Derazantinib: an investigational drug for the treatment of cholangiocarcinoma

INTRODUCTION

This review evaluates the clinical role of fibroblast growth factor receptor 2 (FGFR2) inhibition with derazantinib in patients with intrahepatic cholangiocarcinoma (iCCA) harboring actionable oncogenic FGFR2 fusions/rearrangements, mutations and amplifications. FGFR inhibitors such as derazantinib are currently being evaluated to address the unmet medical need of patients with previously treated, locally advanced or metastatic iCCA harboring such genetic aberrations.

AREAS COVERED

We summarize the pharmacokinetics, and the emerging safety and efficacy data of the investigational FGFR inhibitor derazantinib. We discuss the future directions of this novel therapeutic agent for iCCA.

EXPERT OPINION

Derazantinib is a potent FGFR1‒3 kinase inhibitor which also has activity against colony stimulating factor-1‒receptor (CSF1R) and vascular endothelial growfth factor receptor‒2 (VEGFR2), suggesting a potentially differentiated role in the treatment of patients with iCCA. Derazantinib has shown clinically meaningful efficacy with durable objective responses, supporting the therapeutic potential of derazantinib in previously treated patients with iCCA harboring FGFR2 fusions/rearrangements, mutations and amplifications. The clinical safety profile of derazantinib was well manageable and compared favorably to the FGFR inhibitor class, particularly with a low incidence of drug-related hand-foot syndrome, stomatitis, retinal and nail toxicity. These findings support the need for increased molecular profiling of cholangiocarcinoma patients.

High dialysis clearance of drugs predicts intradialytic hypertension in hemodialysis patients

Introduction/Purpose

An acute drop in highly dialyzable antihypertensive drug levels is considered to be one of the pathophysiological mechanisms of blood pressure rise during hemodialysis (HD). The study aimed to assess the prevalence of intradialytic hypertension (ID-HTN) and identify the most significant risk factors of its development.

Methods

We performed a retrospective case-control single-center study of HD patients from January 1st, 2014 to December 30th, 2016. Baseline evaluation included recording of antihypertensive medications with a focus on dialyzability of drugs. ID-HTN was defined as an increase in systolic blood pressure more than 10 mmHg after HD session.

Results

We enrolled 131 HD patients (52% males, median age 55.7 [53.5; 58.0] years, dialysis vintage 59.3 [51.8; 66.8] months). 79 patients suffered from ID-HTN. Highly dialyzable drugs were used in 61% of patients, most often – in 68% of cases – in the group of beta-blockers, less often among inhibitors of angiotensin-converting enzyme (32%).

ID-HTN was associated with use of beta-blockers (Spearman's rank correlation coefficient (r)=0.212; p=0.015), moxonidine (r=0.313; p=0.001) and highly dialyzable drugs (r=0.440; p<0.0001). Using the identified risk factors, a prediction model for ID-HTN based on logistic regression was constructed: y = −1.015 + 1.720 × highly dialyzed drugs + 0.993 × moxonidine; p = exp (y) / (1 + exp (y)).

Table 1 displays actual and predicted values on the sample of HD patients.

Conclusion

In present study 60% of dialysis patients suffered from ID-HTN. Drugs with high dialysis clearance were widely used (61%) in dialysis population. Highly dialyzable drugs were associated with increased risk of ID-HTN (OR 5.585; 95% CI 2.49–12.54; p<0.0001). The low specificity (65.4%) of the prediction model limits its use in clinical practice.

Figure 1 shows the covariate-adjusted ROC curve by logistic regression model.

Funding Acknowledgement

Type of funding source: None

Combined use of risperidone and olanzapine in the treatment of patients with resistant schizophrenia: a preliminary case series report

Polypharmacy, or the use of multiple drugs in the therapy of psychiatric disorders, is not recommended. However, appropriate combinations of pharmacologic mechanisms may enhance the efficacy of antipsychotic drugs and alter the course of schizophrenia. In recent years, some articles have been published about the successful use of clozapine and risperidone in combination for the treatment of patients with resistant schizophrenic and schizoaffective disorders. However, safety of this drug combination is open to discussion. This report presents the results of a preliminary study of five patients with resistant schizophrenia successfully treated with risperidone-olanzapine combination. The results suggest that this combination may be useful. In the future, the efficacy of risperidone-olanzapine combination should be confirmed in larger study populations before its clinical application is considered.

A longitudinal study of positive symptoms in schizo-affective and paranoid schizophrenia

The purpose of our work was studying the evolution of positive psychopathological symptoms in patients who had suffered from schizo-affective (N=146) and paranoid schizophrenia (N=74) (according to ICD-9CM) for at least 5 years. Using the list of syndromes taken from the Present State Examination, we retrospectively analyzed 2118 relapses registered in these patients' life during their illness (mean 18.1 years). According to our data, when the course of schizo-affective and paranoid schizophrenia incorporates definite periods of remission, there is a tendency towards a simplification of positive symptoms: 1.for 26.4% of the patients, the illness manifested itself in infrequent relapses (once in 4-5 years or less); 2. in 45.9% of the patients (those who displayed prominent regressive tendencies) psychotic symptoms were replaced by symptoms of affective, primarily depressive, type; 3. in 18.6% of the patients the illness took the form of recurring uniform attacks; 4. only in a mere 9.1% of the patients was the disorder diagnosed as progressive; and 5. a tendency to improvement and favorable prognosis was more pronounced in schizo-affective schizophrenia patients than in patients with paranoid schizophrenia (69.9% vs 54.1%, P<0.05).

Characteristics of suicidal attempts in major depression versus adjustment reactions

BACKGROUND

The aim of this present study was to compare the characteristics of suicidal attempts of patients with major depression (MD) and adjustment reaction (AR).

METHOD

Sixty-nine patients with MD and 86 with AR admitted to the Moscow Institute of Emergency Help after the first suicide attempts were studied. All the attempters were interviewed by at least by two psychiatrists and the diagnosis was made according to agreement and to ICD-9CM criteria.

RESULTS

Differences between the two groups were found with regard to social-demographic, clinical-psychological and suicidal characteristics: the AR patients were less educated, had lower social status and in most cases were unmarried, compared with the MD patients. A large number (51.2% of the attempters in the AR group and 34.8% in the MD group) had an unstable parental family, early orphanhood or an emotionally deprived childhood. No differences were found in the methods of the suicidal attempts between the groups. Suicidal attempts under alcohol abuse occurred more often among the AR group (34.9 vs. 10.1%). The interval from the beginning of the disorder until the suicidal attempt was significantly shorter within the AR group. In this group the suicidal attempts were not planned, in comparison with the MD group.

LIMITATION

The sample is a selected study, because the research included only inpatients with AR and MD after their first suicidal attempt.

CONCLUSION

We believe that our data may be important for improving the assessment of suicidal risk and in planning treatment strategies for prevention of repeated suicidal attempts.