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Abstract
Chemotherapy-induced nausea and vomiting (CINV) is a common side effect of most chemotherapy agents. Suboptimal management of CINV impacts quality of life, nutrition, gastrointestinal (GI) integrity, and adherence to chemotherapy treatment plans. This article reviews the principles of CINV management, planning and implementation of antiemetic regimens, and pharmacology of the antiemetics currently available in the United States appropriate for pediatric use. With the advent of more targeted therapies, increased use of immunotherapy, and the effects of radiotherapy to the brain, spine, and abdomen, treatment of CINV now has a broader application than just for chemotherapeutics alone.
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Affiliation(s)
- Mya Merrow
- Department of Pharmacy, Children's Hospital Colorado, 13123 East 16(th) Avenue, Aurora, CO 80045, United States of America.
| | - Nancy King
- Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital Colorado, 13123 East 16(th) Avenue, Aurora, CO 80045, United States of America
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Merheb D, Dib G, Zerdan MB, Nakib CE, Alame S, Assi HI. Drug-Induced Peripheral Neuropathy: Diagnosis and Management. Curr Cancer Drug Targets 2021; 22:49-76. [PMID: 34288840 DOI: 10.2174/1568009621666210720142542] [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: 01/28/2021] [Revised: 05/07/2021] [Accepted: 05/21/2021] [Indexed: 01/09/2023]
Abstract
Peripheral neuropathy comes in all shapes and forms and is a disorder which is found in the peripheral nervous system. It can have an acute or chronic onset depending on the multitude of pathophysiologic mechanisms involving different parts of nerve fibers. A systematic approach is highly beneficial when it comes to cost-effective diagnosis. More than 30 causes of peripheral neuropathy exist ranging from systemic and auto-immune diseases, vitamin deficiencies, viral infections, diabetes, etc. One of the major causes of peripheral neuropathy is drug induced disease, which can be split into peripheral neuropathy caused by chemotherapy or by other medications. This review deals with the latest causes of drug induced peripheral neuropathy, the population involved, the findings on physical examination and various workups needed and how to manage each case.
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Affiliation(s)
- Diala Merheb
- Department of Internal Medicine, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Georgette Dib
- Department of Internal Medicine, Division of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maroun Bou Zerdan
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Clara El Nakib
- Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Saada Alame
- Department of Pediatrics, Clemenceau Medical Center, Faculty of Medical Sciences, Lebanese University, Beirut,, Lebanon
| | - Hazem I Assi
- Department of Internal Medicine Naef K. Basile Cancer Institute American University of Beirut Medical Center Riad El Solh 1107 2020 Beirut, Lebanon
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Chua AV Jr, Hernandez ARB, Real IO. Transdermal versus oral granisetron in controlling chemotherapy-induced nausea and vomiting: a meta-analysis. Support Care Cancer 2020; 28:5611-9. [PMID: 32623521 DOI: 10.1007/s00520-020-05611-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the efficacy of transdermal granisetron versus oral granisetron in controlling chemotherapy-induced nausea and vomiting (CINV) in patients with cancer METHODS: Data sources were CENTRAL, MEDLINE, EMBASE, Clinicaltrials.gov , and Google Scholar. Inclusion criteria included randomized controlled trials comparing transdermal versus oral granisetron in patients with CINV. For data extraction, two authors independently analyzed the methodological quality and extracted data. A random effects model was used to estimate the risk ratio (RR) or odds ratio (OR) with 95% confidence interval (CI). RESULTS Three studies (1086 patients) were included. Oral granisetron is superior (OR 0.77; 95% CI 0.60 to 0.99) to its transdermal form in achieving complete control of CINV in patients receiving chemotherapy. As for the risk of constipation (RR 1.32; 95% CI 0.73 to 2.40) and QTc prolongation (RR 0.17; 95% CI 0.02 to 1.40) as adverse effects, no statistically significant difference was observed between the two routes. CONCLUSION Oral granisetron is better in achieving complete control of CINV in patients receiving chemotherapy. As for the risk of constipation and QTc prolongation as adverse effects, there was no statistically significant difference between the two routes.
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Pei Y, Zheng K, Shang G, Wang Y, Wang W, Qiu E, Li S, Zhang X. Therapeutic Effect of Strontium Ranelate on Bone in Chemotherapy-Induced Osteopenic Rats via Increased Bone Volume and Reduced Bone Loss. Biol Trace Elem Res 2019; 187:472-481. [PMID: 29882118 DOI: 10.1007/s12011-018-1401-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/29/2018] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to determine whether treatment with strontium ranelate (SrR) can restore bone mass and strength at a skeletal site with established osteopenia in chemotherapy-induced rats. Forty-five Sprague-Dawley male rats were randomly assigned to three study groups (n = 15 rats per group): normal rats (control group), osteopenic rats (chemo group), and osteopenic rats with SrR (chemo-SrR group). We chose a male rat model that mimicked a clinical setting by weekly intravenous injection of cyclophosphamide at 20 mg/kg. The control and chemo groups were maintained without treatment, and the chemo-SrR group was intragastrically administered strontium ranelate at a dosage of 900 mg/kg/day. All animals were fed a standard laboratory diet, and blood samples were collected for biochemical analysis. After 12 weeks of treatment, micro-CT, biomechanical testing, and histomorphometry were examined. In addition, bone samples were obtained to evaluate the content of mineral substances in bones. SrR treatment of chemo rats significantly increased tibial trabecular bone volume, trabecular thickness, and BV/TV. Serum levels of the bone formation marker alkaline phosphatase (ALP) in the SrR group were significantly higher than those in the chemo animals, which was accompanied by an increase in the bone mineral content, bone calcium and phosphate, as well as reduced serum Ca and P concentrations. The serum level of tartrate-resistant acid phosphatase (TRAP) in the SrR treatment group showed no obvious changes. Histomorphological analyses revealed that chemotherapy resulted in decreased osteoclast number, which may be due to the inhibition of bone turnover. However, SrR treatment enhanced the number of osteoblasts while restoring bone mass and improving bone strength in chemo rats. Therefore, the results of this study indicate that SrR treatment has a positive effect on bone in chemotherapy-induced osteoporosis.
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Affiliation(s)
- Yi Pei
- Department of Bone and Soft Tissue Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, No.44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China
| | - Ke Zheng
- Department of Bone and Soft Tissue Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, No.44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China
| | - GuanNing Shang
- Department of Bone and Soft Tissue Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, No.44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China
| | - YuMing Wang
- Department of Bone and Soft Tissue Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, No.44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China
| | - Wei Wang
- Department of Bone and Soft Tissue Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, No.44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China
| | - EnDuo Qiu
- Department of Bone and Soft Tissue Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, No.44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China
| | - ShenLong Li
- Department of Bone and Soft Tissue Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, No.44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China
| | - XiaoJing Zhang
- Department of Bone and Soft Tissue Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, No.44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China.
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Clemmons AB, Orr J, Andrick B, Gandhi A, Sportes C, DeRemer D. Randomized, Placebo-Controlled, Phase III Trial of Fosaprepitant, Ondansetron, Dexamethasone (FOND) Versus FOND Plus Olanzapine (FOND-O) for the Prevention of Chemotherapy-Induced Nausea and Vomiting in Patients with Hematologic Malignancies Receiving Highly Emetogenic Chemotherapy and Hematopoietic Cell Transplantation Regimens: The FOND-O Trial. Biol Blood Marrow Transplant 2018; 24:2065-2071. [PMID: 29906570 DOI: 10.1016/j.bbmt.2018.06.005] [Citation(s) in RCA: 26] [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] [Received: 03/10/2018] [Accepted: 06/05/2018] [Indexed: 12/16/2022]
Abstract
Evidence supports olanzapine for prophylaxis of chemotherapy-induced nausea/vomiting (CINV) for highly emetogenic chemotherapy; however, most studies focus on solid malignancies and single-day regimens. A randomized, double-blinded, placebo-controlled trial was conducted to compare the addition of olanzapine to triplet therapy (fosaprepitant, ondansetron, dexamethasone [FOND-O]) versus triplet therapy alone (FOND) in preventing CINV in hematology patients receiving single-day and multiple-day highly emetogenic chemotherapy and hematopoietic cell transplant (HCT) regimens (NCT02635984). The primary objective of this study was to compare complete response (CR; no emesis and minimal nausea, <25 mm on a 100-mm visual analog scale) during the overall assessment period (chemotherapy days plus 5 days after). Secondary objectives were the number of emesis, number of rescue medications, percent achieving minimal nausea, and percent achieving complete protection (CP; no emesis, rescue antiemetic, or significant nausea), all of which are reported as acute (chemotherapy days), delayed (5 days after chemotherapy), and overall phases. Olanzapine 10 mg or matching placebo were given on each chemotherapy day and 3 days after. Adults with hematologic malignancy receiving HCT regimens of melphalan, BEAM (carmustine, etoposide, cytarabine, melphalan), busulfan (Bu)/cyclophosphamide (Cy), Bu/fludarabine (Flu), Bu/melphalan, FluCy, FluCy-total body irradiation (TBI), etoposide-TBI, and ICE (ifosfamide, carboplatin, etoposide) or 7+3 chemotherapy regimens were included. An estimated 98 patients were required using alpha = .05 and 80% power. No significant differences existed in baseline characteristics between FOND-O (n = 51) and FOND (n = 50) arms. Mean duration of olanzapine was 7.7 days (range, 4 to 11). Discontinuation for possible adverse events occurred in 3 placebo and 0 olanzapine patients. CR was significantly higher for FOND-O in overall (55% versus 26%, P = .003) and delayed (60.8% versus 30%, P = .001) but not acute (P = .13) phases. Significantly more patients receiving FOND-O achieved no more than minimal nausea in overall (P = .001) and delayed phases (P = .0002), as well as fewer overall mean emesis counts (P = .005). CP rates were not different in any assessment phase (P ≥ .05 each). Within the HCT subgroup (n = 64), the CR, CP, and no significant nausea rates were significantly better for FONDO-O in overall and delayed phases (all P < .05). Analysis within the HCT subgroup revealed significant improvement in outcomes in delayed and overall phases with FOND-O in the autologous but not allogeneic cohort. Addition of olanzapine to an NK-1-based triplet antiemetic regimen significantly improved clinically relevant outcomes in the HCT population.
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Affiliation(s)
- Amber B Clemmons
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, Georgia; Department of Pharmacy, Augusta University Medical Center, Augusta, Georgia.
| | - Julianne Orr
- Department of Pharmacy, Indiana University, Indianapolis, Indiana
| | - Benjamin Andrick
- Geisinger Enterprise Pharmacy, Center for Pharmacy Innovations and Outcomes, Danville, Pennsylvania
| | - Arpita Gandhi
- Department of Pharmacy, Augusta University Medical Center, Augusta, Georgia
| | - Claude Sportes
- Department of Medicine, Division of Hematology and Medical Oncology, Augusta University Medical Center, Augusta, Georgia
| | - David DeRemer
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida
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Abstract
Proton pump inhibitors (PPIs) are potent acid-suppressive medications commonly used for management of acid-related diseases. Over the past decade, gastrointestinal injury following chemotherapy has attracted wide attention from oncologists. Two international clinical practice guidelines, the National Comprehensive Cancer Network (NCCN) and the Multinational Association of Supportive Care in Cancer (MASCC) antiemesis guidelines, recommend omeprazole for the treatment of chemotherapy-induced epigastric pain. In recent years, PPIs have been widely used for the prevention and treatment of chemotherapy-induced gastrointestinal mucositis. This paper summarizes the mechanisms by which chemotherapy causes damage to the gastrointestinal tract, the mechanisms underlying the protection afforded by PPIs against gastrointestinal injury induced by chemotherapy, and their clinical applications.
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