Molecular and genetic targets within metastatic colorectal cancer and associated novel treatment advancements

Colorectal cancer results in the deaths of hundreds of thousands of patients worldwide each year, with incidence expected to rise over the next two decades. In the metastatic setting, cytotoxic therapy options remain limited, which is reflected in the meager improvement of patient survival rates. Therefore, focus has turned to the identification of the mutational composition inherent to colorectal cancers and development of therapeutic targeted agents. Herein, we review the most up to date systemic treatment strategies for metastatic colorectal cancer based on the actionable molecular alterations and genetic profiles of colorectal malignancies.

Safety considerations with new treatment regimens for anal cancer

Introduction: Anal cancer is a rare malignancy, but incidence rates are rising. Primary chemoradiation is the standard of care for early disease with surgery reserved for salvage. Despite success in terms of survival, patients suffer significant morbidity. Research is underway to advance the field and improve outcomes for these patients.Areas covered: This review aims to discuss the safety and efficacy of new approaches to treat anal cancer. A literature search was performed from January 1950 through November 2020 via PubMed and ClinicalTrials.gov databases to obtain data from ongoing or published studies examining new regimens for the treatment of anal cancers. Pertinent topics covered include miniature drug conjugates, epidermal growth factor receptor inhibitors, checkpoint inhibitor combinations, and novel immunomodulators.Expert opinion: Based on emerging clinical data, the treatment paradigm for anal cancer is likely to shift in the upcoming years. One of the largest areas of investigation is the field of immunotherapy, which may emerge as an integral component of anal cancer for all treatment settings.

Up-and-Coming Experimental Drug Options for Metastatic Colorectal Cancer

Colorectal cancer is one of the top causes of cancer and cancer-related deaths worldwide. The prognosis of metastatic colorectal cancer is poor and treatment options are limited. Many patients will run out of treatment options before they become medically unfit for therapy. As such, there is a need to expand upon the current understanding of disease biology as well as drug resistance mechanisms in order to create new approaches for therapy. In this review article, we will discuss the mechanistic rationale and clinical data for new drugs and therapeutic combinations under development for metastatic colorectal cancer.

Incidence of ifosfamide induced encephalopathy in patients receiving concomitant fosaprepitant

INTRODUCTION

The incidence of Ifosfamide-induced encephalopathy (IIE) ranges from 5-30%. Aprepitant and fosaprepitant may increase the risk of IIE; however, data is limited. The objective of this study was to characterize the incidence of IIE in patients receiving concomitant fosaprepitant.

METHODS

This single-center, retrospective chart review included adult patients diagnosed with sarcoma who received at least one administration of high dose ifosfamide (≥1800mg/m²) and fosaprepitant between January 2017 and June 2018. The primary endpoint was the percentage of patient cycles in which IIE was experienced. Secondary endpoints included characterization of IIE management strategies, time to IIE resolution, and the incidence of IIE upon ifosfamide re-challenge. Subgroup analyses were performed to assess whether the following variables predisposed a patient to neurotoxicity: elevated serum creatinine, hypoalbuminemia, metabolic acidosis, hyperbilirubinemia, shorter infusion time, and higher body mass index. The role of CYP2B6 inhibitors and prior cisplatin use were also examined.

RESULTS

Fifty-one patients who received 215 total cycles of ifosfamide were included. Twenty (9.3%) patient cycles included documented evidence of IIE. The most common management strategies were to prolong the infusion time and administer methylene blue. The mean time to resolution of IIE was 2.58 days. The incidence of secondary IIE upon re-challenge was 26.3%. Baseline albumin <3.5 g/dL (p<0.001) was statistically associated with the development of IIE.

CONCLUSION

Co-administration of fosaprepitant and ifosfamide in sarcoma appears to be safe. Hypoalbuminemia was a notable risk factor confirmed in this study. Further research is needed to delineate IIE risk factors.

Clinical impact of the etoposide injection shortage

PURPOSE

Drug shortages have become a constant challenge in patient care over the past two decades. In 2018, there was a shortage of etoposide injection in the United States. The purpose of this study was to analyze the impact of the etoposide injection shortage.

METHODS

This single-center, retrospective chart review included patients prescribed an etoposide-containing chemotherapy regimen between January 2018 and August 2018. The primary objective was to determine the percentage of patients who required a change in treatment due to the etoposide injection drug shortage. For the secondary objectives, the following was compared between patients who received etoposide injection versus alternative etoposide formulations (etopophos injection or oral etoposide): adverse events, medication errors, treatment delays, disease progression, and drug costs.

RESULTS

Twenty-two patients were included in this study. Overall, seven (32%) patients required a change in treatment due to the etoposide injection shortage. Of the seven patients, six required the use of an alternative etoposide formulation and one patient had etoposide omitted in at least one treatment cycle. There were no significant differences in adverse events, medication errors, treatment delays, or disease progression when comparing patients who received etoposide injection versus alternative etoposide formulations. The average drug cost per cycle was significantly higher in the patients who required a change in treatment.

CONCLUSIONS

To our knowledge, this is the first study to characterize the clinical impact of the etoposide injection shortage. Results from this study highlight the direct impact that drug shortages have on patient care.