain
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Argyriou AA, Mantovani E, Mitsikostas DD, Vikelis M, Tamburin S. A systematic review with expert opinion on the role of gepants for the preventive and abortive treatment of migraine. Expert Rev Neurother 2022; 22:469-488. [PMID: 35707907 DOI: 10.1080/14737175.2022.2091435] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Gepants are small molecules targeting the calcitonin gene-related peptide (CGRP) that have been recently introduced and are under additional clinical development as preventive and abortive treatment options for migraine. AREAS COVERED After providing a narrative overview of current preventive and acute treatment options for migraine and summarizing the pathophysiology of migraine attack and the role of CGRP, we performed a systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, on trials on gepants in preventive and acute treatment of migraine. Studies and results were reviewed and discussed, and expert opinion was presented. We also collected data on relevant ongoing trials. EXPERT OPINION Whether direct targeting CGRP pathways within the central nervous system or indirectly modulating them from the peripheral nervous system is more effective and safer in migraine remains still unclear. The available data on the efficacy and safety of gepants suggest they may represent an abortive, and to some extent, preventive treatment option for migraine, in patients who do not respond or have adverse effects to first/second line treatments or at high risk for medication overuse headache; thus opening new therapeutic horizons.
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Affiliation(s)
- Andreas A Argyriou
- Headache Outpatient Clinic, Department of Neurology, 'Agios Andreas' State General Hospital of Patras, Patras, Greece
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Dimos-Dimitrios Mitsikostas
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Argyriou AA, Dermitzakis EV, Vlachos GS, Vikelis M. Long-term adherence, safety, and efficacy of repeated onabotulinumtoxinA over five years in chronic migraine prophylaxis. Acta Neurol Scand 2022; 145:676-683. [PMID: 35170031 DOI: 10.1111/ane.13600] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND OnabotulinumtoxinA (BoNTA) demonstrated a positive benefit-risk in chronic migraine (CM) patients in PREEMPT I and II phase III trials and many subsequent real-world studies. We herein aimed at evaluating the adherence to repeated BoNTA over a period of five years, while secondary objectives included the assessment of its long-term safety/efficacy and patients' satisfaction to treatment. METHODS We studied 56 CM patients who had successfully received consequent cycles of BoNTA over five years. Adherence was calculated as the percentage of patients actively choosing to follow with repeated BoNTA treatment, as instructed. Safety and efficacy data were collected throughout the study period. The overall patients' belief in and satisfaction by the efficacy of treatment was assessed at last follow-up, using the self-report 7-point measure patient global impression of change (PGIC). RESULTS A total of 36 (64.3%) out of 56 patients remained adherent to BoNTA over five years. Long-term BoNTA exposure was safe and well-tolerated, without severe side-effects justifying treatment discontinuation. The mean monthly headache days and associated clinical efficacy outcomes remained consistent and quite low at last follow-up with evidence of continuous improvements in headache monthly frequency between year three and over five years of therapy. All patients who were able to maintain treatment over five years (n = 36), remained very satisfied and scored at least 5 in PGIC. CONCLUSION Considerably high adherence, considerable satisfaction and sustained safety/efficacy were observed in patients followed up for five years, supporting a favorable benefit/risk profile for consistently delivering long-term BoNTA in CM.
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Affiliation(s)
- Andreas A. Argyriou
- Neurology Department Headache Outpatient Clinic Saint Andrew’s State General Hospital of Patras Patras Greece
| | | | | | - Michail Vikelis
- Headache Clinic Mediterraneo Hospital Glyfada Greece
- Glyfada Headache Clinic Glyfada Greece
- 1st Department of Neurology Headache Outpatient Clinic National and Kapodistrian University of Athens Athens Greece
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22
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Dermitzakis EV, Vikelis M, Vlachos GS, Argyriou AA. Assessing the Significance of the Circadian Time of Administration on the Effectiveness and Tolerability of OnabotulinumtoxinA for Chronic Migraine Prophylaxis. Toxins (Basel) 2022; 14:toxins14050296. [PMID: 35622543 PMCID: PMC9145697 DOI: 10.3390/toxins14050296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022] Open
Abstract
We aimed to provide insights on the role of the circadian time of administration in influencing the efficacy and tolerability/safety profile of OnabotulinumtoxinA (BoNTA) for chronic migraine (CM) prophylaxis. Methods: We retrospectively reviewed the medical files of BoNTA-naïve patients with CM who completed three consecutive cycles of treatment, according to the standard PREEMPT paradigm. Participants were classified to those scheduled to be treated in the morning hours from 8:00 to 12:00 (AM) or afternoon hours from 13:00 to 18:00 (PM). We then assessed and compared between groups the changes from baseline (T0—trimester before BoNTA’s first administration) to the period after its third administration (T3) in the following efficacy outcomes: (i) mean number of headache days/month, (ii) mean number of days/month with peak headache intensity of >4/10, (iii) mean number of days/month with consumption of any abortive treatment. Safety−tolerability was also compared between groups. Results: A total of 50 AM and 50 PM-treated patients were evaluated. The within-group analysis in both groups showed a significant decrease in all efficacy variables between T0 and T3. However, the between-group comparisons of all BoNTA-related efficacy outcomes at T3 vs. T0 documented comparable improvements between AM vs. PM-treated patients. Safety/tolerability was also similar between groups. Conclusions: We were not able to identify significant differences between patients treated in the AM vs. PM, so as to demonstrate that the circadian time of administration should be considered before initiating BoNTA in CM patients.
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Affiliation(s)
| | - Michail Vikelis
- Headache Clinic, Mediterraneo Hospital, 16675 Glyfada, Greece; (M.V.); (G.S.V.)
- Glyfada Headache Clinic, 16675 Glyfada, Greece
| | - George S. Vlachos
- Headache Clinic, Mediterraneo Hospital, 16675 Glyfada, Greece; (M.V.); (G.S.V.)
| | - Andreas A. Argyriou
- Neurology Department of the “Agios Andreas” State General Hospital of Patras, Headache Outpatient Clinic, 26335 Patras, Greece
- Correspondence:
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Karteri S, Bruna J, Argyriou AA, Mariotto S, Velasco R, Alemany M, Kalofonou F, Alberti P, Dinoto A, Velissaris D, Stradella A, Cavaletti G, Ferrari S, Kalofonos HP. Prospectively Assessing Serum Neurofilament Light Chain Levels As A Biomarker Of Paclitaxel-Induced Peripheral Neurotoxicity In Breast Cancer Patients. J Peripher Nerv Syst 2022; 27:166-174. [PMID: 35384143 DOI: 10.1111/jns.12493] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/24/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022]
Abstract
Our aim was to assess the significance of measuring serum neurofilament light chain (sNfL) levels as biomarker of paclitaxel-induced peripheral neurotoxicity (PIPN). We longitudinally measured sNfL in breast cancer patients, scheduled to receive the 12-weekly paclitaxel-based regimen. Patients were clinically examined by means of the Total Neuropathy Score-clinical version (TNSc), while sNfL were quantified, using the highly-sensitive Simoa technique, before starting chemotherapy (Baseline), after 2 (week-2) and 3 (week-3) weekly courses, and at the end of chemotherapy (week-12). Among 59 included patients (mean age: 53.1±11.5 years), 33 (56%) developed grade 0-1 and 26 (44%) grade 2-3 PIPN at week-12. A significant longitudinal increase of sNfL levels from baseline to week-12 was determined, whereas patients wth TNSc grade 2-3 PIPN had significantly increased sNfL levels at week-12, compared to those with grade 0-1. ROC analysis defined a value of NfL of >85 pg/mL at week-3 as the best discriminative determination to predict the development of grade 2-3 PIPN at week-12 (sensitivity 46.2%, specificity 84.8%). The logistic binary regression analysis revealed that age >50 years and the cutoff of >85 pg/mL of sNfL levels at week-3 independently predicted the development of grade 2-3 PIPN at week-12 with a sensitivity of 46%, a specificity of 91%, and a positive and negative predictive values of 75% and 67%, respectively. sNfL levels seem to be a valuable biomarker of neuro-axonal injury in PIPN. Early increase of this biomarker after a 3 weekly chemotherapy course can be a predictive marker of final PIPN severity. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Sofia Karteri
- Department of Medicine-Division of Oncology, University Hospital of Patras, Greece
| | - Jordi Bruna
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet (IDIBELL), Barcelona, Spain
| | - Andreas A Argyriou
- Neurology Department, Saint Andrew's General Hospital of Patras, Patras, Greece
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Roser Velasco
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet (IDIBELL), Barcelona, Spain
| | - Montse Alemany
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet (IDIBELL), Barcelona, Spain
| | - Foteini Kalofonou
- Department of Oncology, Imperial NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | - Paola Alberti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy and NEUROMI (Milan Center for Neuroscience), Milan, Italy
| | - Alessandro Dinoto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Agostina Stradella
- Department of Medical Oncology - Breast Cancer Unit, ICO L'Hospitalet (IDIBELL), Barcelona, Spain
| | - Guido Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy and NEUROMI (Milan Center for Neuroscience), Milan, Italy
| | - Sergio Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Tamburin S, Park SB, Schenone A, Mantovani E, Hamedani M, Alberti P, Yildiz-Kabak V, Kleckner IR, Kolb N, Mazzucchelli M, McNeish BL, Argyriou AA, Cavaletti G, Hoke A. Rehabilitation, exercise, and related non-pharmacological interventions for chemotherapy-induced peripheral neurotoxicity: Systematic review and evidence-based recommendations. Crit Rev Oncol Hematol 2022; 171:103575. [PMID: 34968623 PMCID: PMC10658987 DOI: 10.1016/j.critrevonc.2021.103575] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 12/22/2022] Open
Abstract
Pharmacological strategies for chemotherapy-induced peripheral neurotoxicity (CIPN) are very limited. We systematically reviewed data on rehabilitation, exercise, physical therapy, and other physical non-pharmacological interventions and offered evidence-based recommendations for the prevention and treatment of CIPN. A literature search using PubMed, Web of Science and CINAHL was conducted from database inception until May 31st, 2021. 2791 records were title-abstract screened, 71 papers were full-text screened, 41 studies were included, 21 on prevention and 20 on treatment of CIPN. Treatment type, cancer type, chemotherapy compounds were heterogeneous, sample size was small (median: N = 34) and intention-to-treat analysis was lacking in 26/41 reports. Because of the methodological issues of included studies, the reviewed evidence should be considered as preliminary. Exercise, endurance, strength, balance, and sensorimotor training have been studied in low-to-moderate quality studies, while the evidence for other treatments is preliminary/inconclusive. We offer recommendation for the design of future trials on CIPN.
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Affiliation(s)
- Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.
| | - Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Angelo Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Italy; IRCCS San Martino Hospital, Genoa, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Mehrnaz Hamedani
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Italy
| | - Paola Alberti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Vesile Yildiz-Kabak
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ian R Kleckner
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Noah Kolb
- Department of Neurological Sciences, University of Vermont, Burlington, VT, USA
| | | | - Brendan L McNeish
- Department of Neurological Sciences, University of Vermont, Burlington, VT, USA
| | - Andreas A Argyriou
- Department of Neurology, "Saint Andrew's" State General Hospital of Patras, Patras, Greece
| | - Guido Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ahmet Hoke
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Park SB, Tamburin S, Schenone A, Kleckner IR, Velasco R, Alberti P, Kanzawa-Lee G, Lustberg M, Dorsey SG, Mantovani E, Hamedani M, Argyriou AA, Cavaletti G, Hoke A. Optimal outcome measures for assessing exercise and rehabilitation approaches in chemotherapy-induced peripheral-neurotoxicity: Systematic review and consensus expert opinion. Expert Rev Neurother 2022; 22:65-76. [PMID: 34894974 PMCID: PMC8963967 DOI: 10.1080/14737175.2022.2018300] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Chemotherapy-induced peripheral neurotoxicity (CIPN) remains a significant toxicity in cancer survivors without preventative strategies or rehabilitation. Exercise and physical activity-based interventions have demonstrated promise in reducing existing CIPN symptoms and potentially preventing toxicity, however there is a significant gap in evidence due to the lack of quality clinical trials and appropriate outcome measures. AREAS COVERED We systematically reviewed outcome measures in CIPN exercise and physical rehabilitation studies with expert panel consensus via the Peripheral Nerve Society Toxic Neuropathy Consortium to provide recommendations for future trials. Across 26 studies, 75 outcome measures were identified and grouped into 16 domains within three core areas - measures of manifestations of CIPN (e.g. symptoms/signs), measures of the impact of CIPN and other outcome measures. EXPERT OPINION This article provides a conceptual framework for CIPN outcome measures and highlights the need for definition of a core outcome measures set. The authors provide recommendations for CIPN exercise and physical rehabilitation trial design and outcome measure selection. The development of a core outcome measure set will be critical in the search for neuroprotective and treatment approaches to support cancer survivors and to address the gap in the identification of effective rehabilitation and treatment options for CIPN.
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Affiliation(s)
- Susanna B. Park
- Faculty of Medicine and Health, School of Medical Sciences, Brain and Mind Centre, The University of Sydney, Sydney, Australia,Corresponding author: Susanna Park, Address: Brain and Mind Centre, The University of Sydney, Camperdown NSW 2050, Australia, Telephone: +61 2 9351 0932,
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Angelo Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa Italy,IRCCS San Martino, Genoa, Italy
| | - Ian R. Kleckner
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Roser Velasco
- Neurology Department, Neuro-Oncology Unit-IDIBELL, Hospital Universitari de Bellvitge-Institut Català d’Oncologia L’Hospitalet, 08907 Barcelona, Spain,Department of Cell Biology, Institute of Neurosciences, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 08193 Bellaterra, Spain
| | - Paola Alberti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Grace Kanzawa-Lee
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Maryam Lustberg
- Yale Breast Center and Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Susan G. Dorsey
- Department of Pain & Translational Symptom Science, University of Maryland, Baltimore, Baltimore Maryland USA
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mehrnaz Hamedani
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa Italy
| | - Andreas A. Argyriou
- Department of Neurology, “Saint Andrew’s” State General Hospital of Patras, Patras, Greece
| | - Guido Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ahmet Hoke
- Johns Hopkins School of Medicine, Department of Neurology, Baltimore, Maryland, USA
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Argyriou AA, Karteri S, Bruna J, Mariotto S, Simo M, Velissaris D, Kalofonou F, Cavaletti G, Ferrari S, Kalofonos HP. Serum neurofilament light chain levels as biomarker of paclitaxel-induced cognitive impairment in patients with breast cancer: a prospective study. Support Care Cancer 2021; 30:1807-1814. [PMID: 34599664 DOI: 10.1007/s00520-021-06509-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/15/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To prospectively assess the utility of serum neurofilament light chain (sNfL) levels in identifying the risk to develop chemotherapy-induced cognitive impairment (CICI) in cancer patients. We also examined if sNfL can be identified as an early biomarker of CICI development. METHODS We longitudinally measured sNfL levels in 20 female patients with breast cancer, scheduled to receive the 12 weekly paclitaxel-based regimen. An equal number of age-matched female heathy subjects was incuded as control group. CICI was graded by means of the Montreal Cognitive Assessment scale (MOCA); peripheral neurotoxicity (PN) was graded using the neurosensory Common Criteria for Adverse Events (CTCAE)v5.0, while sNfL levels were quantified using a high-sensitive technique (Quanterix, Simoa) before the administration of chemotherapy (T0), after 3 courses (T1), and at the end of chemotherapy (T2). RESULTS Pre-treatment sNfL levels were comparable in patients and controls (p = 0.103). At T2, 5/20 patients (mean age 61.4 ± 5.0 years) developed CICI. These 5 patients also had clinically-significant PN. Patients with and without CICI had comparable sNfL values at T2 (p = 0.1). In addition, at T2, sNfL levels did not correlate significantly with MOCA score in CICI patients (p = 0.604). The difference of sNfL levels between T1 and T0 failed to predict independently the occurrence of CICI at T2. CONCLUSION Our findings do not support the utility of measuring sNfL levels as a biomarker of CICI. Grade 2-3 PN most strongly confounded our outcomes. Considering the small sample size, which might have prevented the results from being extrapolated, further testing in larger studies is warranted.
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Affiliation(s)
- Andreas A Argyriou
- Neurology Department, Saint Andrew's General Hospital of Patras, Patras, Greece
| | - Sofia Karteri
- Oncology Unit, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Jordi Bruna
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet (IDIBELL), Barcelona, Spain
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marta Simo
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet (IDIBELL), Barcelona, Spain
| | | | - Foteini Kalofonou
- Department of Oncology, Imperial NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | - Guido Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Sergio Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Haralabos P Kalofonos
- Neurology Department, Saint Andrew's General Hospital of Patras, Patras, Greece.
- Department of Medicine, Division of Oncology, University Hospital, University of Patras Medical School, 26504, Rion-Patras, Greece.
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Argyriou AA, Mitsikostas DD, Mantovani E, Vikelis M, Tamburin S. Beyond chronic migraine: a systematic review and expert opinion on the off-label use of botulinum neurotoxin type-A in other primary headache disorders. Expert Rev Neurother 2021; 21:923-944. [PMID: 34289791 DOI: 10.1080/14737175.2021.1958677] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Botulinum neurotoxin type-A (BoNTA) is licensed for the treatment of chronic migraine (CM), but it has been tested off-label as a therapeutic choice in other primary headaches (PHs). We aimed to provide a systematic review and expert opinion on BoNTA use in PHs, beyond CM.Areas covered: After providing an overview on PHs and mechanism of BoNTA action, we report the results of a systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, of BoNTA therapeutic trials in PHs beyond CM. Studies and results were reviewed and discussed, and levels of evidence were graded. We also collected data on relevant ongoing trials.Expert opinion: Although there are contradictory findings on PHs other than CM, BoNTA may represent a therapeutic option for patients who do not respond to conventional prophylactic treatments. Based on limited available evidence, BoNTA may be considered in refractory tension-type headache, trigeminal autonomic cephalalgias, primary stabbing headache, nummular headache, hypnic headache, and new daily persistent headache, after the primary nature of cephalalgia has been documented and other drugs have failed. Experienced physicians in BoNTA treatment are required to guide the therapeutic protocol for each patient to optimize good and safe outcomes.
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Affiliation(s)
- Andreas A Argyriou
- Headache Outpatient Clinic, Department of Neurology, Saint Andrew's State General Hospital of Patras, Greece
| | - Dimos-Dimitrios Mitsikostas
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Alberti P, Bernasconi DP, Cornblath DR, Merkies ISJ, Park SB, Velasco R, Bruna J, Psimaras D, Koeppen S, Pace A, Dorsey SG, Argyriou AA, Kalofonos HP, Briani C, Schenone A, Faber CG, Mazzeo A, Grisold W, Valsecchi M, Cavaletti G. Prospective Evaluation of Health Care Provider and Patient Assessments in Chemotherapy-Induced Peripheral Neurotoxicity. Neurology 2021; 97:e660-e672. [PMID: 34078718 PMCID: PMC10365895 DOI: 10.1212/wnl.0000000000012300] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/07/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE There is no agreement on the gold standard for detection and grading of chemotherapy-induced peripheral neurotoxicity (CIPN) in clinical trials. The objective is to perform an observational prospective study to assess and compare patient-based and physician-based methods for detection and grading of CIPN. METHODS Consecutive patients, aged 18 years or older, candidates for neurotoxic chemotherapy, were enrolled in the United States, European Union, or Australia. A trained investigator performed physician-based scales (Total Neuropathy Score-clinical [TNSc], used to calculate Total Neuropathy Score-nurse [TNSn]) and supervised the patient-completed questionnaire (Functional Assessment of Cancer Treatment/Gynecologic Oncology Group-Neurotoxicity [FACT/GOG-NTX]). Evaluations were performed before and at the end of chemotherapy. On participants without neuropathy at baseline, we assessed the association between TNSc, TNSn, and FACT/GOG-NTX. Considering a previously established minimal clinically important difference (MCID) for FACT/GOG-NTX, we identified participants with and without a clinically important deterioration according to this scale. Then, we calculated the MCID for TNSc and TNSn as the difference in the mean change score of these scales between the 2 groups. RESULTS Data from 254 participants were available: 180 (71%) had normal neurologic status at baseline. At the end of the study, 88% of participants developed any grade of neuropathy. TNSc, TNSn, and FACT/GOG-NTX showed good responsiveness (standardized mean change from baseline to end of chemotherapy >1 for all scales). On the 153 participants without neuropathy at baseline and treated with a known neurotoxic chemotherapy regimen, we verified a moderate correlation in both TNSc and TNSn scores with FACT/GOG-NTX (Spearman correlation index r = 0.6). On the same sample, considering as clinically important a change in the FACT/GOG-NTX score of at least 3.3 points, the MCID was 3.7 for TNSc and 2.8 for the TNSn. CONCLUSIONS MCID for TNSc and TNSn were calculated and the TNSn can be considered a reliable alternative objective clinical assessment if a more extended neurologic examination is not possible. The FACT/GOG-NTX score can be reduced to 7 items and these items correlate well with the TNSc and TNSn. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that a patient-completed questionnaire and nurse-assessed scale correlate with a physician-assessed scale.
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Affiliation(s)
- Paola Alberti
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria
| | - Davide P Bernasconi
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria
| | - David R Cornblath
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria
| | - Ingemar S J Merkies
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria
| | - Susanna B Park
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria
| | - Roser Velasco
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria
| | - Jordi Bruna
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria
| | - Dimitri Psimaras
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria
| | - Susanne Koeppen
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria
| | - Andrea Pace
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria
| | - Susan G Dorsey
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria
| | - Andreas A Argyriou
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria
| | - Haralabos P Kalofonos
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria
| | - Chiara Briani
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria
| | - Angelo Schenone
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria
| | - Catharina G Faber
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria
| | - Anna Mazzeo
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria
| | - Wolfgang Grisold
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria
| | - MariaGrazia Valsecchi
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria
| | - Guido Cavaletti
- From Experimental Neurology Unit (P.A., G.C.) and Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4 (D.P.B., M.G.V.), School of Medicine and Surgery, University of Milano-Bicocca, Monza; NeuroMI (Milan Center for Neuroscience) (P.A., G.C.), Milan, Italy; Johns Hopkins University School of Medicine (D.R.C.), Baltimore, MD; Department of Neurology (I.S.J.M., C.G.F.), Maastricht University Medical Centre, the Netherlands; Department of Neurology (I.S.J.M.), St Elisabeth Hospital, Willemstad, Curaçao; University of New South Wales (S.B.P.), Sydney, Australia; Unit of Neuro-Oncology, Neurology Department (R.V., J.B.), Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, L'Hospitalet de Llobregat, Barcelona; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology (R.V., J.B.), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain; Service de Neurologie Mazarin (D.P.), Hôpital de la Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France; Department of Neurology and West German Cancer Center (S.K.), University of Essen, Germany; IRCCS Regina Elena Cancer Institute (A.P.), Neuro-Oncology Unit, Rome, Italy; Department of Pain & Translational Symptom Science (S.G.D.), University of Maryland Baltimore; Neurological Department (A.A.A.), Saint Andrew's General Hospital of Patras; Department of Medicine, Division of Oncology (A.A.A., H.P.K.), Medical School, University of Patras, Greece; Department of Neurosciences (C.B.), University of Padova; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI) (A.S.), University of Genova; Unit of Neurology and Neuromuscular Diseases (A.M.), Department of Clinical and Experimental Medicine, University of Messina, Italy; and Ludwig Boltzmann Institute for Experimental und Clinical Traumatology (W.G.), Vienna, Austria.
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Argyriou AA, Mitsikostas DD, Mantovani E, Litsardopoulos P, Panagiotopoulos V, Tamburin S. An updated brief overview on post-traumatic headache and a systematic review of the non-pharmacological interventions for its management. Expert Rev Neurother 2021; 21:475-490. [PMID: 33682560 DOI: 10.1080/14737175.2021.1900734] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Post-traumatic headache (PTH), a common type of headache secondary to traumatic brain injury (TBI) or whiplash, carries a relevant burden on patients. PTH is still an undertreated condition because of limited pharmacological treatment options. Therefore, multimodal non-pharmacologic approaches, which account for comorbidities and biopsychosocial factors, are often used in PTH patients. AREAS COVERED After providing a brief overview of PTH, a systematic review was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations on recently published (2015-2020) papers on non-pharmacological interventions for PTH. We also collected data on ongoing trials on this topic. Studies and results are reviewed and discussed. EXPERT OPINION PTH is one of the most common complications of TBI and accounts for almost 4% of symptomatic headache disorders. The most common clinical presentations of PTH are migraine-like or tension type (TTH)-like headache, neck pain, cognitive complaints, and psychological/psychiatric symptoms. Growing evidence suggests that combined pharmacological and non-pharmacological interventions, encompassing noninvasive neuromodulation, physical therapy, cognitive-behavioral treatment, and education, may be the best approaches for PTH and related comorbidities. Acute/preemptive pharmacological treatments for PTH include drugs used for migraine and TTH. When PTH management is multidisciplinary, the patient benefits most.
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Affiliation(s)
- Andreas A Argyriou
- Headache Outpatient Clinic, Department of Neurology, Saint Andrew's State General Hospital of Patras, Greece
| | - Dimos-Dimitrios Mitsikostas
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Pantelis Litsardopoulos
- Headache Outpatient Clinic, Department of Neurology, Saint Andrew's State General Hospital of Patras, Greece
| | | | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Alemany M, Domènech M, Argyriou AA, Vilariño N, Majós C, Naval-Baudin P, Lucas A, Palmero R, Simó M, Nadal E, Bruna J. Perilesional edema in brain metastases as predictive factor of response to systemic therapy in non-small cell lung cancer patients: a preliminary study. Ann Transl Med 2021; 9:648. [PMID: 33987346 PMCID: PMC8106019 DOI: 10.21037/atm-20-6497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The significance of upfront systemic therapies as an alternative to whole brain radiotherapy (WBRT) for multiple brain metastases (BM) is debatable. Our purpose is to investigate if peritumoral edema could predict the intracranial response to systemic chemotherapy (chemo) in patients with advanced non-squamous non-small cell lung cancer (non-SQ-NSCLC) and synchronous multiple BM. METHODS In this observational cohort study, we evaluated the outcome of 28 patients with multiple BM (≥3) treated with chemo based on cisplatin/carboplatin plus pemetrexed (chemo, group A, n=17) or WBRT plus subsequent chemo (group B, n=11). The intracranial response, assessed by the response assessment neuro-oncology (RANO) BM criteria, was correlated with the degree of BM-associated edema estimated by the maximum diameter ratio among fluid attenuated inversion recovery (FLAIR) and gadolinium-enhanced T1WI (T1Gd) per each BM at the baseline brain magnetic resonance imaging (MRI). RESULTS No differences were observed in baseline characteristics between both groups, except for the number of patients under steroid treatment that was clearly superior in group B (P=0.007). Median OS was similar between groups. Regarding FLAIR/T1Gd ratio (F/Gd), patients treated with chemo alone exhibited significantly higher values (P=0.001) in those who developed intracranial progression disease (PD) (2.80±0.32 mm), compared with those who achieved partial response (PR) (1.30±0.11 mm) or stable disease (SD) (1.35±0.09 mm). In patients treated with WBRT, F/Gd ratio was not predictive of response. CONCLUSIONS Peritumoral edema estimated by F/Gd ratio appears a promising predictive tool to identify oligosymptomatic patients with multiple BM in whom WBRT can be postponed.
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Affiliation(s)
- Montse Alemany
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L’Hospitalet (IDIBELL), Barcelona, Spain
| | - Marta Domènech
- Thoracic Oncology Unit, Catalan Institute of Oncology, L’Hospitalet, Barcelona, Spain
| | - Andreas A. Argyriou
- Department of Neurology, Saint Andrew’s State General Hospital of Patras, Patras, Greece
| | - Noelia Vilariño
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L’Hospitalet (IDIBELL), Barcelona, Spain;,Thoracic Oncology Unit, Catalan Institute of Oncology, L’Hospitalet, Barcelona, Spain
| | - Carles Majós
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L’Hospitalet (IDIBELL), Barcelona, Spain;,Radiology Department ICS-IDI, Hospital Universitari Bellvitge, L’Hospitalet, Barcelona, Spain
| | - Pablo Naval-Baudin
- Radiology Department ICS-IDI, Hospital Universitari Bellvitge, L’Hospitalet, Barcelona, Spain
| | - Anna Lucas
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L’Hospitalet (IDIBELL), Barcelona, Spain
| | - Ramón Palmero
- Thoracic Oncology Unit, Catalan Institute of Oncology, L’Hospitalet, Barcelona, Spain
| | - Marta Simó
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L’Hospitalet (IDIBELL), Barcelona, Spain
| | - Ernest Nadal
- Thoracic Oncology Unit, Catalan Institute of Oncology, L’Hospitalet, Barcelona, Spain
| | - Jordi Bruna
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L’Hospitalet (IDIBELL), Barcelona, Spain
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Velasco R, Besora S, Argyriou AA, Santos C, Sala R, Izquierdo C, Simó M, Gil-Gil M, Pardo B, Jiménez L, Clapés V, Calvo M, Palmero R, Bruna J. Duloxetine against symptomatic chemotherapy-induced peripheral neurotoxicity in cancer survivors: a real world, open-label experience. Anticancer Drugs 2021; 32:88-94. [PMID: 33332891 DOI: 10.1097/cad.0000000000001005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The objective of this observational study was to evaluate the efficacy and safety of duloxetine in a cohort of 100 cancer survivors with chemotherapy-induced peripheral neurotoxicity (CIPN). CIPN was graded employing the TNSc and the NCI-CTCv4. The Patient Global Impression of Change (PGIC) scale measured the efficacy of duloxetine (1: no benefit; to 7: excellent response). A clinically meaningful response was considered a PGIC > 4. Median age was 62 (29-81) years and 42% were male. CIPN was graded as grades 1, 2 and 3 in 20, 66, and 14% of patients, respectively. Median time to duloxetine initiation was 6 (1-63) months after chemotherapy. Fifty-seven patients early dropped out from duloxetine, due to lack of efficacy (20%) or side effects (37%). Male patients more frequently discontinued duloxetine due to lack of efficacy (35.7 vs. 8.6% P = 0.001). PGIC scores were higher in female patients (4 vs. 1, P = 0.001), taxane-treated patients (4 vs. 1, P = 0.042) and with short-lasting (<6 months) CIPN (4 vs. 1, P = 0.008). Patients with long-lasting CIPN had a higher rate of adverse events (47 vs. 27%, P = 0.038) and discontinuation (54.8 vs. 45.1%, P = 0.023). In the multivariate analysis, female gender and short-lasting CIPN were independently associated with a favorable response to duloxetine. Low tolerability, male gender, and long-lasting CIPN significantly limited duloxetine use in daily practice setting. A minority of cancer survivors with CIPN treated with duloxetine had a meaningful CIPN improvement, and tolerability was overall low. Female gender and short-term CIPN were independently associated with a favorable response to duloxetine.
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Affiliation(s)
- Roser Velasco
- Neuro-Oncology Unit, Department of Neurology, Hospital Universitari de Bellvitge-ICO L'Hospitalet, IDIBELL, Barcelona
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra
| | - Sarah Besora
- Neuro-Oncology Unit, Department of Neurology, Hospital Universitari de Bellvitge-ICO L'Hospitalet, IDIBELL, Barcelona
- Hospital Universitari Mútua de Terrassa, Terrassa
| | | | | | - Rosó Sala
- Neuro-Oncology Unit, Department of Neurology, Hospital Universitari de Bellvitge-ICO L'Hospitalet, IDIBELL, Barcelona
- Department of Medical Oncology, ICO L'Hospitalet, Barcelona
| | - Cristina Izquierdo
- Neuro-Oncology Unit, Department of Neurology, Hospital Universitari de Bellvitge-ICO L'Hospitalet, IDIBELL, Barcelona
- Department of Neuroscience, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Marta Simó
- Neuro-Oncology Unit, Department of Neurology, Hospital Universitari de Bellvitge-ICO L'Hospitalet, IDIBELL, Barcelona
| | - Miguel Gil-Gil
- Neuro-Oncology Unit, Department of Neurology, Hospital Universitari de Bellvitge-ICO L'Hospitalet, IDIBELL, Barcelona
- Department of Medical Oncology, ICO L'Hospitalet, Barcelona
| | - Beatriz Pardo
- Department of Medical Oncology, ICO L'Hospitalet, Barcelona
| | - Laura Jiménez
- Department of Medical Oncology, ICO L'Hospitalet, Barcelona
| | - Victoria Clapés
- Department of Clinical Hematology, ICO L'Hospitalet, Barcelona, Spain
| | - Mariona Calvo
- Department of Medical Oncology, ICO L'Hospitalet, Barcelona
| | - Ramón Palmero
- Department of Medical Oncology, ICO L'Hospitalet, Barcelona
| | - Jordi Bruna
- Neuro-Oncology Unit, Department of Neurology, Hospital Universitari de Bellvitge-ICO L'Hospitalet, IDIBELL, Barcelona
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra
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Argyriou AA, Kalofonou F, Litsardopoulos P, Anastopoulou GG, Kalofonos HP. Oxaliplatin rechallenge in metastatic colorectal cancer patients with clinically significant oxaliplatin-induced peripheral neurotoxicity. J Peripher Nerv Syst 2020; 26:43-48. [PMID: 33345432 DOI: 10.1111/jns.12426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 12/11/2022]
Abstract
We investigated whether rechallenge with oxaliplatin (OXA) can worsen the pre-existing oxaliplatin-induced peripheral neurotoxicity (OXAIPN) in metastatic colorectal cancer (mCRC) patients. Patients previously treated with OXA, having clinically significant grade 1 or 2 OXAIPN were assessed, after receiving rechallenge with OXA, using the clinical version of the Total Neuropathy Score (TNSc). Peripheral neuropathy was assessed at the end of first OXA exposure and at completion of OXA rechallenge. The first line OXA-based chemotherapy was completed at least 9 months earlier (OXA-free interval). We studied 25 mCRC patients, 14 males and 11 females, with a median age of 63 (35-77) years. After their first exposure to OXA-based chemotherapy, 9 (36%) patients developed grade 1 OXAIPN and 16 patients grade 2 (64%) neurotoxicity. OXA reintroduction with a median of 10 (8-14) cycles led to grade 1 OXAIPN in two patients (8%), grade 2 in 19 patients (76%), and grade 3 neuropathy in 4 (16%) patients Worsening of pre-existing OXAIPN was documented in seven (28%) patients and was significantly associated with higher OXA delivered cumulative dose (P < .001). Median TNSc scores following treatment (10; range 4-18) were significantly increased (P < .001), when compared to the scores recorded at the end of first line treatment (8; range 2-12). Rechallenging OXA appears to relatively worsen the severity of existing OXAIPN. However, the majority of rechallenged patients developed a clinically significant (grade 2) OXAIPN, rather than treatment-emergent grade 3. As such, OXA rechallenge might be a feasible option in patients previously having OXAIPN.
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Affiliation(s)
- Andreas A Argyriou
- Neurological Department, Saint Andrew's General Hospital of Patras, Patras, Greece.,Department of Medicine, Division of Oncology, Medical School, University of Patras, Patras, Greece
| | - Foteini Kalofonou
- Department of Oncology, Imperial NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | | | | | - Haralabos P Kalofonos
- Department of Medicine, Division of Oncology, Medical School, University of Patras, Patras, Greece
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Vikelis M, Dermitzakis EV, Vlachos GS, Soldatos P, Spingos KC, Litsardopoulos P, Kararizou E, Argyriou AA. Open Label Prospective Experience of Supplementation with a Fixed Combination of Magnesium, Vitamin B2, Feverfew, Andrographis Paniculata and Coenzyme Q10 for Episodic Migraine Prophylaxis. J Clin Med 2020; 10:jcm10010067. [PMID: 33375459 PMCID: PMC7794912 DOI: 10.3390/jcm10010067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND To investigate the efficacy and safety of supplementation with a fixed combination of magnesium, vitamin B2, feverfew, andrographis paniculata and coenzyme Q10 in episodic migraine (EM) prevention. METHODS A pilot, single-arm, open-label study was conducted. After a one-month baseline period, the above-described supplementation was introduced in 113 EM Greek patients, who were prospectively followed-up for three months. The primary endpoint was the change in monthly migraine days between baseline period (BSL) and the third month of supplementation (T3). Secondary endpoints included changes in mean intensity of migraine and in days with use of acute migraine medications. Changes in scores of Migraine Disability Assessment questionnaire (MIDAS), Headache Impact Test-6 (HIT-6), Migraine Therapy Assessment questionnaire (MTAQ), Migraine-Specific Quality-of-life questionnaire (MSQ-QOL), Hospital Anxiety and Depression Scale (HADS) were also evaluated. Those with ≥50% reduction in monthly migraine days at T3, compared to BSL were considered supplementation-responders. RESULTS The mean number of migraine days was significantly decreased between BSL and T3 (9.4 ± 3.7 vs. 6.1 ± 3.5; p < 0.001). Likewise, days with peak headache intensity of >4/10 (5.7 ± 3.4 vs. 4.9 ± 3.1; p < 0.001) as well as days using acute headache medications per month (8.9 ± 3.6 vs. 5.7 ± 3.4; p < 0.001) were significantly reduced. At T3, 64 patients (56.6%) were classified as responders. The beneficial effect of supplementation was also associated with significant changes in HIT-6, MIDAS, MTAQ and MSQ-QOL scores. There were no safety concerns. CONCLUSIONS The supplementation we have tested appears to be an effective and well-tolerated preventive approach against EM. A randomized, placebo-controlled study is needed to confirm our results.
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Affiliation(s)
- Michail Vikelis
- Headache Clinic, Mediterraneo Hospital, 16675 Glyfada, Greece;
- Glyfada Headache Clinic, 16675 Glyfada, Greece
- Headache Outpatient Clinic, 1st Department of Neurology, National and Kapodistrian University of Athens, 11528 Athens, Greece;
- Correspondence: ; Tel.: +30-2109681760
| | | | | | | | | | - Pantelis Litsardopoulos
- Headache Outpatient Clinic, Neurology Department of the Saint Andrew’s State General Hospital of Patras, 26335 Patras, Greece; (P.L.); (A.A.A.)
| | - Evangelia Kararizou
- Headache Outpatient Clinic, 1st Department of Neurology, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Andreas A. Argyriou
- Headache Outpatient Clinic, Neurology Department of the Saint Andrew’s State General Hospital of Patras, 26335 Patras, Greece; (P.L.); (A.A.A.)
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Argyriou AA, Vikelis M, Mantovani E, Litsardopoulos P, Tamburin S. Recently available and emerging therapeutic strategies for the acute and prophylactic management of cluster headache: a systematic review and expert opinion. Expert Rev Neurother 2020; 21:235-248. [PMID: 33243037 DOI: 10.1080/14737175.2021.1857240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Introduction: Although it causes a huge burden to sufferers, cluster headache (CH), remains an undertreated condition, partly due to the absence of established acute and prophylactic treatment options. New therapeutic approaches providing fast and safe relief from CH are needed. Areas covered: A systematic review was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendation on recently published (last 5 years) papers on CH treatment. The authors also collected preliminary results from ongoing trials on emerging therapeutic/preventive pharmacological and interventional approaches for CH. Studies and results are reviewed and discussed. Expert opinion: The complexity of CH pathophysiology prevents the definition of reliable acute and preventive treatments. In the real-world clinical setting, several treatments are combined to provide relief to patients and increase their quality of life. Drugs targeting neuropeptides or their receptors within the trigeminovascular network are of particular interest to prevent CH attacks. Calcitonin gene-related peptide (CGRP) blockade seems attractive and promising, but studies on anti-CGRP monoclonal antibodies indicated rather modest or even absence of a prophylactic effect. A deeper insight into CH pathophysiology, and combined approaches may lead the path to new, more effective, and personalized CH therapies.
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Affiliation(s)
- Andreas A Argyriou
- Headache Outpatient Clinic, Department of Neurology, Saint Andrew's State General Hospital of Patras , Patras, Greece
| | - Michail Vikelis
- Headache Clinic, Mediterraneo Hospital , Glyfada, Greece.,Glyfada Headache Clinic , Glyfada, Greece
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona , Verona, Italy
| | - Pantelis Litsardopoulos
- Headache Outpatient Clinic, Department of Neurology, Saint Andrew's State General Hospital of Patras , Patras, Greece
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona , Verona, Italy
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Makri OE, Dimitrakopoulos FI, Tsapardoni F, Tsekouras I, Argyriou AA, Kalofonos H, Georgakopoulos CD. Isolated optic neuritis after pembrolizumab administration for non-small-cell lung carcinoma. Int J Neurosci 2020; 132:643-648. [PMID: 32998608 DOI: 10.1080/00207454.2020.1831489] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To report a case of isolated optic neuritis associated with pembrolizumab immunotherapy for metastatic non-small cell lung carcinoma. CASE PRESENTATION A 76-year-old man, with a history of metastatic non-small cell lung carcinoma, presented with vision loss in his left eye for the past week. He had been treated with pembrolizumab for the underlying disease for 2 months. On presentation, best corrected visual acuity was 20/30 in the right eye and 20/200 in the left eye. Fundoscopy revealed optic nerve edema in the left eye. Visual fields examination in right eye revealed an enlarged blind spot and an extended defect in the inferior nasal quadrant. In the left eye a partial superior arcuate defect and an extended defect in the inferior hemisphere was observed. The mean deviation was -12.15 dB in the right eye and -13.70 dB in left eye. Pembrolizumab was withheld and corticosteroids were administered for a total of nine weeks, first intravenously and then slowly tapered orally, resulting in resolution of optic neuritis, restoration of visual acuity and in relative improvement in the visual field defects after 3 months. Calculated Naranjo Nomogram score was 7, indicating a 'highly probable' correlation. CONCLUSIONS Optic neuritis is a relatively rare immune-related adverse event after exposure to checkpoint inhibitors cancer immunotherapy. Prompt discontinuation of the offending agent and early initiation of corticosteroid therapy is the mainstay of the treatment.
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Affiliation(s)
- Olga E Makri
- Department of Ophthalmology, Medical School, University of Patras, Patras, Greece
| | | | - Foteini Tsapardoni
- Department of Ophthalmology, Medical School, University of Patras, Patras, Greece
| | - Iasonas Tsekouras
- Department of Ophthalmology, Medical School, University of Patras, Patras, Greece
| | | | - Haralabos Kalofonos
- Division of Oncology, Department of Medicine, Medical School, University of Patras, Patras, Greece
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Liourdi D, Litsardopoulos P, Dimitropoulou D, Fatourou A, Argyriou AA. Pneumococcal Otogenic Meningitis Complicated With Pneumocephalus and Coma State. Cureus 2020; 12:e10917. [PMID: 33194484 PMCID: PMC7657374 DOI: 10.7759/cureus.10917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We herein describe the unusual case of a male patient with pneumococcal otogenic meningitis, which was complicated with non-traumatic pneumocephalus and coma, in the absence of head trauma or a neurosurgical procedure. The initiation of an aggressive, empirical scheme with wide-spectrum antibiotics was achieved to stop the progression of meningitis, pneumocephalus, and their underlying causes in this patient. We propose pathogenetic mechanisms to explain this life-threatening condition.
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Huang X, Zhang X, Wang X, Rong X, Li Y, Li H, Jiang J, Cai J, Zhuo X, Pi Y, Lin J, Chua MLK, Argyriou AA, Lattanzi S, Simone CB, Glass J, Palmer JD, Chow E, Brown PD, Yue Z, Tang Y. A nomogram to predict symptomatic epilepsy in patients with radiation-induced brain necrosis. Neurology 2020; 95:e1392-e1403. [PMID: 32631922 DOI: 10.1212/wnl.0000000000010190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/11/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To develop and validate a nomogram to predict epilepsy in patients with radiation-induced brain necrosis (RN). METHODS The nomogram was based on a retrospective analysis of 302 patients who were diagnosed with symptomatic RN from January 2005 to January 2016 in Sun Yat-sen Memorial Hospital using the Cox proportional hazards model. Discrimination of the nomogram was assessed by the concordance index (C index) and the calibration curve. The results were internally validated using bootstrap resampling and externally validated using 128 patients with RN from 2 additional hospitals. RESULTS A total of 302 patients with RN with a median follow-up of 3.43 years (interquartile range 2.54-5.45) were included in the training cohort; 65 (21.5%) developed symptomatic epilepsy during follow-up. Seven variables remained significant predictors of epilepsy after multivariable analyses: MRI lesion volume, creatine phosphokinase, the maximum radiation dose to the temporal lobe, RN treatment, history of hypertension and/or diabetes, sex, and total cholesterol level. In the validation cohort, 28 out of 128 (21.9%) patients had epilepsy after RN within a median follow-up of 3.2 years. The nomogram showed comparable discrimination between the training and validation cohort (corrected C index 0.76 [training] vs 0.72 [95% confidence interval 0.62-0.81; validation]). CONCLUSION Our study developed an easily applied nomogram for the prediction of RN-related epilepsy in a large RN cohort. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that a nomogram predicts post-RN epilepsy.
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Affiliation(s)
- Xiaolong Huang
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Xiaoni Zhang
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Xicheng Wang
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Xiaoming Rong
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Yi Li
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Honghong Li
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Jingru Jiang
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Jinhua Cai
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Xiaohuang Zhuo
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Yaxuan Pi
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Jinpeng Lin
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Melvin L K Chua
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Andreas A Argyriou
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Simona Lattanzi
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Charles B Simone
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Jon Glass
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Joshua D Palmer
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Edward Chow
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Paul D Brown
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Zongwei Yue
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Yamei Tang
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN.
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Argyriou AA, Bruna J, Park SB, Cavaletti G. Emerging pharmacological strategies for the management of chemotherapy-induced peripheral neurotoxicity (CIPN), based on novel CIPN mechanisms. Expert Rev Neurother 2020; 20:1005-1016. [PMID: 32667212 DOI: 10.1080/14737175.2020.1796639] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Based on results of available clinical trials, the treatment and prevention of chemotherapy-induced peripheral neurotoxicity (CIPN) largely remains an unmet clinical need. However, new approaches have emerged in the last few years, attempting to modify the natural history of acute and late CIPN effects through a better knowledge of the pathogenic process on the molecular level. AREAS COVERED Clinical results of recently published (last 5 years) or ongoing emerging therapeutic/preventive pharmacological approaches based on novel CIPN mechanisms have been identified from Pubmed and ClinicalTrials.gov. Results are reviewed and discussed, in order to assess the trend of new clinical studies but also to infer the role novel approaches may have in the future. EXPERT OPINION The large heterogeneity of disease-causing mechanisms prevents researchers from identifying a reliable approach to effectively and safely treat or prevent CIPN. Understanding of novel pathophysiologic processes is leading the way to novel therapies, which, through targeting the sphingosine 1-phosphate receptor or pharmacologically inhibiting axonal degeneration might achieve in the future both treatment and prevention of CIPN. Toward this end, a multi-targeting approach, combining drugs to target different CIPN pathomechanisms seems to be a rational approach that warrants testing.
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Affiliation(s)
- Andreas A Argyriou
- Department of Neurology, Saint Andrew's State General Hospital of Patras , Patras, Greece
| | - Jordi Bruna
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO L'Hospitalet-IDIBELL , Barcelona, Spain
| | - Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney , Sydney, Australia
| | - Guido Cavaletti
- Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca , Monza, Italy
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Cai J, Zheng J, Shen J, Yuan Z, Xie M, Gao M, Tan H, Liang Z, Rong X, Li Y, Li H, Jiang J, Zhao H, Argyriou AA, Chua MLK, Tang Y. A Radiomics Model for Predicting the Response to Bevacizumab in Brain Necrosis after Radiotherapy. Clin Cancer Res 2020; 26:5438-5447. [PMID: 32727886 DOI: 10.1158/1078-0432.ccr-20-1264] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/28/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Bevacizumab is considered a promising therapy for brain necrosis after radiotherapy, while some patients fail to derive benefit or even worsen. Hence, we developed and validated a radiomics model for predicting the response to bevacizumab in patients with brain necrosis after radiotherapy. EXPERIMENTAL DESIGN A total of 149 patients (with 194 brain lesions; 101, 51, and 42 in the training, internal, and external validation sets, respectively) receiving bevacizumab were enrolled. In total, 1,301 radiomic features were extracted from the pretreatment MRI images of each lesion. In the training set, a radiomics signature was constructed using the least absolute shrinkage and selection operator algorithm. Multivariable logistic regression analysis was then used to develop a radiomics model incorporated in the radiomics signature and independent clinical predictors. The performance of the model was assessed by its discrimination, calibration, and clinical usefulness with internal and external validation. RESULTS The radiomics signature consisted of 18 selected features and showed good discrimination performance. The model, which integrates the radiomics signature, the interval between radiotherapy and diagnosis of brain necrosis, and the interval between diagnosis of brain necrosis and treatment with bevacizumab, showed favorable calibration and discrimination in the training set (AUC 0.916). These findings were confirmed in the validation sets (AUC 0.912 and 0.827, respectively). Decision curve analysis confirmed the clinical utility of the model. CONCLUSIONS The presented radiomics model, available as an online calculator, can serve as a user-friendly tool for individualized prediction of the response to bevacizumab in patients with brain necrosis after radiotherapy.
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Affiliation(s)
- Jinhua Cai
- Department of Neurology, Bioland Laboratory, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Junjiong Zheng
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jun Shen
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhiyong Yuan
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, People's Republic of China
| | - Mingwei Xie
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Miaomiao Gao
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, People's Republic of China
| | - Hongqi Tan
- Division of Radiation Oncology, National Cancer Center Singapore, Singapore
| | - Zhongguo Liang
- Division of Radiation Oncology, National Cancer Center Singapore, Singapore.,The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Xiaoming Rong
- Department of Neurology, Bioland Laboratory, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yi Li
- Department of Neurology, Bioland Laboratory, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Honghong Li
- Department of Neurology, Bioland Laboratory, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jingru Jiang
- Department of Neurology, Bioland Laboratory, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Huiying Zhao
- Medical Research Center of Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | | | - Melvin L K Chua
- Division of Radiation Oncology, National Cancer Center Singapore, Singapore.,Divisions of Medical Sciences, National Cancer Center Singapore, Singapore; Oncology Academic Program, Duke-National University of Singapore Medical School, Singapore
| | - Yamei Tang
- Department of Neurology, Bioland Laboratory, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China. .,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
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Argyriou AA, Kalofonou F, Litsardopoulos P, Anastopoulou GG, Psimaras D, Bruna J, Kalofonos HP. Real world, open label experience with lacosamide against acute painful oxaliplatin-induced peripheral neurotoxicity. J Peripher Nerv Syst 2020; 25:178-183. [PMID: 32277545 DOI: 10.1111/jns.12374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/11/2020] [Accepted: 04/05/2020] [Indexed: 12/19/2022]
Abstract
We report the outcome of a pilot, open-label study that tested the potential of lacosamide (200 mg/bi.d) as an effective and safe symptomatic treatment against acute painful oxaliplatin-induced peripheral neurotoxicity (OXAIPN). Lacosamide was introduced in 18 colorectal cancer patients with evidence of clinically significant acute, painful OXAIPN after infusion of the third course (T1) of oxaliplatin-based chemotherapy (FOLFOX4) and was maintained until completion of all 12 courses (T4). The OXA-Neuropathy Questionnaire (OXA-NQ) was used to record the severity of acute OXAIPN; the PI-NRS estimated the severity of neuropathic pain, while the chronic OXAIPN was graded with TNSc. The EuroQOL (EQ-5D) instrument was also applied. The Patient Global Impression of Change (PGIC) scale measured the lacosamide-attributed perception of change. LCM-responders were considered those with ≥50% reduction in PI-NRS and OXA-NQ scores at T4, compared to T1. Patients experienced on T1 a median number of acute OXAIPN symptoms of 4 and had a median neuropathic pain severity score of 6, which was strongly related to lower quality of life, according to EQ-VAS (P < .001). At T4, 12 patients (66.7%) were classified as responders. A significant clinical improvement was documented in the severity of acute OXAIPN and neuropathic pain in relation to lacosamide (P < .001) at T4 compared to T1, which was associated with improved EQ-VAS scores (P < .001). Twelve patients scored PGIC ≥5 (lacosamide-attributed) at T4. There were no incidences of early drop-outs for safety reasons. Lacosamide appears to be an effective and well-tolerated symptomatic treatment against acute, painful OXAIPN.
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Affiliation(s)
- Andreas A Argyriou
- Neurological Department, Saint Andrew's General Hospital of Patras, Patras, Greece.,Department of Medicine, Division of Oncology, Medical School, University of Patras, Patras, Greece
| | - Foteini Kalofonou
- Department of Oncology, Garry Weston Centre, Hammersmith Hospital, Imperial NHS Healthcare Trust, London, UK
| | | | | | - Dimitri Psimaras
- AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie Mazarin, Paris, France
| | - Jordi Bruna
- Neuro-Oncology Unit, Department of Neurology, Hospital Universitari de Bellvitge-ICO L'Hospitalet, IDIBELL, Barcelona, Spain
| | - Haralabos P Kalofonos
- Department of Medicine, Division of Oncology, Medical School, University of Patras, Patras, Greece
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Velasco R, Alberti P, Bruna J, Psimaras D, Argyriou AA. Bortezomib and other proteosome inhibitors-induced peripheral neurotoxicity: From pathogenesis to treatment. J Peripher Nerv Syst 2020; 24 Suppl 2:S52-S62. [PMID: 31647153 DOI: 10.1111/jns.12338] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/15/2019] [Indexed: 12/14/2022]
Abstract
Proteasome inhibitors (PIs), especially bortezomib (BTZ), have come to the forefront over the last years because of their unprecedented efficacy mainly against multiple myeloma (MM). Unfortunately, peripheral neuropathy (PN) secondary to treatment of MM with PIs has emerged as a clinically relevant complication, which negatively impacts the quality of life of MM survivors. Bortezomib-induced peripheral neuropathy (BIPN) is a dose-limiting toxicity, which develops in 30% to 60% of patients during treatment. Typically, BIPN is a length-dependent sensory axonopathy characterized by numbness, tingling, and severe neuropathic pain in stocking and glove distribution. BIPN mechanisms have not yet been fully elucidated. Experimental studies suggest that aggresome formation, endoplasmic reticulum stress, myotoxicity, microtubule stabilization, inflammatory response, and DNA damage could contribute to this neurotoxicity. A new generation of structurally distinct PIs has been developed, being increasingly used in clinical settings. Carfilzomib exhibits a much lower neurotoxicity profile, with a significantly lower incidence of PN compared to BTZ. Pre-existing PN increases the risk of developing BIPN. Besides, BIPN is related to dose, schedule and mode of administration and modifications of these factors have lowered the incidence of PN. However, to date there is no cure for PIs-induced PN (PIIPN), and a careful neurological monitoring and dose adjustment is a key strategy for preserving quality of life. This review critically looks at the pathogenesis, incidence, risk factors, both clinical and pharmacogenetics, clinical phenotype and management of PIIPN. We also make recommendations for further elucidating the whole clinical spectrum of PIIPN.
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Affiliation(s)
- Roser Velasco
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-Institut Català D'Oncologia L'Hospitalet, IDIBELL, Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Paola Alberti
- NeuroMI (Milan Center for Neuroscience), Milan, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Jordi Bruna
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-Institut Català D'Oncologia L'Hospitalet, IDIBELL, Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Dimitri Psimaras
- AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie Mazarin, Paris, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux Universitaires Pitié-Salpetrière-Charles Foix et Hôpital Percy, Paris, France
| | - Andreas A Argyriou
- Department of Neurology, "Saint Andrew's" State General Hospital of Patras, Patras, Greece
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Tamburin S, Park SB, Alberti P, Demichelis C, Schenone A, Argyriou AA. Taxane and epothilone-induced peripheral neurotoxicity: From pathogenesis to treatment. J Peripher Nerv Syst 2020; 24 Suppl 2:S40-S51. [PMID: 31647157 DOI: 10.1111/jns.12336] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/15/2019] [Indexed: 01/17/2023]
Abstract
Taxane-induced peripheral neurotoxicity (TIPN) is the most common non-hematological side effect of taxane-based chemotherapy, and may result in dose reductions and discontinuations, having as such a detrimental effect on patients' overall survival. Epothilones share similar mechanism of action with taxanes. The typical TIPN clinical presentation is mainly comprised of numbness and paresthesia, in a stocking-and-glove distribution and may progress more proximally over time, with paclitaxel being more neurotoxic than docetaxel. Motor and autonomic involvement is less common, whereas an acute taxane-induced acute pain syndrome is frequent. Patient reported outcomes questionnaires, clinical evaluation, and instrumental tools offer complementary information in TIPN. Its electrodiagnostic features include reduced/abolished sensory action potentials, and less prominent motor involvement, in keeping with a length-dependent, axonal dying back predominately sensory neuropathy. TIPN is dose-dependent and may be reversible within months after the end of chemotherapy. The single and cumulative delivered dose of taxanes is considered the main risk factor of TIPN development. Apart from the cumulative dose, other risk factors for TIPN include demographic, clinical, and pharmacogenetic features with several single-nucleotide polymorphisms potentially linked with increased susceptibility of TIPN. There are currently no neuroprotective strategies to reduce the risk of TIPN, and symptomatic treatments are very limited. This review critically examines the pathogenesis, incidence, risk factors (both clinical and pharmacogenetic), clinical phenotype and management of TIPN.
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Affiliation(s)
- Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Paola Alberti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,NeuroMI (Milan Center for Neuroscience), Milan, Italy
| | - Chiara Demichelis
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy.,IRCCS Policlinico San Martino, Genoa, Italy
| | - Angelo Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy.,IRCCS Policlinico San Martino, Genoa, Italy
| | - Andreas A Argyriou
- Department of Neurology, "Saint Andrew's" State General Hospital of Patras, Patras, Greece
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Park SB, Alberti P, Kolb NA, Gewandter JS, Schenone A, Argyriou AA. Overview and critical revision of clinical assessment tools in chemotherapy-induced peripheral neurotoxicity. J Peripher Nerv Syst 2020; 24 Suppl 2:S13-S25. [PMID: 31647154 DOI: 10.1111/jns.12333] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/15/2019] [Indexed: 12/11/2022]
Abstract
Chemotherapy-induced peripheral neurotoxicity (CIPN) is a major toxicity of cancer treatment, leading to dose reduction and premature treatment cessation, potentially affecting patient function, and quality of life. The development of accurate and sensitive assessment tools for CIPN is essential to enable clinical monitoring during treatment, follow-up of long-term outcomes and measurement of toxicity in clinical trials. This review examines CIPN clinical assessment scales incorporating clinician-based, composite, and patient-reported outcomes (PROs), providing a systematic review of their properties and an updated critical analysis of recommendations on current evidence for their use. This systematic review of CIPN assessment tools identified 50 papers containing 41 assessment tools, across 4 categories (common toxicity criteria; composite neurological scale; PROs; pain scale). The majority of these tools were PROs, underscoring the importance of patient-based assessment of symptoms. While there has been considerable work in the field over the past 10 years, this review highlights significant gaps, including a lack of evaluation of responsiveness and problematic neuropathic pain evaluation. There remains a need for consensus on the best available tool and the need to modify existing instruments to improve utility.
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Affiliation(s)
- Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Paola Alberti
- Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Noah A Kolb
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont
| | - Jennifer S Gewandter
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | - Angelo Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genova, Genoa, Italy
| | - Andreas A Argyriou
- Department of Neurology, Saint Andrew's State General Hospital of Patras, Greece
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Psimaras D, Velasco R, Birzu C, Tamburin S, Lustberg M, Bruna J, Argyriou AA. Immune checkpoint inhibitors-induced neuromuscular toxicity: From pathogenesis to treatment. J Peripher Nerv Syst 2020; 24 Suppl 2:S74-S85. [PMID: 31393660 DOI: 10.1111/jns.12339] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/15/2019] [Indexed: 12/17/2022]
Abstract
Immune checkpoint inhibitors (ICIs) are increasingly used and are becoming the standard of care in the treatment of various tumor types. Despite the favorable results in terms of oncological outcomes, these treatments have been associated with a variety of immune-related adverse events (irAEs). Neurological irAEs are rare but potentially severe. Neuromuscular disorders represent the most common neurological irAEs following anti-PD-1, anti-PD-L1, and anti-CTLA-4 treatment, and include myositis, myasthenia gravis, and demyelinating polyradiculoneuropathy. Instrumental findings may differ from typical neuromuscular disorders occurring outside ICIs treatment. Despite initial severity, neurological irAEs often respond to immune-modulating therapies. Prompt irAEs diagnosis, ICIs discontinuation, and early treatment with corticosteroids, together with patient education and a multi-disciplinary approach, are important for optimizing clinical outcomes. Intravenous immunoglobulin, plasma exchange, and other immune-modulating treatments should be considered in more severe cases. Consideration of re-challenging with the same immunotherapy drug may be given in some cases, based on clinical picture and initial severity of irAEs.
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Affiliation(s)
- Dimitri Psimaras
- AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie Mazarin, Paris, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux Universitaires Pitié-Salpetrière-Charles Foix et Hôpital Percy, Paris, France
| | - Roser Velasco
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-Institut Català D'Oncologia L'Hospitalet, IDIBELL, Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Cristina Birzu
- AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie Mazarin, Paris, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux Universitaires Pitié-Salpetrière-Charles Foix et Hôpital Percy, Paris, France
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maryam Lustberg
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer, Columbus, Ohio
| | - Jordi Bruna
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-Institut Català D'Oncologia L'Hospitalet, IDIBELL, Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Andreas A Argyriou
- Department of Neurology, "Saint Andrew's" State General Hospital of Patras, Patras, Greece
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45
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Bruna J, Argyriou AA, Anastopoulou GG, Alemany M, Nadal E, Kalofonou F, Piulats JM, Simó M, Velasco R, Kalofonos HP. Incidence and characteristics of neurotoxicity in immune checkpoint inhibitors with focus on neuromuscular events: Experience beyond the clinical trials. J Peripher Nerv Syst 2020; 25:171-177. [PMID: 32166812 DOI: 10.1111/jns.12371] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 12/13/2022]
Abstract
Immune checkpoint inhibitors (ICIs) are associated with various neurological adverse events (NAEs). We herein explored the incidence and clinical phenotype of immune-related NAEs in cancer patients. Medical records of ICI-treated cancer patients were reviewed between the years 2010 and 2018, with an aim to characterize immuno-related NAEs. A total of 1185 ICIs-treated patients were identified, 63.7% of which were males and 36.3% were females, with a mean age of 63.4 ± 7.3 years. Twenty-four from the overall ICIs-treated patients (2%) developed NAEs. No differences were identified in terms of age, sex, tumor type and class of ICIs between the patients who developed NAEs and those who did not. The median number of cycles of ICI treatment before NAEs onset were 4.5 (1-10), and the median time was 102 days. Peripheral nervous system (PNS) involvement was present in 14 patients (58.4%) and central nervous system (CNS) involvement in 10 (33.3%), including 2 patients with aseptic meningitis and polyradicular involvement. Amongst PNS complications, there were five (20.8%) with axonal sensory neuropathies, four (16.7%) with Guillain-Barre-like syndromes, and four (16.7%) with myositis and/or myasthenic syndromes. The majority of patients with PNS-related NAEs (n = 11; 78.6%) improved after ICIs discontinuation and treatment with immune-modulating therapies. The time to neuromuscular toxicities onset was significantly shorter, compared to CNS NAEs (median 70 vs 119 days, P = .037). Immune-related NAEs mostly present with neuromuscular complications. Discontinuation of ICIs and appropriate treatment should be commenced early throughout the process, in order to maximize a favorable outcome.
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Affiliation(s)
- Jordi Bruna
- Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, l'Hospitalet de Llobregat, Unit of Neuro-Oncology, Barcelona, Spain.,Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Andreas A Argyriou
- Department of Medicine, Division Oncology, Medical School, University Hospital of Patras, Rion-Patras, Greece.,Neurology Department, Saint Andrew's General Hospital of Patras, Patras, Greece
| | - Garifallia G Anastopoulou
- Department of Medicine, Division Oncology, Medical School, University Hospital of Patras, Rion-Patras, Greece
| | - Montse Alemany
- Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, l'Hospitalet de Llobregat, Unit of Neuro-Oncology, Barcelona, Spain
| | - Ernest Nadal
- Thoracic Oncology Unit, ICO l'Hospitalet, IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Foteini Kalofonou
- Department of Oncology, Garry Weston Centre, Hammersmith Hospital, Imperial NHS Healthcare Trust, London, UK
| | - Josep M Piulats
- Department of Medical Oncology, ICO l'Hospitalet, IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Simó
- Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, l'Hospitalet de Llobregat, Unit of Neuro-Oncology, Barcelona, Spain
| | - Roser Velasco
- Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, l'Hospitalet de Llobregat, Unit of Neuro-Oncology, Barcelona, Spain.,Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Haralabos P Kalofonos
- Department of Medicine, Division Oncology, Medical School, University Hospital of Patras, Rion-Patras, Greece
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46
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Anastogiannis H, Litsardopoulos P, Anastopoulou GG, Petsas A, Tsigkas G, Kounis NG, Ravani I, Argyriou AA. Irreversible diffuse hypoxic-ischemic encephalopathy, secondary to type I Kounis syndrome. Int J Neurosci 2019; 130:746-748. [PMID: 31814489 DOI: 10.1080/00207454.2019.1702541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We herein describe the unusual case of irreversible diffuse hypoxic-ischemic encephalopathy secondary to type I Kounis syndrome. The patient survived and remained in a vegetative state after being mechanically ventilated in the intensive care unit for long. A brief review of the literature on mechanisms for KS-associated brain injury is also presented.
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Affiliation(s)
| | | | | | - Andreas Petsas
- Intensive Care Unit, Saint Andrew's State General Hospital of Patras, Patras, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - Ifigenia Ravani
- Intensive Care Unit, Saint Andrew's State General Hospital of Patras, Patras, Greece
| | - Andreas A Argyriou
- Department of Neurology, Saint Andrew's State General Hospital of Patras, Patras, Greece
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47
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Argyriou AA, Park SB, Islam B, Tamburin S, Velasco R, Alberti P, Bruna J, Psimaras D, Cavaletti G, Cornblath DR. Neurophysiological, nerve imaging and other techniques to assess chemotherapy-induced peripheral neurotoxicity in the clinical and research settings. J Neurol Neurosurg Psychiatry 2019; 90:1361-1369. [PMID: 31256000 DOI: 10.1136/jnnp-2019-320969] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/27/2019] [Accepted: 06/13/2019] [Indexed: 11/03/2022]
Abstract
Chemotherapy-induced peripheral neurotoxicity (CIPN) is a common dose-limiting side effect of several anticancer medications. CIPN may involve multiple areas of the peripheral nervous system from the autonomic and dorsal root ganglia (DRG) to the axon and any peripheral nerve fibre type. Large diameter sensory myelinated (Aβ) fibres are more frequently involved, but motor, small myelinated (Aδ), unmyelinated (C) or autonomic fibres may also be affected. Here, we review the current evidence on techniques for the CIPN assessment in the clinical and experimental settings. Nerve conduction studies (NCS) may be used at the subclinical and early CIPN stage, to assess the extent of large nerve fibre damage and to monitor long-term outcomes, with the sural or dorsal sural nerve as the most informative. The quantitative sensory neurological examination provides valuable data alongside NCS. Quantitative sensory testing and nerve excitability studies add information regarding pathophysiology. Nerve MRI and ultrasound may provide information on enlarged nerve, increased nerve signal intensity and DRG or spinal cord changes. Skin biopsy, corneal confocal microscopy, laser-evoked potentials, contact heat-related potentials and microneurography may reveal the extent of damage to small unmyelinated nerve fibres that go undetected by NCS. The information on the role of these latter techniques is preliminary. Hence, the use of multimodal testing is recommended as the optimal CIPN assessment strategy, employing objective NCS and other specialised techniques together with subjective patient-reported outcome measures.
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Affiliation(s)
- Andreas A Argyriou
- Neurology, "Saint Andrew's" State General Hospital of Patras, Patras, Greece
| | - Susanna B Park
- The University of Sydney, Brain and Mind Centre, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Badrul Islam
- icddr, b, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Bangladesh
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Roser Velasco
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO L'Hospitalet-IDIBELL, Barcelona, Spain
| | - Paola Alberti
- Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Jordi Bruna
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO L'Hospitalet-IDIBELL, Barcelona, Spain
| | - Dimitri Psimaras
- Service de Neurologie 2-Mazarin, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, APHP, Paris, France
| | - Guido Cavaletti
- Experimental Neurology Unit and Milan Center for Neuroscience, University of Milan Bicocca, Monza, Italy
| | - David R Cornblath
- Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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48
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Argyriou AA, Park SB, Bruna J, Cavaletti G. Voltage-gated sodium channel dysfunction and the search for other satellite channels in relation to acute oxaliplatin-induced peripheral neurotoxicity. J Peripher Nerv Syst 2019; 24:360-361. [PMID: 31696990 DOI: 10.1111/jns.12354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Andreas A Argyriou
- Department of Neurology, "Saint Andrew's" State General Hospital of Patras, Greece
| | - Susanna B Park
- The University of Sydney, Brain and Mind Centre, Faculty of Medicine and Health, Sydney, Australia
| | - Jordi Bruna
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO L'Hospitalet-IDIBELL, Barcelona, Spain
| | - Guido Cavaletti
- Experimental Ueurology Unit, University of Milano-Bicocca, Monza, Italy and NeuroMI (Milan Center for Neuroscience), Milan, Italy
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49
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Argyriou AA, Cavaletti G, Park SB. The Toxic Neuropathy Consortium of the Peripheral Nerve Society. J Peripher Nerv Syst 2019; 24 Suppl 2:S4-S5. [PMID: 31647150 DOI: 10.1111/jns.12331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/15/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Andreas A Argyriou
- Department of Neurology, "Saint Andrew's" State General Hospital of Patras, Patras, Greece
| | - Guido Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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50
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Argyriou AA, Antonacopoulou AG, Alberti P, Briani C, Bruna J, Velasco R, Anastopoulou GG, Park SB, Cavaletti G, Kalofonos HP. Liability of the voltage-gated potassium channel KCNN3 repeat polymorphism to acute oxaliplatin-induced peripheral neurotoxicity. J Peripher Nerv Syst 2019; 24:298-303. [PMID: 31486252 DOI: 10.1111/jns.12347] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/01/2019] [Accepted: 09/02/2019] [Indexed: 01/17/2023]
Abstract
Thus far, there are conflicting results on the causal role of K+ channels in the pathogenesis of acute oxaliplatin-induced peripheral neurotoxicity (OXAIPN). As such, we tested the hypothesis that the voltage-gated K+ channel KCNN3 repeat polymorphism confers liability to acute OXAIPN. DNA from 151 oxaliplatin-treated patients for colorectal cancer was extracted and genotyped. The incidence of acute OXIPN was measured by the OXA-neuropathy questionnaire, while the severity of acute OXAIPN was scored basing on the number of symptoms reported by the patients at each clinical assessment. The increased number of acute symptoms was considered as being suggestive of an increased severity of acute OXAIPN. A total of 130/151 (86.1%) patients developed any grade of acute OXAIPN. Grade I acute neurotoxicity was revealed in 43 (28.5%) patients; grade II in 34 (22.5%); and grade III in 53 (53.1%) patients. Genotyping revealed alleles carrying 11 to 20 CAG repeats. The majority of patients were heterozygous (131; 89.4%). The most common numbers of CAG repeats were 15 (n = 46), 16 (n = 53), and 17 (n = 95). Patients carrying alleles with either 15 to 17 CAG repeats (P = .601) did not experience a higher incidence of grade III (treatment-emergent) acute OXAIPN. Likewise, no increased incidence of acute treatment-emergent OXAIPN was noted in heterozygous patients carrying either two short alleles (<19 CAG repeats) or one short and one long (≥19 CAG repeats) allele (P = .701). Our results do not support a causal relationship between the KCNN3CAG repeat polymorphism and acute OXΑIPN.
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Affiliation(s)
- Andreas A Argyriou
- Department of Neurology, "Saint Andrew's" State General Hospital of Patras, Rion-Patras, Greece.,Department of Medicine, Division of Oncology, Clinical and Molecular Oncology Laboratory, University of Patras, Rion-Patras, Greece
| | - Anna G Antonacopoulou
- Department of Medicine, Division of Oncology, Clinical and Molecular Oncology Laboratory, University of Patras, Rion-Patras, Greece
| | - Paola Alberti
- Experimental Neurology Unit, University of Milano-Bicocca, Monza, Italy.,NeuroMI (Milan Center for Neuroscience), Milan, Italy
| | - Chiara Briani
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Jordi Bruna
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO L'Hospitalet-IDIBELL, Barcelona and Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Roser Velasco
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO L'Hospitalet-IDIBELL, Barcelona and Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Garifallia G Anastopoulou
- Department of Medicine, Division of Oncology, "Saint Andrew's" State General Hospital of Patras, Rion-Patras, Greece
| | - Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Guido Cavaletti
- Experimental Neurology Unit, University of Milano-Bicocca, Monza, Italy.,NeuroMI (Milan Center for Neuroscience), Milan, Italy
| | - Haralabos P Kalofonos
- Department of Medicine, Division of Oncology, Clinical and Molecular Oncology Laboratory, University of Patras, Rion-Patras, Greece
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